Further evidence emerged over the weekend that State Sen. Elizabeth Steiner (D – Beaverton/Portland) is the driving force behind HB 3063. On Saturday, May 4, she sent an email to her colleagues in the Oregon legislature posing and answering questions about the bill. Her effort is full of holes as demonstrated below.
Not to be left out, I decided to pose some questions myself. Here’s my email to Steiner Hayward (reinforced by two voice-mails to her office). I don’t imagine she’ll reply, but should she or a staffer surprise, I’ll certainly update this article.
As expected, just this afternoon, the Oregon House of Representatives passed an over-arching mandatory vaccine bill. So, also as expected, it comes down to a vote in the Senate. Senators might wish to read the following, along with – should they prove ambitious – the two articles below that.
But read this one, anyway, one observer’s reaction to the email their colleague sent them pushing a yes-vote.
After some introductory niceties, my emailed query to Steiner Hayward commenced:
I’m also writing and about to publish today another article regarding your Sat., 5/4/19 “Dear Colleagues” email to your fellow lawmakers about HB 3063. The email where you pose questions on the bill and provide your answers.
One exchange leaps out as demanding elucidation. You write:
“Question: Is it safe to give children so many immunizations at once?
Answer: Yes, it is safe, and in fact, giving them together improves the immune response to all of the immunizations so they work better.”
So, I am requesting your reply for publication shortly. Let me ask you to supply the published evidence – either published research or a disseminated CDC guideline, etc. – that allows you to assert to your colleagues as you seek to influence their vote:
1. Is there evidence regarding the overall safety of a catch-up program of immunization for 11 diseases, constituting some 21 shots for a young child? If so, please supply that evidence. (See the statements below by Oregon Health Authority‘s resident expert, the Institute of Medicine and in JAMA that such evidence is actually lacking.)
2. Similarly, please supply the evidence backing up your assertion to your fellow lawmakers seeking to influence their vote that, in fact, giving vaccine shots “together improves the immune response to all of the immunizations so they work better.”
In my slog through the literature, I don’t believe I’ve encountered that claim.
In fact, permit me to borrow from the two articles extant at https://forbesfulminates.wordpress.com/.
At that April 24 subcommittee hearing – sitting right next to you, Sen. Steiner Hayward – Paul R. Cieslak, MD, Oregon Health Authority’s Medical Director, Communicable Diseases and Immunizations, said (around the 15:00 mark) he wasn’t aware of any studies looking at catching up large populations who are behind on their immunizations.
Cieslak was echoing both the recognized national authority, the Institute of Medicine (part of the National Academies of Sciences, Engineering, and Medicine) as well as a guest editorial by a CDC-affiliated national vaccine expert in the Journal of the American Medical Association regarding the lack of overall research on the full passel of required shots – both their timing and cumulative effect.
For its part, the IOM investigated the safety of the entire vaccine schedule. It stated, “key elements of the entire schedule—the number, frequency, timing, order, and age at administration of vaccines—have not been systematically examined in research studies.”
The IOM added, “Experts who addressed the committee pointed not to a body of evidence that had been overlooked but rather to the fact that existing research has not been designed to test the entire immunization schedule.”
Finally, the IOM committee stated its belief that, “although the available evidence is reassuring, studies designed to examine the long-term effects of the cumulative number of vaccines or other aspects of the immunization schedule have not been conducted.”
The JAMA editorial noted that, “the safety and efficacy of individual vaccines [has been studied] separately and in combination with other vaccines.” But “these studies did not examine the safety of the overall schedule.”
Question Number THREE, please, senator.
For further information on medical exemptions, your May 4 email directs your legislative colleagues to CDC guidance on “Contraindications and Precautions” here.
Just prior to directing colleagues to this CDC document, your email noted that OHA will “bring together stakeholders” to develop guidelines for the three licensing boards that will oversee clinicians writing medical exemptions. You express the hope that these “guidelines will give boards the latitude to accept some medical exemptions that do not meet the strict CDC criteria.”
That’s important since the CDC “Contraindications and Precautions” guidance that you referred your colleagues to (and linked above) includes chilling statements from Table 4 – 2. This table is entitled, “Conditions incorrectly perceived as contraindications or precautions to vaccination (i.e., vaccines may be given under these conditions).”
And, alarmingly for Oregon parents who may seek medical exemptions, these CDC guidelines state that neither a “Family history of seizures,” nor a “Family history of sudden infant death syndrome” justify skipping one or more vaccines.
3. Will that be the case here in Oregon? Will someone whose sibling has died “after receipt” of vaccine, as the term of art has it, be required to receive the entire immunization schedule? Or will the licensing boards have “the latitude” to dismiss these particular guidelines in such a case?
4. You may harbor the hope that the boards will embrace such flexibility, but what guarantee do colleagues about to vote have on the matter?
After all, to progress to QUESTION FIVE, your email indicates that OHA will “bring together stakeholders, including the relevant healthcare providers, the licensing boards, and experts on immunization policy & practice to develop” the licensing board guidelines.
Is there any guarantee that the stakeholders will include individuals who may shy from the current immunization orthodoxies? Not to put to fine a point on it, will the stakeholders include any with diverse viewpoints?
I ask in light of the current membership of OHA’s Immunization Policy Advisory Team. With the withdrawal of a prominent Portland naturopath from membership, at the IPAT meeting I attended on March 7, there was basically no membership around the table who’s paycheck didn’t depend, in one fashion or another, on the administration of vaccine. No dissenting views were expressed by the IPAT members present.
5. What guarantee do lawmakers about to vote have that, in effect, the books won’t be similarly cooked – dissent stifled or absent – in the OHA stakeholders group that will instruct the three state licensing boards how to go about their business overseeing the writing of exemptions? (A process that will be overseen by two higher authorities, OHA itself and the state legislature.)
As to QUESTION SIX: you tell colleagues that, “the House and Senate bill carriers” (i.e., HB 3063’s chief proponents) “will make it clear that we understand that especially for the first few years, as everyone is figuring out the new system, we expect that health care providers, OHA, and the licensing boards will take a more permissive stance.”
This is akin to your statement (around the 15:40 mark) to the joint subcommittee on April 24 that, “For the first year or two, I expect we’ll see a little bit more, a slightly more relaxed approach, perhaps, to the medical exemption practice to ensure that parents have the opportunity to have a close consultation with their child’s primary care provider to determine the optimal catch-up schedule for their child.”
6. What guarantee — or even likelihood given the “stakeholders” who will probably draft the guidelines — do lawmakers about to vote on the bill have that, at least initially regarding medical exemptions, “health care providers, OHA, and the licensing boards will take a more permissive stance.”
7. What substance of legal, legislative or any other sort renders this naught but talk soon forgotten?
[8. Here’s a bonus question I should’ve asked but didn’t: Will the possible, short-term latitude on medical exemptions mean anything after the first year or two given that they have be renewed annually?]
Many thanks for your replies to these questions. I plan to publish my article on your 5/4/19 email to colleagues very shortly.