A bipartisan group of senators wants to tighten the rules around granting exemptions from vaccination.
By Rose Hoban
In the wake of dozens of outbreaks of childhood communicable diseases across the country, North Carolina lawmakers are proposing to all but eliminate parents’ options for requesting exemptions from required childhood vaccines.
Sen. Jeff Tarte (R-Cornelius) introduced legislation Thursday that would add five vaccines to the list of required shots and deny parents the option to claim religious exemptions for vaccinating their children.
“We’re not creating any new rules,” Tarte said. “Currently, every child in North Carolina is required to be vaccinated.”
But since 195, parents have been able to request exemptions based on “bona fide religious beliefs and opposition to the immunization requirements” under North Carolina law.
Tarte’s bill would change that, reducing the 1,204 religious exemptions granted by North Carolina law.
“There’s only two groups that we’ve seen published, that we can find, that are formally, across the board saying that we do not want to vaccinate,” Torte said, “Christian Scientists and the Taliban.”
North Carolina does not have a provision for personal-belief exemption from vaccination. There is, however, a provision to claim an exemption for medical conditions such as severe immune deficiencies, as with children being treated for cancer.
According to data from the Centers for Disease Control and Prevention, North Carolina ranks 13th in the country for elementary school vaccinations.
Public health officials emphasize that vaccinating healthy children protects those who might have immune problems that make them more susceptible to disease.
They cite a concept known as “herd immunity”: If someone within a group of people has measles or mumps, the disease won’t spread if the majority have been vaccinated.
Tarte said one of the reasons he supports the bill is because too many children in the state are getting exemptions, thus “violating the herd immunity.”
The problem is at its worst in Buncombe County, where more than 4 percent of children have been granted exemptions, according to Sen. Terry Van Duyn (D-Asheville), a co-sponsor of the bill.
“We have the highest exception rate for immunization, and we’re starting to see cases of serious diseases we thought we had eradicated,” said Van Duyn, who has served on Buncombe County’s board of health and human services.
“This is a serious public health problem,” she said, citing the vaccination rate as the reason she signed onto the bill.
Health directors from at least five counties were present for the announcement of the bill, including Cumberland County health director Buck Wilson, who is also president of the state Association of Local Health Directors
“Sen. Tarte mentioned the herd immunity, and that’s what really concerns us,” Wilson said. “If we get too many people exempting themselves, and they get one of the diseases, then they could easily pass it onto others.”
“You can’t put the entire population at risk,” Tarte said. “That is the superseding principle.”
One roadblock the bill may encounter is the additional requirement for at least five more vaccinations, including meningitis, chicken pox and rotavirus vaccines. Adding required vaccines could cost the state’s Medicaid program millions, as Medicaid will pay for those vaccines for tens of thousands of eligible children – this at a time when legislators are looking for ways to trim the Medicaid budget.
The HPV vaccine, given to teens and used to prevent cervical cancer, would not be required.
Tarte said he knew there would be objections to eliminating religious exemptions. Only two other states, Mississippi and West Virginia, have eliminated those exemptions. The West Virginia law was litigated to the Fourth Circuit Court of Appeals, which Tarte said upheld the law.
The Fourth Circuit also has jurisdiction over North Carolina, and, according to ACLU of North Carolina policy director Sarah Preston, that would be the “controlling law” here.
But Preston said that even though the science behind the vaccination requirement is strong, removing the religious exemption is a sticky situation.
“The legislature needs to be balancing the civil liberties interests that do exist with what is, in fact, a compelling governmental interest in containing communicable disease,” she said.
“We believe that these kinds of policies need to be designed so as not to unduly infringe on civil liberties and should be as minimally intrusive as possible,” Preston said, adding that the legislature should “spend a little time and make sure they’re coming up with the least intrusive way of achieving their goals.”
Tarte said he’s looking forward to the process of vetting the bill publicly.
“I anticipate there is going to be some fine-tuning to this,” he said.
Even if every child in North Carolina gets immunized, it might not keep some diseases from causing outbreaks. That’s the case, in particular, with pertussis, commonly known as whooping cough.
Health officials used to recommend a vaccine formulation made with live bacteria that have been killed by radiation, but that formulation had a higher rate of side effects such as fevers and seizures. So in the 1990s, they switched to a vaccine formulation that has fewer side effects but that depends only on purified pieces of the bacteria to give immunity from whooping cough.
The effectiveness of these newer formulations of whooping cough vaccine tends to wane over time, and by the time a child is 7 or 8 years old their immunity is reduced enough that they can catch the disease if exposed. Public health experts think this is why the number of outbreaks of pertussis among older elementary school children has increased in recent years.
There’s been some discussion by experts at the Centers for Disease Control and Prevention and the World Health Organization about either changing the schedule for getting whooping cough shots or reverting back to the old vaccine formulation. Until then, parents can expect to see more outbreaks unless children get a booster shot at a younger age.