Editorial: When 'choice' undermines public health


There's little to celebrate about the measles outbreak now hitting the nation, with most of the reported cases in California. But one positive outcome is the level of attention being given to laws that allow parents to opt out of immunizing their children – and the risks that option poses not only to the unvaccinated kids but to the community at large.

The reasons parents give for their decision not to have their children immunized vary, and can be complicated. Some argue that such parents are scornful of science, which has debunked misinformation that's come out in the past about vaccines, including that they cause such ills as autism.

But perhaps the anti-vaccine phenomenon results not so much from a mistrust of science as from an under-appreciation and ignorance of history. Many of these parents weren't even born when measles and other diseases plagued the population, before immunization regimens made them almost unheard of.

A historical reality check leaves no doubt that contagious diseases such as measles, chickenpox and polio caused significant suffering, and sometimes lifelong consequences or death before effective immunization protocols were put in place. The spotlight turned on the current outbreak reveals that many children who have not received the measles vaccine haven't been vaccinated against other possibly even more dire diseases, such as polio. It's ironic, then, that parents who have decided that the risk of vaccination is greater than the risk of the diseases are drawing their conclusion from a place of ignorance about the diseases themselves – illnesses nearly wiped out by the very vaccines the parents are now saying aren't necessary.

Locally, Peninsula School in Menlo Park has the highest rate of unvaccinated children, with 30 percent of this year's kindergartners not immunized under the state's "personal belief" exemption, according to state records. Other schools with high rates of kids who have opted out of vaccinations with personal-belief exemptions are Las Lomitas (6 percent), Laurel (5 percent) and Encinal (4 percent) in Atherton; and Philips Brooks (5 percent) in Menlo Park.

State and federal legislators are responding to the current measles outbreak by urging state officials to reconsider the state's immunization exemption law – which allows parents to opt out of immunizing their kids for medical reasons or for personal beliefs – and with a proposed state law that would end the personal-belief exemption. No one is suggesting an end to the medical exemption, which applies to children with a compromised immune system. But the other category must be rigorously reviewed.

The current law does have serious consequences - non-immunized children without an exemption may not attend school or day care, whether public or private. Current law gives any non-exempt student without all the required immunizations for their age only 10 school days after notification before being barred from attending.

State senators Richard Pan and Ben Allen last week introduced a bill taking away a parent's option to opt out of immunizing a child for personal beliefs. Sen. Pan stands on particularly solid ground to judge the seriousness of the problem. A recent San Francisco Chronicle article quoted him thus: "As a pediatrician, I have personally witnessed children suffering lifelong injury or death from vaccine-preventable infection. This doesn't have to happen."

U.S. senators Barbara Boxer and Diane Feinstein are going one step further, asking state health officials to reconsider not only the personal-belief exemption but also urging that religious exemptions not be allowed. Currently parents whose religious beliefs do not allow immunizations may apply for an exemption under the personal-belief exemption. Although ending the exemption for personal beliefs may be an easier sell and, we believe, the right thing to do treading on parents' religious beliefs might meet some stiff resistance. But a thorough debate over that issue is certainly needed as the state comes to terms with the long-term consequences of the current exemption law.

Meanwhile, public education is key to this issue. Interestingly, Sen. Pan, the pediatrician, successfully wrote a bill that went into effect in January 2014 requiring parents applying for a personal-belief exemption to talk first with a licensed health care practitioner about the impacts to their children and the community. Although it will take longer than one year to determine whether the law is effective, it's encouraging to note that the rate of personal-belief exemptions went down this year for the first time in many years. Dr. Eric Weiss of the Village Doctor in Woodside told the Almanac that he believes assurances by a trusted doctor can go far in allaying parents' fears about vaccinating their children. He notes that at his clinic, where doctors take the time to talk about the risks of not vaccinating kids, there are no families who have opted out of immunization.

More public awareness is critical, but lawmakers must also take action now to stem the growing problem of non-immunized children who are at risk of preventable disease, and putting the wider community at risk. Public health must trump parental choice in this matter.

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3 people like this
Posted by Willows resident
a resident of Menlo Park: The Willows
on Feb 12, 2015 at 11:33 am

Peninsula School...30%???!!! Really? How can these kids even be there?

3 people like this
Posted by great list
a resident of Atherton: other
on Feb 12, 2015 at 12:00 pm

That KQED list of CA schools was pretty amazing - great work by a public news source. And a good link provided by the Almanac.

