Senate Passes Bill to Restrict Vaccine Exemptions

Republicans opposed the bill on the grounds that vaccines could infringe on religious liberty, but Democrats argued the threat of communicable disease to children and the community outweighs those concerns as state drops below herd immunity for certain preventable diseases.
The Lund Report

June 7, 2013 — The Senate passed a bill designed to reverse the number of children who enter public schools without vaccinations, putting in place new restrictions for nonmedical exemptions, despite partisan opposition from Republicans who said the restrictions usurp the rights of religious minorities, such as Christian Scientists, who oppose Western medicine on religious grounds.

Republicans had been able to filibuster Senate Bill 132 for weeks as the Democrats were unable to muster a constitutional majority. But with Sen. Betsy Johnson, D-Scappoose, now back in Salem as she recovers from a car accident, the Democrats carried Senate Bill 132 on a party-line, 16-13 vote.

“In an attempt to do something wonderful, we’re trampling on the Oregon Constitution,” said Sen. Jeff Kruse, R-Roseburg.

But Sen. Elizabeth Steiner Hayward, D-Portland, cited a 1944 U.S. Supreme Court decision that ruled “the right to practice religion freely does not include the right to expose the community or the child to communicable disease or the latter to ill-health or death,” as she read from the majority opinion in Prince vs. Massachusetts.

Steiner Hayward said Oregon had the legal option to prohibit religious exemptions, as Massachusetts does, but specifically tailored protocols that would allow religious exemptions to continue with informed consent.

“I’m a deeply religious person, and a member of a religious minority,” said Steiner Hayward, an active member of Congregation Neveh Shalom, a synagogue in southwest Portland.

She said Oregon’s wide-open allowance for non-medical vaccine exemptions had created a public health crisis. SB 132 was brought forward to the Senate this session as a result of work that Sen. Laurie Monnes Anderson, D-Gresham, had done with the Oregon Pediatric Society in the past year.

State Has Lost Herd Immunity

State immunization records show that 6.4 percent of kindergarteners have non-medical exemptions — both a national high and a modern high for Oregon, up from about 2 percent in 2001.

Steiner Hayward, a family physician, said the “herd immunity” rate — which protects people who have not been immunized — was 94 percent.

“We are now below that rate,” Steiner Hayward told her colleagues. “We will not be able to protect our children. … I have seen babies die from whooping cough in my care.”

Current practice allows parents to opt-out of vaccines simply by signing a form stating they opposed on religious grounds. Monnes Anderson said this is easier to do than tracking down a child’s immunization records.

SB 132 requires parents to show informed consent by either submitting a signed note from a healthcare practitioner saying they had been consulted about the health effects of vaccines or watched an online video sponsored by the Oregon Health Authority. Parents would then have the option of exempting their children from vaccines for any reason.

Doctor and Parent Perspective

While Steiner Hayward spoke as a physician who’s been witness to the perils of whooping cough, Sen. Arnie Roblan, a Coos Bay Democrat, spoke from experience with the contagious and potentially fatal disease, also known as pertussis, as a parent.

Roblan said his youngest child was not protected from herd immunity and she developed whooping cough when she was 2 months old — an alarming experience he said no parent would ever forget: “To watch a 2- to 3-month-old child’s chest cave in when she’s trying to get air.”

He said her breathing had to be monitored 24 hours a day until she eventually overcame the infection.

The former high school principal said despite Republican objections on grounds of religious freedom, it did not prohibit anyone from opting out. “It just allows a little education.”

But Republicans staged a lengthy floor debate and submitted their own proposal, which would supplement the Democrats’ options for parents with a signed affidavit that would allow for religious exemptions without any of the additional informed consent.

Sen. Tim Knopp, R-Bend, said the affidavit was identical to one Democratic Gov. Jerry Brown insisted be included when California tightened its non-medical exemptions. But California does not let parents watch an educational video to be exempt. Parents can otherwise only submit an informed consent affidavit, signed by a health care practitioner.

Knopp said it was unfair to subject a religious minority to a state-run video or a doctor who gave advice that was against their beliefs.

The Republicans’ version failed on a 13-16 vote, while the Democratic version passed on the opposite, 16-13 vote.

Weaker but Safer Vaccine a Factor in Epidemic

Senate Bill 132 is modeled after legislation in Washington state that worked to sharply reverse a trend in non-medical exemptions. That bill came only after the worst whooping epidemic in Washington in over half a century, due in no small part to lowered herd immunity.

A U.S. Centers for Disease Control investigation after the outbreak did produce some surprising results: more than three-quarters of teenagers who fell victim to pertussis had received their latest vaccination. A potential culprit may have been the new vaccine formula, which uses an acellular formula rather than a whole pertussis cell.

“The acellular vaccine is much safer, but we know it’s not as effective,” Sen. Alan Bates, D-Medford told The Lund Report. Bates is an osteopathic physician in family practice. “We’re going to have to reimmunize people,” he said, suggesting more frequent booster shots. Pertussis is typically combined with vaccines for diphtheria and tetanus.

Ironically, the new acellular vaccine has helped to reduce one complaint of vaccines — the potential for bad reactions, according to Steiner Hayward.

A federal fund exists to compensate people who are injured or killed by vaccines, and Steiner Hayward said many of those vaccine injuries were from the old pertussis vaccine.

The CDC data still pointed to the importance of vaccines, as unvaccinated children were eight times more likely to get whooping cough than those who’d had their pertussis shot.

SB 132 goes to the House, where it will have to pass through the Rules Committee to make it to the full house for a vote. The House Health Care Committee has stopped taking bills for the 2013 session, which may close at the end of the month.

Image for this story by Sanofi Pasteur (CC BY-NC-ND 2.0) via Flickr.

Christopher David Gray can be reached at

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I've heard that most parents using the religious exemption are college-educated, middle to upper income. I don't believe this "hoop" will stop them from continuing to exempt their children. They've done their research and have chosen not to vaccinate their children. This trend of not vaccinating will likely continue despite this law (if it passes).

We can't prevent parents from making poor decisions for their own children in this area in any way ever likely to be made law in the U.S. There are many highly educated folks whose ability to evaluate scientific or pseudo-scientific literature remains poor, some of them scientists themselves and some in health professions. We can make the consequences more appropriate, keeping to a minimum those children's contacts with others who are vulnerable and to family members of them who may carry an infection home to the vulnerable child or adult. There are many parents who are not completely unable to change their decisions about vaccines; enforcing full educational information as part of decisions, and more significant restrictions on school participation and other ways to put people at risk, are important influences. No matter what else, they reduce the risk that bad decisions will hurt others.