For almost seven months, California parents have been free to claim without offering any proof that their religion forbids getting their children vaccinated against once dreaded and disabling diseases like polio, mumps, pertussis and smallpox.
This allows parents who believe false myths to exempt their children from the vaccinations usually required for public school enrollment, even if they really have no religious beliefs at all.
Is it just coincidence that first six months of this new “personal belief” rule saw cases of pertussis, also known as whooping cough, more than double from last year? Through mid-June, 4,558 cases had been reported in the state, fully 1,100 during a single two-week period in June. There were three deaths in this year’s first six months.
The state’s officially-declared whooping cough epidemic is now on pace to top even 2010, when California recorded 9,120 cases, 809 hospitalizations and 10 deaths from the ailment. That year saw the most cases in more than 60 years, since record-keeping began.
Officials are reluctant to tie the new epidemic to a once-unpublicized 2012 signing message from Gov. Jerry Brown, attached to his approval of a bill originally designed to make it more difficult for parents to evade vaccinating their kids.
Brown’s words now allow parents merely to check off a box on a form, rather than having a doctor, school nurse or nurse practitioner sign a paper attesting that they have been informed of the benefits of vaccinations, as was previously needed for an exemption.
From the time his message became reality late last year, Brown has appeared oblivious to its the potential harm, his press secretary saying earlier this year that he “believes that vaccinations are profoundly important and a major public health benefit.” He has said nothing beyond stating that his order aimed only to “take into account First Amendment religious freedoms through an extremely narrow exemption.”
But the exemption turns out to be wide enough, as the football cliché goes, to drive a truck through.
So far, no one is directly blaming the Brown message for the epidemic of whooping cough, whose symptoms include “rapid coughing spells that end with a tell-tale ‘whooping’ sound,” according to a state Public Health department description.
“Pertussis is just cyclical,” the department’s deputy director and chief epidemiologist, Dr. Gil Chavez, said during a conference call. “The biggest contributor now is that the most modern vaccine’s effects wane over time, with the fullest protection lasting just two to three years.”
In fact, current pertussis vaccines given children under nine have shorter-term effects than those used in prior generations. “The vaccine is now easier on children, producing less fevers and less arm soreness than previous ones,” said Catherine Flores Martin, executive director of the California Immunization Coalition. The tradeoff is shorter duration.
Martin added that only after school opens this fall and officials report how many personal belief exemptions are filed will there be certainty about some effects of the Brown message. But she agreed that the confluence of the new form and the record number of cases, coming more rapidly than ever, might be linked.
“Politicians have a responsibility to protect the public and they don’t when they issue an order like this one,” she said.
The health department reported rates of pertussis cases this year are highest in Marin and Sonoma counties. “It boils down to the number of susceptible individuals in those counties,” said Chavez.
But Martin said, “It’s worth noting that those two counties also are the ones with the highest rates of parental refusals to allow their children to be vaccinated.”
That’s in line with a Johns Hopkins University study which concluded last year that California’s 2010 pertussis epidemic was fueled in part by an increase in the numbers of parents refusing to vaccinate children. The study showed the locations with the highest disease rates were also those with the most personal belief exemptions.
And that was before Brown’s order produced the new, easier to employ form in use this year. Still, it will be a few months before anyone can definitely establish cause and effect between the form and the newest outbreak.