Pandemic prompting closer look at vaccine exemption

Boston Statehouse

BOSTON (SHNS) – More than 400 people had thoughts they wanted to share with lawmakers Tuesday on bills related to vaccines and immunization policy, issues catapulted to the forefront of public discussion by the COVID-19 pandemic.

Over the first few hours of what Public Health Committee Co-Chair Rep. Marjorie Decker said could be a 20-hour virtual hearing if everyone who registered to testify did speak, many of the comments focused on a pair of bills that Rep. Andy Vargas said aim to tackle the same issue.

Vargas said his bill (H 2411) to remove the current religious exemption for the required vaccines for Massachusetts students — which would maintain the existing medical exemption — and legislation filed by Sen. Becca Rausch and Rep. Paul Donato both seek to “address the high rates of vaccine exemptions in our state.”

The Rausch/Donato bill (S 1517, H 2271) seeks to standardize immunization requirements and exemption processes, fill gaps in vaccine rate data, and boost outreach efforts.

Vargas, a Haverhill Democrat, said all but one county in Massachusetts has one or more schools where herd immunity for measles has not been met. He said several other states, including Connecticut, New York and Maine, have removed non-medical exemptions for childhood vaccines.

“Above all the lessons learned through the pandemic, perhaps the most powerful one is that whether we like it or not, Americans, Massachusetts residents and human beings have a responsibility for the health and safety of one another,” he said. “As lawmakers, we have to reason with the facts, listen to trained experts, trust the science and make tough decisions to stop preventable death and illness. We learned this the hard way during the pandemic.”

State law requires students entering school to be immunized against “diphtheria, pertussis, tetanus, measles and poliomyelitis and such other communicable diseases as may be specified from time to time by the department of public health,” but allows exemptions in cases where a physician certifies the child’s health would be endangered by a vaccine or in cases where the parent or guardian “states in writing that vaccination or immunization conflicts with his sincere religious beliefs.”

Last summer, the DPH added flu shots to the list of required immunizations for students and then removed that requirement in January 2021, citing preliminary data showing a mild flu season to date.

A state average of 1.1 percent of kindergarteners had either religious or medical vaccine exemptions in 2020, according to the Department of Public Health, which said that most exemptions claimed in Massachusetts are religious. The rates vary, from 0.7 percent in Suffolk County and 0.8 percent in Middlesex County, to 8.5 percent in Dukes County, 7.3 percent in Nantucket County, and 2.7 percent in Franklin County. Many students, the DPH said, have exemptions to only one or two vaccines and are otherwise immunized.

Dr. Sylvia Fogel, a psychiatrist who opposed the bills, told the committee that removing religious exemptions or “having DPH implement or prove exemptions” would be “simply targeting the wrong thing, with large potential downsides.” She said several schools with the lowest measles vaccination rates do not have any exemptions on file.

Several of those who testified against one or both bills identified themselves as parents, including some who cited beliefs in limiting medical intervention, said they wanted more flexibility in the timeline for vaccinating their children to observe effects, or decried government mandates around health decisions that they said belong with parents.

Timothy Murzycki, who described himself as a “frightened and frustrated” father, said the bills pose limits to medical and religious freedoms.

“When evaluating the proposed bills, please contemplate the following questions,” he told the committee. “Is this freedom? Is this a democracy? Is this a free and fair society?”

Another parent, Beth Cook, said the bills are “discriminatory towards families whose sincere moral and religious beliefs influence their decisions regarding vaccination and medical intervention.”

Supporters of the bills pointed to a need to protect immunocompromised people, cancer patients, transplant recipients, and others who cannot get vaccinated, and said that COVID-19 has underscored the way individual health choices affect a broader community.

Rausch described the state’s current youth immunization law as “Swiss cheese at best” and said its “holes have led to significant confusion, widely disparate implementation and serious public health gaps that threaten the health and safety of communities all across the commonwealth.”

Rausch said that her bill, dubbed the Community Immunity Act, does not strike the religious exemption and that it “doesn’t mandate vaccines, it doesn’t compel speech, it doesn’t give government any subjective review of any exemption application, it doesn’t permit a young person to waltz into a pharmacy and get a vaccine, [and] it doesn’t change anything about summer camp enrollment for parents who vaccinate their children on schedule.”

“The Community Immunity Act will significantly boost our ability to combat not just COVID-19 but all vaccine-preventable illnesses,” she said. “Our current laws simply don’t cut it. If the fault lies in our statutes, so too must a solution.”

Rausch listed the Massachusetts Health and Hopsital Association, Massachusetts Nurses Association, American Federation of Teachers-Massachusetts and Massachusetts Association of School Superintendents as among groups that have endorsed the bill.

The Massachusetts Medical Society “strongly supports” eliminating the religious exemption and backs “certain provisions” of the community immunity bill “that would improve the remainder of the vaccine system by centralizing, standardizing, and streamlining the medical exemption process while improving the collection, monitoring, and publication of immunization data,” the organization said in a statement.

Dr. Carole Allen, the MMS president and a retired pediatrician, told the committee that in her 40-year career, she “encountered numerous instances of vaccine-preventable infections and witnessed and welcomed the miraculous development of vaccines to prevent them.”

“Just as we have seen with the COVID pandemic, the health of communities of color and low-income populations continues to be disproportionately threatened by these diseases,” she said.

Versions of both bills were proposed in 2019, months before the COVID-19 pandemic took hold and intensified interest in issues around infectious diseases and immunization. As of Monday, more than 4.27 million people in Massachusetts were fully vaccinated against COVID-19.

Last session, the Public Health Committee killed Vargas’ vaccine exemption bill by including it in an order for further study, but advanced redrafted versions of the Donato and Rausch bills, which went on to die in the Health Care Financing and Senate Ways and Means committees, respectively.

This term, the Rausch and Donato bills are co-sponsored by a total of 27 lawmakers, including 17 of the 40 state senators. Nineteen lawmakers are signed on to the Vargas bill, which also has the support of the Lexington School Committee.

“If we have learned anything during this pandemic, it is the need to be proactive and not reactive. We need to act now to ensure vaccination rates are high enough to prevent outbreaks of highly contagious diseases,” Kathleen Lenihan, the school committee’s chair, told lawmakers.

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