Limiting Vaccination Exemptions

 

The time has come for limiting vaccine exemptions. In my last post, Do Adults Need the Measles Vaccine?, I discussed the growing crisis of measles reinfestation in this country and other parts of the world after near eradication many years ago.

The problem is fake news about the safety of vaccines. Bogus medical research by British doctor Andrew Wakefield was published in 1998 in the British medical journal, The Lancet. He claimed measles vaccine caused autism. This research has since been discredited and The Lancetpublished a retraction. Wakefield was even stripped of his medical license in 2010.

Yet the myth of vaccine-associated autism continues, in part due to social media. The result has been declining vaccination rates in this country and especially in Europe. The tragic impact has been rising measles cases and even deaths.

The solution is increasing vaccination rates. The vaccine is safe and effective. The disease is dangerous. The risk of serious neurological disease following vaccination is one in 365,000 – the risk of death with the disease is 1 – 2 in 1,000.

States are responding with new legislation designed to address the problem. But some aren’t responding enough. New York has recorded 600-plus cases alone out of 839 cases reported this year nationwide. This is more in New York alone than the number recorded nationwide in 2018.

Jason Riley, writing in The Wall Street Journal, says the cases have been concentrated in New York City and its suburbs, where pockets of Muslim, Christian and Orthodox Jewish families object to receiving the shots on religious grounds. Public health officials across the country are scrambling to raise awareness about the importance of inoculations, a task made more difficult by others spreading quackery on social media. On social media last week, a state legislator in Texas compared vaccines to “sorcery” and called them “dangerous.” Such a false claim by politicians for political purposes is both reckless and irresponsible. It highlights the need for new legislation to protect the safety of the public.

The problem is exemptions. There are far too many of them.  According to the National Conference of State legislature, all but three states – California, West Virginia and Mississippi – grant exemptions from school immunization requirements for “religious reasons.” And 16 states “allow philosophical exemptions for those who object to immunizations because of personal, moral or other beliefs.” Even medical exemptions need more scrutiny.

The issue is safety – plain and simple. When your actions increase the likelihood of danger for others in this country then you must be held accountable. Therefore, there must be no exemptions for religious grounds and no exemptions for medical grounds except when the patient is immunocompromised. If these rules were followed, those few unvaccinated individuals would be protected by “herd immunity.”

Parents who refuse to comply with vaccinations must have their children excluded from the schools and public places lest they present a danger to others and themselves. Reckless drivers have their licenses revoked for the safety of the public. Reckless parents should be treated likewise.

Do Adults Need the Measles Vaccine?

 

Recent outbreaks of measles have raised the alarm again about measles vaccinations. More than 760 cases of measles have been reported in 23 states, including two in my home state of Florida. This is the highest number of cases recorded in the United States in the past 25 years.

The reason for this increase in measles cases is no mystery. Measles vaccinations have declined in recent years due to widespread false reports that measles vaccine can cause autism.

This hysteria over the safety of the vaccine was started by a British doctor, Andrew Wakefield, who published an article in the respected medical journal, The Lancet, in which he claimed an association between autism and the measles vaccine. Although Wakefield’s research has since been widely discredited, the myth he spawned continues to impact vaccination rates largely because of social media promotion of the myth.

This problem is not unique to the United States. Rising cases of measles in Europe, especially Romania, are sounding alarms.

Pietro Lombardi, writing for The Wall Street Journal, says Romania is fighting a deadly measles outbreak that has seen more than 15,000 people infected with the disease and that has claimed 59 lives since one of Europe’s most lethal measles outbreaks in decades started in 2016. More than 41,000 people were infected with measles in the first half of this year in the wider European region, compared with roughly 24,000 for all of 2017, according to the World Health Organization (WHO).

The problem, once again, is skepticism about vaccine safety. Despite consistent medical evidence that these vaccines are safe, ignorance and misinformation continues to plague attempts to improve rates of vaccination.