Pen School is at 30%. Crazy. Way beyond every other school in the county, and tops in the state.

yay - we're number ONE!!!!

uhhhh.... hold on, folks. The only prize you win for that is the booby prize. Complete with a pointy cone hat. Enjoy. Take it with your kid to the emergency room.

Science, folks. It goes hand in hand with math. It's the law. Unless you're an fool who thinks the Theory of Gravity is just a theory, in which case, allow me to hold this brick over your head for a moment. Just a moment, I promise.

Heh, heh.

It's like Scott Walker, running for President, doing a campaign trip in England and the foreign press asks him a socialist question yesterday - if he believes in evolution. Because: science and stuff. Making informed policy decisions. Not being a flat-earther conspirator type.

- of course Scott Walker understands that evolution is real.


"I'm going to punt on that one as well. That's a question a politician shouldn't be involved in one way or another."


Is this a joke?

A small fragment of nuts hold the GOP at gunpoint (measles-point?) Walker, Rand Paul, Chris Christie do not understand science. Or math. Just look at the economies of their states as they descend into Laffer curve recession like Kansas.

How on earth does anyone listen to those crazies?

Get vaccinated!

3 people like this
Posted by great list
a resident of Atherton: other
on Feb 12, 2015 at 12:06 pm

"On Darwin Day, 5 facts about the evolution debate"

From Pew. Web Link

Required reading. While you read it, you will, I dunno.... evolve? As will our bacteria and viruses. Step by step...

Here is a lovey photo of California from the 50's, specifically, Los Angeles: Web Link

Those poor souls didn't have a vaccine available.

You do. Get vaccinated.

4 people like this
Posted by EasyDoesIt
a resident of Menlo Park: Downtown
on Feb 12, 2015 at 1:51 pm

The issue isn't measles, the issue is freedom.
Can the government dictate to you that you must have a vaccine, which is a medical treatment, or are you free to choose what you put in your body?

As long as we live in a free republic, there can be no mandatory medical treatments. Medical treatments are obviously highly personal, often invasive, and always come with some risk. A doctor can order any treatment for you, but you have the right to refuse that treatment.
Making vaccines of any sort mandatory flies in the face of your freedom and your personal authority over your own body. It also co-opts parents' rights to do what they think is right for their child.

Anyone who wants to can get the vaccine, and since they believe this will protect them, they have no need to worry about what others choose to do.

5 people like this
Posted by great list
a resident of Atherton: other
on Feb 12, 2015 at 2:08 pm

"always come with some risk"

What risk?

If the students of Peninsula School were on BART last week with that measles Web Link case, they would now be spreading it all over the area, including to those unable to get vaccinated (infants, cancer patients, etc...)

Hundreds of Pen School Typhoid Mary's spreading it through our community because they have (insert pejorative here) parents.

You mean that risk?

Get vaccinated. Do not be a tool.

@EasyDoesIt - do you believe in evolution?

9 people like this
Posted by Peter Carpenter
a resident of Atherton: Lindenwood
on Feb 12, 2015 at 3:21 pm

Peter Carpenter is a registered user.

"free to choose what you put in your body?"

Absolutely as long as what you do does not put others at risk.

So don't get vaccinated and then avoid all contact with other people - your choice.

2 people like this
Posted by Menlo Voter
a resident of Menlo Park: other
on Feb 12, 2015 at 3:25 pm

Menlo Voter is a registered user.

I don't think government should be mandating vaccination. I think it is perfectly fine for the government to mandate that unvaccinated children cannot attend school. Then ignorant folks can still make a choice whether or not they vaccinate - the school system for their kids or home schooling.

Get vaccinated. It is unbelievably stupid not to and to not have your children vaccinated.

15 people like this
Posted by Tunbridge Wells
a resident of Menlo Park: Allied Arts/Stanford Park
on Feb 12, 2015 at 3:42 pm

Tunbridge Wells is a registered user.

EasyDoesIt displays a breathtakingly cavalier attitude toward public health. Failing to vaccinate your children is not a personal liberty decision, unless that unvaccinated child never goes out into public. We are seeing now what happens when people freeload off the herd immunity. Diseases that had been nearly eradicated are roaring back because we are privileged enough to not live with disease and don't remember how terrible those diseases are. There are people with legitimate medical reasons, people who have compromised immune systems, and those people depend on the rest of us having the social responsibility to fully vaccinate. Failing to immunize without a valid medical reason is selfish and endangers innocent people.

