Last night I was privileged to participate in a conference call about a piece of legislation moving its way through the California state senate, AB 2109. What made it a particular privilege was having the chance to speak with both Dr. Richard Pan, a California pediatrician, state assemblymember and the author of the bill, and also Dr. Paul Offit, who has done as much as anyone in recent history to promote vaccination for all appropriate children. It is no disrespect to Dr. Pan to say that it was a special treat to speak with Dr. Offit, who is a person I admire immensely. (This has been a great week for me for interacting with personal heroes. I got to meet Barney Frank on Saturday.) (It was also super-cool to hear your voice, Liz.)
Anyhow, AB 2109 would make it more difficult to cite “philosophical” objections as a reason to eschew vaccinating one’s child. As of now, parents in California who opt out of vaccinating their children are required to do no more than sign a two-sentence statement citing a personal or “philosophical” objection to vaccination, and their unvaccinated children can attend school. The law, if passed, would require a signed statement from a licensed medical provider (physician, nurse practitioner, physician’s assistant, school nurse, or naturopath working under physician supervision) stating that the parents have been informed of the risks and benefits of vaccination, and of not vaccinating their children, and have opted out of vaccinating anyway. It would make it more onerous to opt out of vaccinations and still send one’s kids to school.
I have expressed skepticism about how effective a similar law in Vermont would be in lowering refusal rates, and I brought up my concerns along those lines to Dr. Pan. While I now work in a practice that doesn’t accommodate parents who want to opt out of vaccinating their kids, at my last job I had a certain number of patients whose parents refused vaccines. I spent lots of time talking about the benefits of immunization with them, and discussed their concerns about the health risks at length. In my experience, very few people changed their minds.
However, Dr. Pan made some good points in response. For some parents, opting out of vaccinations is kind of a default option, borne of convenience, and they haven’t really given it much thought either way. The new requirement could well be effective in getting their children vaccinated. And there are certainly some persuadable parents, for whom a slightly more difficult opt-out process and required conversation and statement might provide sufficient motivation to get their kids vaccinated. From whatever combination of factors, a similar law in Washington state (which really needs the help) reduced refusal rates from 6% to 4.5% in just one year. When it comes to maintaining herd immunity to vaccine-preventable illness, a few percentage points can make a significant difference.
Obviously, I hope AB2109 passes. I’m likely to support almost any reasonable measure that makes it more difficult to not vaccinate one’s child. There is absolutely no good reason that almost all children should not be vaccinated. If this law protects more children from preventable disease, then I’m all for it. But I suspect most of the benefit will be at the margins. For the true believers, whose bizarre fears about one of the greatest public health advances of the past hundred years continue to confound me, I don’t think a conversation with a licensed medical provider will make any difference. As I’ve seen in my own real-life practice, and as the occasional more strident commenter hereabouts (more of which I am now bracing myself for) has demonstrated, the non-evidence-based beliefs of the anti-vaccine crowd are unlikely to budge under the weight of all the evidence I can muster.