A Shot In The Arm

February 12, 2004
Parents who believe vaccinations may pose health risks to their children now legally can refuse to have their children immunized. Last September, the Texas Legislature passed House Bill 2292, which includes a provision that allows parents, for the first time, to refuse vaccinations "for reason of conscience." Texas is the 19th state to pass such legislation.shot
In order to seek this exemption, a parent must request in writing a form from the Texas Department of Health and have it notarized within 90 days of submitting it to a school. The law also changed the requirements for religious exemptions. Previously, parents had to claim that immunization conflicted with the belief and practice of a recognized religion to which they belong; now, they can claim an exemption "for religious reasons."
The new law was hailed as a victory for parent rights and informed consent by members of Parents Requesting Open Vaccine Education (PROVE), a 3,500-member Texas-based organization that advocated changes to the statute.
"Parents and their children live with the consequences of the decision to vaccinate and so should have the right to informed consent, which implies the right to refuse any medical treatment they believe may be harmful," says PROVE director Dawn Richardson of Austin, Texas.
The concerns of PROVE members often center on the safety of specific -- not all -- vaccines and the potential for side effects and long-term health problems. These parents may have a child who experienced a reaction to a vaccine or who has a medical condition that they believe may place their children at risk of adverse effects, Richardson says.
"Parents are losing faith in health officials because of what they perceive as misinformation and denial of potential vaccine reactions. Many parents feel they are not fully informed," she says.
The Texas Medical Association (TMA) opposed the new exemption. "Vaccination is one of the great public health success stories of the last century -- preventing disease and saving lives," says Dr. Andrew Eisenberg, chair of the TMA Council on Public Health. "In 1960, for example, there were more than a half-million cases of measles in the U.S., which caused 400 deaths; in 1998, 68 cases were reported with no deaths."
Some children do react to vaccines, he says, but these reactions usually are mild, resulting in swelling, tenderness and slight fever. Despite media reports that suggest a link may exist between certain childhood vaccinations and autism, a number of research studies throughout the world have demonstrated no evidence that vaccines are the cause, he says.
Dr. Scott Lea, BS '72, MD '75 (Baylor College of Medicine), an infectious disease specialist and the former medical director of the Waco-McLennan County Public Health District, says that a basic tenet of communicable disease prevention may be weakened by the new exemption.
"The small numbers of individuals susceptible to vaccine-preventable diseases are protected by 'herd immunity' -- the fact that those around them are immune and cannot transmit these diseases. The larger the herd of immune individuals, the less chance of disease spreading throughout the community," he says.
Dr. Lea says he is concerned that broader exemptions will lull parents into a false sense of security. "Enclaves of people will begin to believe they don't need immunizations, and we will see the rates of preventable, highly infectious diseases rising," he says.
Research supports his prediction. A study published in the New England Journal of Medicine in December 2000 reported that children in Colorado who did not receive immunizations because of philosophical or religious reasons were 22 times more likely to get measles, and six times more likely to get pertussis (whooping cough) than children who have been vaccinated.
Parents should discuss the benefits and risks of childhood immunizations thoroughly with their health care provider before making any decision, Dr. Lea says. "I am an infectious disease specialist, and I vaccinated my kids to the hilt. Ask any infectious disease specialist, and they'll tell you the same thing."

Beal is a lecturer in Baylor's Louise Herrington School of Nursing, where she teaches "The Experience of Illness." She received her BS from Columbia University and her MN from Emory. She is a freelance health and medical writer.
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