5 people like this
Posted by painful memories
a resident of Menlo Park: Central Menlo Park
on Feb 12, 2015 at 3:58 pm

Menlo Voter, I admit to being conflicted about this, and it's tempting to straddle the fence with you in the name of keeping the government out of our personal health decisions. And the option of not mandating vaccinations but also not allowing unvaccinated children to go to school with others is certainly better than the system now in place.

What pushes me off the fence is this question: Should a parent be allowed to choose putting a child at risk of, say, polio when a safe vaccine is available and recommended by any sane medical professional? I went to elementary school with a child who had polio (that dates me now doesn't it?). The sight of her small wracked body was traumatic enough to deal with as child. But the sadness and yearning evident on her face as she watched her schoolmates run off to the playground at recess is a memory that will forever haunt me. Does a parent have a right to do that to a child?

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Posted by really?
a resident of Menlo Park: other
on Feb 12, 2015 at 4:06 pm

Unfortunately the health of the 'herd' cannot rely on personal preference to be effective. All this empty talk about 'freedom'.....

But then I've heard people arguing with the same indignant passion about ensuring everyone gets the flu jab in he same breath as they support vaccinating against polio. Over zealous?

1 person likes this
Posted by Peter Carpenter
a resident of Atherton: Lindenwood
on Feb 12, 2015 at 4:09 pm

Peter Carpenter is a registered user.

really - you might want to reword your posting as it does not make sense as currently worded.

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Posted by great list
a resident of Atherton: other
on Feb 12, 2015 at 6:14 pm

"But then I've heard people arguing"

here, let me help -> Web Link

But I'm with Peter on the nonsensical grammar (and similar attitude.)

2 people like this
Posted by Menlo Voter
a resident of Menlo Park: other
on Feb 12, 2015 at 7:47 pm

Menlo Voter is a registered user.

painful memories:

it's unfortunate, but we allow parents to make stupid decisions when it comes to their children all the time. They are "their" children. Those parents get to suffer the consequence along with their children for their stupid decisions. It's not just vaccinations it is many other things that parents make decisions about. They are free to be stupid. Just don't let them anywhere me or my children. Unfortunately, if we are to start making parenting decisions for everyone, pretty soon all children will be in foster care due to "parental neglect." It's a slippery slope.

I think the best we can do is keep the unvaccinated away from the rest of us. People are free to be stupid unfortunately. One can only hope that Darwin's principles wipe these morons out of the gene pool.

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Posted by pogo
a resident of Woodside: other
on Feb 12, 2015 at 8:57 pm

pogo is a registered user.

I have vaccinated my children and myself and certainly encourage people to do so in their own families.

Medical treatments are about weighing risks and benefits. In this case, the risk of an adverse reaction (and I'm not talking about autism, there are REAL adverse reactions associated with all treatments) is very small compared with the benefits of avoiding these diseases and protecting our society.

But I do find it interesting that many people are pro-choice on abortion reasoning that government officials have no right to tell someone what they can and can't do with their own body can rationalize a government forcing you put a needle and drug into your child's arm. How do you explain that?

I'm not sure why the government has no right to interfere with one decision but can in another. And if you're going to suggest that failure to vaccinate impacts others, I think the cost of pregnancies in our society (in dollars and impacts on others) is magnitudes the cost of last year's 700 measles cases.

7 people like this
Posted by Tunbridge Wells
a resident of Menlo Park: Allied Arts/Stanford Park
on Feb 13, 2015 at 12:34 pm

Tunbridge Wells is a registered user.

pogo, pregnancy isn't contagious. It doesn't linger in a space for hours after a pregnant woman walks through, waiting to make hapless innocent strangers pregnant. But measles will do that to little babies to young to be vaccinated, people undergoing chemotherapy, and so forth. That the government has the right to impose quarantines for public health is clearly understood. Trying to draw an analogy to abortion is silly and wrong.

11 people like this
Posted by CCB
a resident of Menlo Park: Linfield Oaks
on Feb 13, 2015 at 12:43 pm

Pogo, many pro-choice people would probably argue that life begins at birth, not conception, so abortion *is* a personal decision about the woman's body, one that doesn't harm others. Pro-lifers disagree fundamentally about when a child's life begins and see abortion as murder. It's pretty morally ambiguous territory (and I say this as a strong proponent of legalized abortion).

We DO make some laws to keep parents from harming their children post-birth--e.g. carseat laws. I've never heard of a personal belief exemption here, even when the only person whose health and well-being is at stake is the child who is strapped in (or not). Of course, parents are still allowed to smoke and keep loaded weapons in the home, kids be damned, so we've got a long way to go in protecting kids from their own parents.

