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Vaccine opt-outs worry Michigan health officials

Jonathan Oosting
Detroit News Lansing Bureau

Lansing — Michigan vaccine waiver rates for school-age children ticked up in 2016 but remain well below 2014 levels after the state began requiring parents to attend educational sessions if they want to delay or decline immunizations.

While public health officials say the parental mandates implemented in 2015 have helped discourage vaccine opt-outs, Michigan’s kindergarten waiver rate still ranks 11th highest in the nation, and some lawmakers want to undo the new state rule.

Data from the Michigan Department of Health and Human Services shows 3.2 percent of kindergartners and seventh-graders received immunization waivers in 2016. That’s down from 4.8 percent in 2014 but up from 3.1 percent in 2015.

Michigan was among 36 states that last year experienced a kindergarten waiver rates increase.

“What we’re seeing is more vaccine hesitancy, more vaccine-resistant parents,” said Bob Swanson, division of immunization director for the Michigan Department of Health and Human Services. “And that’s a concern to all of us.”

Waiver rates vary widely across the state and are particularly high in some regions, creating a challenge for state officials seeking to create “herd immunity” from preventable diseases like measles, mumps, whooping cough, polio, diphtheria, hepatitis B and chickenpox.

Houghton County had the state’s highest immunization waiver rate of 13.5 percent last year, a figure that is of “very large concern,” Swanson said.

Other “problem areas” include Lapeer (9.5 percent waiver rate), Grand Traverse (7.5 percent), Leelanau (6.8 percent), Antrim (6.1 percent) and Livingston (6 percent) counties. Rates in Oakland (4.4 percent) and Macomb (3.8 percent) counties also exceeded the statewide average.

“The more kids we have vaccinated, the better our population is, and that’s really what our primary goal is,” Swanson said.

Some parents fear possible side effects, which officials say are rare, and want to protect their ability to opt out.

“I believe it should be a parent’s choice,” Lisa Wiervbicki of Canton Township said of vaccines. “I chose to delay at first. I was giving my son one at a time, and I did my research.”

Wiervbicki sought a waiver for her daughter after her son had an adverse reaction to a hepatitis B vaccine after birth. Her son has a blood disorder called chronic benign neutropina, she said.

While she is not certain what caused it, Wiervbicki said his white blood cell count appeared to fall after receiving subsequent vaccinations.

“I think vaccine injury is everywhere, and nobody knows the reactions to vaccines so they’re not seeing it,” Wiervbicki said.

Michigan’s rules

Michigan schools are required to report the immunization status of kindergarten, seventh-grade and transferring students. Those without a complete immunization record or a waiver cannot be enrolled.

While all states allow parents to obtain vaccination waivers for medical reasons, Michigan is one of 16 that also allows waivers on both religious and philosophical grounds.

Nationally, six states saw decreases in waiver rates for kindergartners during the 2016-17 school year, according to new data from the U.S. Centers for Disease Control and Prevention.

The rising resistance from some parents was on display earlier this month as Swanson presented state and federal data at a forum hosted by Michigan State University’s Institute for Public Policy and Social Research.

While officials stressed the importance of immunizations, more than a dozen mothers spoke out against vaccines during a question-and-answer period.

“But it didn’t protect my child,” said one woman, suggesting her child had been injured by a vaccine.

“Or mine, or mine, or mine,” said others who had discussed attending the forum online, according to Wiervbicki.

Some parents fear vaccinations could cause autism in children, a theory health officials have dismissed. There is no link between vaccines and autism, according to the CDC, which also says vaccine ingredients do not cause autism. Studies have shown that “with rare exceptions, these vaccines are very safe,” according to the CDC.

Parents and politics

Waiver rates plummeted here in 2015, a change officials attribute to the new administrative rules requiring parents who request a non-medical exemption to visit their local health department to discuss the benefits of vaccines and the risks of not receiving them.

