With High Rate of Vaccination, N.H. Also Sees Growing Number of Parents Opting Out

Feb 13, 2019

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Eleven states have reported measles outbreaks, including a large one in Washington state, which allows for philosophical exemptions for families who disagree with the mandate to vaccinate.  Although all 50 states allow for medical exemptions — religious and philosophical exemptions are also allowed in many states. New Hampshire allows for religious exemptions — and according to recent immunization reports that number has risen to 4,234 from about 3,700. 

New Hampshire requires vaccination against nine or 10 different diseases to enter into childcare, pre-school, or kindergarten. The state's vaccination rate is at about 80 percent for that series of vaccines, according to Benjamin Chan, epidemiologist for the N.H. Department of Health and Human Services.  When it comes to measles, New Hampshire is at about 94 percent.  

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The rise in unvaccinated children  —and diseases once considered rare if not almost entirely eradicated— is a source of much frustration for Dr. Patricia Edwards, pediatrician at Concord Pediatrics and a member of the N.H. Vaccine Association.  Edwards joined The Exchange to discuss vaccinations in New Hampshire. 

"Our practice believes very strongly in vaccination. These are preventable diseases that have caused death and severe illness in the past, and in this century there's no need to have this going on. Vaccines are widely available for a very low price, if not free, to patients," Edwards said. 

"We do not allow patients to be unvaccinated in our practice," she said. That's in part because unvaccinated children can put other children with serious illnesses who may happen to be sitting near them in the waiting room at serious risk.

But Edwards said she sometimes does allow parents with concerns about doing multiple vaccinations at once to spread out vaccines over time until their children are fully vaccinated by the age of 2.  

She blames misinformation spread through "false news" —including on many Facebook posts— for the resistance to vaccination.  Edwards said in some cases doctors can spend "half an hour of a half-hour visit discussing why vaccines are safe and effective." 

For Kathy Barth, head of the New Hampshire School Nurses Association, the religious exemption, "feels like a bit of a loophole. We know who these children are. I try to work with those parents to encourage them to understand why their children need to be vaccinated."

"We don't have philosophical exemptions in New Hampshire and I agree with that. I think there's a tension here between wanting to get as high a vaccination rate in the state as possible but still leave room for religious freedom." -Dr. Benjamin Chan, epidemiologist for the N.H. Department of Health and Human Services.

But Dr. Chan said eliminating the religious exemption raises tough questions. "We don't have philosophical exemptions in New Hampshire and I agree with that," he said. "I think there's a tension here between wanting to get as high a vaccination rate in the state as possible but still leave room for religious freedom." 

Still, Chan said, the higher the vaccination rate, the better.

"Back in 2000, the CDC declared the United States free of measles transmission, so this was a disease that was not common one to two decades ago. And in the last five to 10 years we've really seen a resurgence of measles in this country largely due to under-vaccinations of some populations."

This year alone, there have already been 100 cases of measles reported to the CDC, he said. 

SCHOOLS

Kathy Barth said school nurses are working hard to make sure students are immunized. 

State law requires schools to do a full immunization review at the beginning of the school year, with a focus on new students and kindergartners, Barth said. "Occasionally, it's just a paperwork issue, but oftentimes it is parents who are holding back on immunizaions and nurses are working hard to educate parents because we're up against the highway of information that's online," she said.  

If parents don't have the immunication documentation, they must have either a medical or a religious exemption. 

VACCINATION CONCERNS

Several Exchange callers questioned the safety of vaccines, among them a practicing nurse, with concerns about the presence of such potentially dangerous elements as aluminum in some vaccines.  "The amount of aluminum is such an infinitesimal amount," Edwards responded. "It's to preserve the vaccine and protect it from bacteria that would cause much more of a problem. You are probably consuming more aluminum from cooking pots. So I'm not going to worry about that. I'm going to worry more about the diseases that can kill your child."

NOTE: Regarding the above comments on aluminum, we heard from an Exchange listener after the show who pointed out that aluminum is an adjuvant rather than a preservative. You can find this information on the CDC website: According to the CDC, aluminum is an adjuvant, used to help improve how vaccines work: Small amounts of aluminum are added to help the body build stronger immunity against the germ in the vaccine. The CDC says they have been used safely for decades. 

Dr. Chan added:  Safety studies by such agencies as the FDA and the CDC do not support claims that such adjuvants are unsafe. And safety monitoring continues, with a national reporting system for any concerns regarding side effects or reactions to vaccines.

Several callers referred to the National Vaccine Injury Compensation Program (VICP), established in 1988 by the federal government to evaluate vaccine injury claims.  According to the VICP website:  "In very rare cases, a vaccine can cause a serious problem, such as a severe allergic reaction. In these instances, the National Vaccine Injury Compensation Program (VICP) may provide financial compensation to individuals who file a petition and are found to have been injured by a VICP-covered vaccine.  Even in cases in which such a finding is not made, petitioners may receive compensation through a settlement." 

An Exchange listener objected to the increasing number of vaccines and said she chooses to vaccinate her children against some but not all diseases. Edwards acknowledged that the vaccine list has become longer due in part to the outbreak of certain diseases once associated with travelling overseas, such as Hepatitis A.  

One listener brought up an alleged link between autism and vaccines. But the study proposing such a link has been widely discredited, Edwards said. In addition, there is some research suggesting that signs of autism can be detected even before a child is vaccinated. Another concern: Inadequate research and research allegedly tainted by the for-profit pharmaceutical industry. Edwards said she stands by studies conducted by the CDC and NIH. "I don't think there's a money trail that's making bad vaccines." 

STATES WITH RELIGIOUS AND PHILOSOPHICAL EXEMPTIONS FROM SCHOOL IMMUNIZATION REQUIREMENTS. For more information, visit NCSL

States With Religious and Philosophical Exemptions From School Immunization Requirements
Credit National Conference of State Legislatures