In this case, however, it's pretty clear: parents who opt out of vaccines for their (healthy, non immuno-compromised) children pose an unambiguous threat to public health, not just their own kids' well-being. Enough already.

5 people like this
Posted by Seen the effect
a resident of Menlo Park: other
on Feb 13, 2015 at 3:46 pm

My aunt, born in the 40's, was not exposed to rubella until she was pregnant with her first child. Although the child, my cousin, was born in the 1960s (e.g. might have gotten the vaccine as a toddler), she was infected in utero. She was born deaf and mentally impaired, and was given up for adoption. She rediscovered her birth family when she was in her 30s. Imagine the pain everyone felt with that reunion - a young woman, considered a mistake and a bother by her mother, coming back but unable to communicate beyond minimal expressions because none of us knew ASL.

If you don't vaccinate your children, they may get infected at an older age, when these diseases are much more uncomfortable. If your girls grow up without the vaccine and without catching these things "the natural way" by their teen years, they will have the same risk as my aunt and cousin, of losing the full health and potential of their children. if you choose not to vaccinate, you are risking the well-being of your future grandchildren. If they travel outside the US, they could come back dead. What will you do when they're in the rebellious, risk-seeking teen years if they want to travel adventurously, and head off to parts of the world where these preventable diseases are common?

It's rare that mumps causes infertility in boys, but a bad case at the wrong stage of development can do that. Do you have a right to deprive your son of having his own children because you believe in natural exposure?

An early form of germ warfare was to hurl a diseased corpse inside the walls of a town under siege. Very effective.

Does Peninsula School have a special insurance fund to set up isolation wards if it spreads in the school?

1 person likes this
Posted by Perspective
a resident of Menlo Park: other
on Feb 13, 2015 at 5:56 pm

Slight change in topic, but I wish american's would get twice as incensed about traffic deaths and gun fatalities as they do about vaccines!!

Why is it no one seems to care the 32,000 americans die each and every year in mostly preventable traffic accidents. That includes 1000+ children annually.

In California alone, 3000 people die every year in traffic accidents.

People driving dangerously while drinking, using, texting, talking put us all at risk. Speeding, drag racing, driving while sleepy... etc., they put all of us at HUGE risk. And while a small percentage of people don't insist their children are in seat belts or car seats, and they are not putting you or I at risk, they shouldn't be allowed a "personal belief exemption" for negligence that increases the risk to their own children or passengers.

Too many deaths. Not enough rage at this enormous problem.

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Posted by pogo
a resident of Woodside: other
on Feb 13, 2015 at 8:31 pm

pogo is a registered user.

Point taken about seatbelts and car seats, CCB. But many people still don't use them (ask Bob Simon, for instance) and I still see little kids unbelted in cars all the time.

But my narrower point is about the government forcing people to inject a drug into their child's arm. There is no choice as with seatbelts and car seats. My point is that a key tenet of the pro-choice movement is keeping government out of the bedroom and leaving decisions about a person's body to them and their doctor - something I agree with wholeheartedly. So why shouldn't that apply here?

5 people like this
Posted by Peter Carpenter
a resident of Atherton: Lindenwood
on Feb 13, 2015 at 8:46 pm

Peter Carpenter is a registered user.

"leaving decisions about a person's body to them and their doctor "

That is fine as long as they don't then have ANY contact with other people that puts those other people at risk.

It is called PUBLIC HEALTH for a reason.

1 person likes this
Posted by Stop the Trolls
a resident of another community
on Feb 14, 2015 at 5:26 pm

@Peter Carpenter: Thank you for pointing what out what is at the heart of this issue -- namely, that of PUBLIC health.

If you anti-vaxxers have no intention of vaccinating yourselves or your children, then by all means find a way to live on some VERY isolated island. Because you have no right to put the rest of us at risk due to your choices.

2 people like this
Posted by pogo
a resident of Woodside: other
on Feb 14, 2015 at 7:17 pm

pogo is a registered user.

Excellent article in today's Washington Post about this topic. It discussed climate change and vaccinations but this paragraph (referencing climate change) was particularly insightful.

"Americans fall into two basic camps, Kahan says. Those with a more “egalitarian” and “communitarian” mind-set are generally suspicious of industry and apt to think it’s up to something dangerous that calls for government regulation; they’re likely to see the risks of climate change [NOTE: or vaccinations]. In contrast, people with a “hierarchical” and “individualistic” mind-set respect leaders of industry and don’t like government interfering in their affairs; they’re apt to reject warnings about climate change [or vaccinations], because they know what accepting them could lead to — some kind of tax or regulation...

Web Link

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