Measles Exemptions: The New Loophole in Washington State

This week, the measles outbreak reached a record-breaking number of more than 1,000 cases spread across 28 states in the U.S.  In the first half of 2019, there have been more cases than in any other year since measles was “eradicated” in the year 2000. 

Washington State had 81 measles cases, 71 of which were in Clark County this past year.  Measles is extremely contagious and 90% of those who contracted the disease were unvaccinated.  Therefore, the Washington State Legislature went to great lengths to pass House Bill 1638, a law that removed the personal or philosophical exemptions for vaccination against measles, mumps, and rubella, believing this would reduce the chance of another measles outbreak.

 

While Washington lawmakers had good intentions, their actions were largely symbolic, because they overlooked a few issues that will interfere with this law having its’ intended effect.  According to the Washington State Constitution, “absolute freedom of conscience in all matters of religious sentiment, belief and worship shall be guaranteed to every individual...”  And to that end, the new vaccine exemption form replaced the philosophical exemption with a new box for parent-initiated religious exemption.

 

Parents can make an autonomous choice to exempt their child for religious reasons.  In order to honor a religious exemption, Washington State schools requires the patient be seen by a physician, nurse practitioner, physician assistant, or naturopathic physician.  These same health professionals may also grant a medical exemption if they see fit to do so.  This created another loophole. 

Naturopathic physicians have considerable expertise in the use of natural medicine; however, tend to be less supportive of the standard immunization schedule. Studies show care from a naturopath is associated with fewer vaccinations and a greater likelihood of contracting vaccine preventable disease.  A survey of naturopathic students in Canada found approximately 12.8% were supportive of the pediatric vaccination schedule.  And finally, a survey of Massachusetts naturopaths and homeopaths noted that most did not recommend vaccination at all.

According to Brigham Young University, only Washington and Oklahoma recognize the signature of a naturopath on a religious vaccine exemption form.  Three states—Washington, Oregon, and California—recognize the signature of a naturopath on the philosophical exemption form.  And based on my research, it seems only one state honors a medical exemption signed by a naturopath: Washington State.  (California honors a medical exemption by a naturopath, but only with physician supervision.) 

Will HB 1638 reduce the risk of contracting measles in Washington State?  It is unlikely.

About a dozen families in my practice have already obtained medical exemptions from naturopathic physicians in order to attend school next fall.  Over the last month, I have had more requests for religious exemptions than in the last seventeen years combined. HB 1638 does nothing to address the reasons behind low vaccine rates in the first place.

 

Fifty years ago, the idea that any parent would refuse vaccination against life-threatening disease was beyond comprehension.  But today, we have arrived at a place where many do not trust mainstream medicine.  In my opinion, laws which mandate medical interventions in the name of patient safety do nothing to solve this problem.  Even worse, enforcement of such regulations alienates families from seeking medical care when necessary.  Parents who decline immunizations for their children are not crazy.  They love their children and deserve a chance to have open dialogue with their physician to discuss the risks and benefits of vaccinations. Public health agendas laced with fear do not build trust and will not produce meaningful change.

In reality, Washington lawmakers have tried to place a Band-Aid over a gaping wound.  Life-threatening diseases, once eradicated, have made a roaring “comeback” for a variety of reasons that were not addressed by lawmakers.  If they want to make a difference, lawmakers have a decision to make: mandating vaccinations for school attendance or allow people the autonomy to make their own decisions on this issue. Either way, lawmakers did not “solve” this public health crisis.  HB 1638 missed the boat entirely.