Concern has now spread to even adults who worry they could get measles, too. The risk for adults depends on your age and exposure to measles in the past. Any adult who has had measles previously is at virtually no risk of ever contracting measles again. Those who never had measles but were vaccinated in 1969, the first year of the vaccine, probably should consider getting a booster vaccination because the original was less effective.

If you’re unsure of your vaccination history or about prior measles infection as a child, the simple answer is to be vaccinated. If you’re already immune, the additional vaccination won’t hurt you. If you’re not, you’ll be protecting yourself from the disease. If this is your first vaccination, a second shot is recommended to increase your protection from about 95% with one to 100% with two.

Measles is not an innocuous disease. Before 1963, when the measles vaccine became available in the U. S., there were more than 500,000 reported measles cases every year, according to the CDC. On average, 432 cases a year resulted in death. By the year 2000 the number of cases had dwindled to 86 and the number of deaths in the U.S. to zero.

But recent outbreaks in Europe mentioned above prove the virus has not lost its deadly potential. Parents should be aware that the risk of serious neurological disease following vaccination is one in 365,000 doses – but the risk of death with the disease is one or two in just 1,000. Adults who have never had the disease nor the vaccination should be vaccinated as soon as possible.

The Canadian Medicare for All Experience

 

The Bernie Sanders’ push for Medicare for All is gaining some steam as his presidential campaign ratchets up the rhetoric.

In a recent Fox News town hall appearance, Sanders said, “What we are talking about is simply a single-payer insurance program, which means that you will have a card which says Medicare on it, you go to any doctor that you want, you will go to any hospital that you want. You’re not paying any more premiums, you’re not paying any more copayments, you’re not paying any more deductibles.” He went on to say the plan, “would allow all Americans, regardless of their income, to get the healthcare they need when they need it.”

How do these statements by Sanders compare with the real world? The best comparison to his Medicare for All system is our northern neighbor, Canada. What has been their experience?

Regina E. Herzlinger and Bacchus Barua, discussed the answer to this question in a recent Op-ed for The Wall Street Journal. Herzlinger is a professor at Harvard Business School and Barua is associate director of the Canadian Fraser Institute’s Centre for Health Policy Studies.

They say the Canadian model follows Sanders’ Medicare for All single-payer plan but “is not the best way to achieve the goal of access to timely care.” Like the Sanders plan, it is universal, taxpayer funded without deductibles or copays, and excludes premiums for most users. But objective measures of performance show it’s a comparatively expensive system whose results are mediocre at best – and sometimes very poor.

A Fraser Institute study published in November, 2018, examined 28 universal healthcare systems across 45 indictors of performance. Canada’s system ranked among the top spenders – fourth highest as percentage of GDP and 10thhighest per capita. Yet it had less medical resources available for patients and painfully long wait times for specialists (emphasis mine).

Canada ranked:

  • 26thout of 28 for number of physicians
  • 22ndout of 27 for MRI units
  • 25thout of 26 for hospital beds
  • 11thout of 11 for waiting times greater than 4 weeks

Canada performed well on only five of the 12 indicators of clinical performance and quality included in the Fraser Institute’s study. Its performance on the other seven was poor or average.

Why these dismal results for Canada in comparison to systems in Europe? Unlike Canada’s single-payer system, the Swiss, Dutch and German systems rely on private insurers, whether nonprofit or for-profit. The Sanders Medicare for All system would eliminate private health insurers.

Unlike the U.S., with Medicare and its massive trillion-dollar unfunded liabilities, these countries cannot pass unreimbursed current expenses onto future generations. If the expenses of private insurers exceed their revenues, they face bankruptcy. There is also an advantage to private vendors who can access private capital to fund medical innovations – unlike government-run systems, which need bureaucratic approval to use tax revenues.

The Canadian experience is a lesson American voters should be learning. Medicare for All will not produce the utopian healthcare system of Senator Sanders’ rhetoric. His healthcare promises are no better than President Obama’s who famously said, “If you like your doctor, you can keep your doctor.” The American people should not be fooled again.