Compared with 2014, there were 7,657 fewer waivers reported for schools in 2015, according to the state, which says nearly 18,000 kids have received all required vaccines since the new rule took effect.

Some state lawmakers have tried but failed to repeal the new vaccine opt-out rules.

State Sen. Patrick Colbeck, a Canton Township Republican who is running for governor, has called the rules a form of bureaucratic overreach.

Colbeck argues that they force parents to “ take time off of work to meet with specific people, view videos or sign inflammatory forms to exert a right they should be able to exercise more simply.”

But Michigan’s waiver exemption rule has been a “fantastic success” and helped balance public health with personal liberty, said Mark Navin, a philosophy professor at Oakland University who has studied and written about vaccination policy.

If critics overturn the rules and waiver rates increase, Navin predicted vaccine advocates could push to eliminate all non-medical waivers. It is a move California legislators took in 2015 after a large measles outbreak in that state.

“The great shame of California is they had a law that was working,” Navin said, noting that state, like Michigan, had started requiring parental education sessions under an earlier 2014 law.

“They passed a law that now removed parental liberty and further politically polarized — unnecessarily so — a vitally important aspect of public health,” he said.

Joel Dorfman of the Michigan for Vaccine Choice Waiver nonprofit said requiring parental education sessions did nothing to reduce the vaccine wavier rate, which he said spiked in 2010 after new vaccines were added to the mandatory schedule.

“They’re dishonest in presenting vaccines for what they are,” Dorfman said about the state after unsuccessfully suing last year over the new immunization waiver rules.

“They have benefits and risks, and because there are risks, people should be able to make their own choices about when and how many vaccines they feel are necessary for themselves and their children.”

Some major health organizations, including the American Medical Association and the American Academy of Pediatrics, are pushing states to eliminate non-medical waivers.

But that would be a mistake, Navin said. If waivers are too difficult to obtain, resistant parents will pull their kids out of school, he said. But by making it a little more difficult, Michigan is encouraging compliance by parents who may be “on the fence,” he said.

Michigan schools, risks

The immunization debate escalated in Michigan last month when a Ferndale mom was jailed for refusing to comply with a court order to vaccinate her child as part of a messy custody battle.

But public health officials say the case was more about the legal process than about vaccine policy or parental choice.

“The real issue was the court order that she violated,” said Rhonda Lennise Conner-Warren, an assistant professor of health programs at Michigan State University. “You don’t violate a court order without expecting to have some kind of repercussions.”

Officials are now focusing efforts on portions near the Thumb, Upper Peninsula and lower northern Michigan where waiver rates are especially high. State records show individual schools across the state also continue to have above-average waiver rates.

In Oakland County, 36 percent of kindergartners had non-medical opt-outs at Kingbury Country Day School in Oxford last year, and 22 percent had religious or philosophical waivers at the Four Corners Montessori Academy in Madison Heights.

In Macomb County, 18 percent of kindergartners at Orville C Krause Elementary School in Armada had non-medical waivers in 2016. In Wayne County, 12 percent had non-medical waivers at Randolph Elementary School in Livonia.

Despite the pushback from some concerned parents, Swanson said the state must continue to promote vaccines as a “safe and effective” way to protect kids, students and adults.

But the waiver battle in Michigan shows the tension surrounding the issue.

“There’s a profound lack of trust in the messages that authorities are providing in vaccine safety,” Navin said. “… It’s not just about vaccines. It’s a huge political social problem for our country.”

Vaccine waiver rates

The top five Michigan counties with families seeking vaccine waivers for their kindergarten and seventh-grade students in 2016 as well as the four Metro Detroit rates.

Top 5

1. Houghton: 13.5 percent

2. Lapeer: 9.5 percent

3. Grand Traverse: 7.5 percent

4. Leelanau: 6.8 percent

5. Antrim: 6.1 percent

Metro Detroit

Livingston: 6 percent

Oakland: 4.4 percent

Macomb: 3.8 percent

Wayne: 2.6 percent

Source: Michigan Department of Health and Human Services