Local House reps., and other members in Olympia on Feb. 5 took another step toward removing the personal and philosophical choice for parents to opt their school-aged children out of the Measles Mumps and Rubella (MMR) vaccine. They voted 57-40 in favor of HB 1638, which removes the personal exemption but leaves religious and medical exclusions.

The House bill was formed on the heels of an ongoing Measles outbreak in the state. As of March 2, there have been 71 cases confirmed in Washington. One case was in King County, and the remainder of cases were confirmed in Clark County. Fifty-one (51) of those impacted are younger than 10 and a majority are unvaccinated.

In Clark County, typically at this time of year, about 200 MMR vaccines are administered each week. Numbers have shot up to more than 1,000 vaccines being given, state health officials said. Many of those seeking vaccines are older than 19.

Rep. Larry Springer, a Democrat representing the 45th District, voted for the bill and said he had heard objection to the bill, receiving a few hundred emails, some from his constituents but primarily from others in the state. Understandably, Springer said, they are against decision-making power being taken away.

“We’ve had vaccine issues before, but this is the first time we’ve passed the bill limiting parental choice to what constitutes an exemption,” Springer said. “There’s bound to be controversy, but the interest of the public’s health and protecting other children outweighed that.”

Springer described a “healthy and long” floor debate leading up to the vote. Considered a bipartisan issue by many, he was surprised to see many Republicans opposing the bill.

My-Linh Thai (D-Bellevue) is a non-practicing, trained pharmacist who has studied medication.

“In health care you learn there’s no perfect treatment,” she said, adding that she heard stories from parents whose children experienced side effects after receiving vaccination, causing some doubt for them. Their stories are equally validated, like other stories legislators heard, she said. “But this decision benefits the majority,” Thai added. She too voted in favor of the House bill.

Untold consequences

U.S. Surgeon General Jerome Adams was in Seattle Thursday, touring the Odessa Brown Children’s Clinic, in an effort to stress the importance of vaccinations.

Adams said often people talk about the 71 Measles cases in the state.

“But we don’t talk about the 800 people who are missing school because they’ve been quarantined,” he said. “We don’t talk about the 4,000 case contacts that had to get followed up on — measles affects the entire community.”

Marissa Armstrong, of Clark County Public Health, confirmed that in total, since the outbreak began in January, 849 students were excluded from 15 schools in Clark County. The time at which the student was asked to remain home depended on when they were suspected to have been exposed to a person with measles.

When a case is confirmed, an interview is conducted to find out where those infected have been. Schools will go through their records to locate any students they suspect are susceptible, not having had the vaccine or no history of the disease. The schools then issue letters to those individuals asking them to remain at home for 21 days.

And the outbreak is not deemed over until 42 days — two incubation periods — have passed after the newest confirmed case. The last measles case confirmed in the state was on March 2.

Following his tour, Adams said his wife, battling cancer, relies on “herd immunity” levels for protection from vaccine-preventable diseases. Washington has struggled to obtain the 95-percent vaccinated levels needed to obtain community immunity, giving protection to children too young and people too sick to vaccinate.

He said there’s no one reason people choose not to vaccinate, that different cohorts around the country are choosing not to. In New York it was a group of Orthodox Jewish people. In Ohio it was an Amish population. In Washington, he said, it was those of eastern European descent choosing not to vaccinate. But the number-one reason people choose to vaccinate, is trust in their medical providers and their recommendation to do so.

Medical exemptions

Rep. Shelley Kloba, of the 1st Legislative District, said she voted yes to removing personal exemptions in representing her many constituents who overwhelmingly favor vaccines. However, she said the medical exemption needs to remain. And she has concerns about the way medical exemptions are being handled.

A couple Kloba spoke with felt they weren’t listened to. Their young child had been vaccinated, and afterward had cried solidly for about 16 days and experienced other oddities — creating what they felt was a contraindication for any subsequent vaccines.

She admits she’s not an expert in immunology, and doesn’t have a basis for evaluating whether patients she’s talked with are getting the appropriate review from physicians. Even still, she calls on medical professionals to review their standards of practice, to ensure a safety exists for people who have legitimate medical reasons for seeking an exemption for their child.

Julie Graham, with the Washington State Department of Health, said no requirement exists for clinicians to do specific standard actions when issuing medical exemptions.

“The goal is to make sure people and parents have had the opportunity to discuss the benefits and any potential concerns about vaccination before deciding to choose not to immunize their children for school-required vaccines,” she said.

Benjamin Danielson, senior medical director at Odessa, stressed that vaccination conversations needed to be founded on trust and respect. Health care providers needed to really listen, he said.

“We have to be deep listeners — we can not jump into a place of judgment or forcefulness,” he said. “We really have to seek to understand, and you have to do that honestly. You can’t just wait your turn to make your point which is what we sometimes find ourselves doing in many conversations.”

Adams stressed that access to vaccines had to be increased — that sometimes it’s the single, working parent that struggles to vaccinate their child.

“The Measles vaccine is safe, it is effective and we have to make it easier for people to get vaccinated than it is for them to get exemptions,” Adams said.