Immunization is necessary - or is it? Doctors advocate for it as more parents claim exemption

A small but increasing number of parents have exempted their children from vaccination requirements, but doctors say immunizations are important to prevent the spread of diseases.

Retired licensed social worker Susan Thatcher of Carver has had her doctor give her son and daughter all the required vaccines for school, no question, but that doesn't mean she doesn't question whether a vaccine is right for her children.

For Thatcher, it's about respecting the concerns of the parents and spacing the vaccines that are given. She said it's important that parents are educated about those vaccines, but more importantly are ones that are not required, like the HPV vaccine, and their doctors need to work with them on that.

"People need to know, to get their facts straight and know what is going into their bodies and into their chidren's bodies," she said.

Thatcher has worked with children in foster care and with pediatricians on issues of compliance with the state Department of Public Health, is the parent of two children, one with neurological issues and one who is severely autistic and has done her research on every vaccine.

She said anything chemical or preservative is a challenge to the body. She would like to see more dialogue around the subject of immunization.

"I just think we need to be careful," she said.

She said big pharma is a real challenge because it dictates what doctors recommend. She said doctors have to recommend vaccines.

Her family does not get flu shots, for example, despite the public pressure to do so from doctors, nurses and other health care providers. She said each family, each parent, if healthy, can make that kind of decisions on what chemicals they want in their bodies by talking to others.

She said she waived the HPV vaccine for her son because she doesn't feel that research shows that it is truly necessary or worth the risk, although when it's time for him to choose it will be up to him.

Massachusetts state law requires that children receive a series of immunizations, including the Measles-Mumps-Rubella vaccine, polio vaccine and the DtaP - or diphtheria, tetanus and acellular pertussis vaccine - before entering school. Children with certain documented medical conditions are exempted from receiving live vaccines.

Under state law, parents can also claim an exemption on religious grounds by signing a letter stating that vaccinating their child against disease violates a sincerely held religious belief. Beyond signing the letter, no proof of religious affiliation or belief is required.

There are laws and regulations in place outlining the immunization requirements for school and child care entry, but the enforcement of the school entry requirement is left up to the local school district, and enforcement of the child care requirements are the state Department of Early Education and Care's responsibility.

The policy of the Carver Public Schools on inoculations of students is as follows: "Students entering school for the first time, whether at kindergarten or through transfer from another school system, will be required to present a physician's certificate attesting to immunization against diphtheria, whooping cough, poliomyelitis, tetanus, measles, and such other communicable diseases as may be specified from time to time by the Department of Public Health.

The only exception to these requirements will be made on receipt of a written statement from a doctor that immunization would not be in the best interests of the child; or, the student's parent or guardian stating that vaccination or immunization is contrary to the religious beliefs of the student or parent."

Based on the state's information on immunization and exemption survey results for 2016-2017, albeit with warnings on factors that affect results, there were zero percent exemption rates in preschool and kindergarten at Carver elementary and a zero percent exemption rate for seventh-graders at the middle school.

The percentage was zero percent at CAPT PAL Preschool and Kidstop Early Childhood Center. Cranberry Crossing Early Education and Little Crusaders Early Learning Center reported fewer than 30 students, so data could not be released.

While Massachusetts has one of the highest childhood vaccination rates in the country, there are pockets in the state where increasing numbers of parents are choosing to exempt their children from required immunizations.

"The more people you have that are unimmunized, the more risk there is to them and the population as a whole," said Dr. Henry Dorkin, president of the Massachusetts Medical Society. "I have grave concerns over large numbers of people who, for non-medical reasons, are not having their children immunized."

Statewide, 1.3 percent of kindergarten students had an exemption in 2016, three-quarters of whom claimed religious exemptions, according to the state Department of Public Health.

Significantly higher concentrations of students with exemptions are clustered on the Cape and Islands and in Western Massachusetts. In Barnstable County, for example, 3.1 percent of kindergarteners had an exemption last year. On Martha's Vineyard, the rate was 9.2 percent.

Dorkin declined to speculate on reasons behind the geographic patterns, but said increasing numbers of unimmunized people can compromise herd immunity. When immunization rates are high, that prevents the spread of diseases through the community, helping protect people who are not immunized. Unimmunized people may include organ transplant recipients, people with rare medical conditions, young infants and those claiming a religious exemption.

Herd immunity also protects the small number of people who don't respond to vaccinations, Dorkin said.

"Immunizations are critically important," he said. "They are one of the best, most effective values in terms of health care imaginable."

Dr. Joely Edwards, a pediatrician from Southcoast Physicians Group Pediatrics in Dartmouth, stresses the importance of vaccinations for children. "Immunization is extremely important," Edwards said. "I'd venture to say that it is one of the most important things as a parent and a pediatrician that we offer and want our patients to do. A child by the age of 2 in this country can be fully immunized against 14 different illnesses that can cause serious health issues or even death. Back when polio was rampant and people were paralyzed or dying, no one would question the value of vaccinations. But today, we're lucky enough that we have mostly eradicated most of these diseases. As result, unfortunately, people who are not old enough to remember or experience any of these diseases firsthand don't recognize them as a threat."

The number of people claiming religious exemptions has risen in recent years. Dorkin said he attributes the trend to some parents' misguided fears and the spread of misinformation, including a 1998 study that claimed a link between the measles vaccine and autism - a study that has since been debunked by the professional medical community.

In 2000, 354 kindergarten students had religious exemptions statewide. In 2016, there were 702 religious exemptions, and that came as the total number of kindergarten students in the state dropped from 80,971 to 70,109 over the 16-year span.

Jamie Murphy, the Watertown-based author of the 1993 book "What Every Parent Should Know About Childhood Immunization," researched old medical journal articles and studies. He believes all vaccinations are dangerous and accuses the medical community and political establishment of intentionally misleading the public.

"The real problem is that we have a medical procedure written into the law," Murphy said. "There's no other law that forces a person to get a certain medical procedure. It's free choice for all."

He points to reports in the federal Vaccine Adverse Event Reporting System database as evidence of injuries and deaths linked to immunizations. The Centers for Disease Control and Prevention, however, maintains that such claims are misleading. The VAERS database tracks reports of incidents occurring around the time of vaccination, but does not prove that such incidents are actually the result of vaccination, according to the CDC. Serious injuries and death are statistically extremely rare, the CDC says, and the overwhelming majority of side effects are minor, such as a sore arm or mild fever.

The risk of a serious side effect from a vaccination is much smaller than the risk of a serious complication from contracting a preventable illness, according to the CDC. The risk of dying after contracting measles, for example, is two in 1,000. The risk of getting encephalitis or having a severe allergic reaction from the MMR vaccine is one in 1 million, according to the CDC.

"People have misconceptions about the risks of immunizations," Dorkin said. "While nothing in the world is without risk, the risk is extremely small there. The risk of side effects from immunization is exceedingly small compared to the risk of extreme complications from these diseases. No parent wants to have their child neurologically devastated or impaired for life because they didn't immunize their child."