By Lori Higgins
A new Michigan rule requiring parents to attend a class at their local health department if they want a vaccination waiver for their kids before school starts is reigniting the debate over mandatory vaccinations.
The rule applies to children entering a licensed day care, a preschool, the Head Start program, kindergarten, seventh grade or enrolling in a new school district.
The goal? Slash the number of vaccination waivers in Michigan, which has the fourth-highest rate of waivers in the nation, according to the federal Centers for Disease Control and Prevention.
Any parent who wants a waiver for philosophical or religious reasons must attend a session. Parents who have a medical waiver aren't required. "We need to have this rule to help parents get as much information as they can to make the most informed decision regarding whether or not they're going to vaccinate their child," said Dr. Eden Wells, chief medical executive at the Michigan Department of Health and Human Services.
Statewide, 5.9% (or 7,049) of Michigan children entering kindergarten in 2013 had vaccine waivers, according to the CDC. But there's considerable variation by county. Leelanau County had the highest rate at 19.5%, while Keweenaw County had the lowest, with no waivers. The rates for metro Detroit counties: Macomb, 6.9%; Oakland, 10.1%; Washtenaw, 7.2%, and Wayne, 7.1%. The rate for the city of Detroit was 2.3%.
"Infection can spread pretty rapidly among schoolchildren," Wells said. "What will happen is even if the non-vaccinated child isn't sick ... they may be asked to stay out of school until the outbreak is over. And that could mean a couple of weeks out of school."
Tina Thurston of Walled Lake was dreading her Aug. 3 session, worried that she'd be berated by the nurse conducting the session for opting against vaccinations and pressured into changing her mind. But she found the opposite to be the case.
"She didn't discredit my points," said Thurston, who received a medical waiver for one son and a philosophical waiver for her oldest son. "She counter-argued them politely."
But while she's not opposed to the information being presented to parents, "I am opposed that they're questioning my rights as a parent or my belief system."
Suzanne Waltman, president of Michigan Opposing Mandatory Vaccines, said parents opting not to vaccinate their children "are doing it because they have studied the issues, both pro and con, and are making a very educated decision."
Waltman said she doesn't believe the required sessions will change minds and isn't "an effective way to improve vaccination rates. Everyone deserves to make health care choices."
State and local officials say changing parents' minds isn't what they're after.
"We're still not taking away the option for those parents who are adamant about signing the waivers," said Dr. Kevin Lokar, medical director at the Macomb County Health Department. "We want the parents to be informed when they make the decisions."
The sessions themselves are relatively short -- from about 15 minutes to about 30 minutes. Some parents only want to keep their child from taking a particular vaccine, or have their children vaccinated on a schedule that's different than what's required.
"We really do tailor our education to their concerns," said Jane Nickert, director of nursing at Washtenaw County Public Health.
During the sessions, parents learn about the required vaccines, the diseases they're designed to prevent, the benefits of the vaccines and the implications if kids don't receive the vaccines.
"There's a lot of thoughtful dialogue going on with parents," said Kathy Forzley, health officer for the Oakland County Health Department.
Wells said the new rule in part is targeted at parents who receive waivers out of convenience -- those who run out of time to schedule a visit to get their children vaccinated, and opt to just sign a waiver instead.
Language a concern
But even with the no-pressure approach, the new rule is raising some concerns. Parents are required to sign a form in which they "acknowledge that I may be placing my child and others at risk of serious illness should he or she contract a disease that could have been prevented through proper vaccination."
Connie Rubino of St. Clair Shores, who opts not to vaccinate her children for religious and philosophical reasons, objected to that language when she went in for her session in May.
"Personally I don't believe I'm putting my child at risk," Rubino said. "I believe we've made an educated decision."
Rubino initially refused to sign the waiver, but then returned to the Macomb County Health Department several weeks ago. Her beliefs hadn't changed, but she said the alternative to not receiving a waiver --homeschooling her children -- isn't an option. So, she says, she signed with the letters V.C. next to her signature. Those letters -- an abbreviation for the Latin term "vi coactus" -- essentially indicated she was signing under duress. She says the health department subsequently told her the waiver was no longer valid.
Bob Swanson, director for the division of immunization at the MDHHS, said local health departments are free to establish their own rules for the waivers. But he said that from the state's perspective, the form provides a spot where parents can explain why they signed.
Lokar, of the Macomb health department, wasn't available Wednesday to comment on Rubino's experience.
No grace period
Rubino doesn't have much leeway. Wells said the state prefers that all kids be vaccinated -- or have waivers -- by the beginning of the school year. But she said some districts do provide parents with a grace period. Meanwhile, Waltman and Rubino point to language in a state law they believe gives parents until Feb. 1 to have their child vaccinated or get a waiver. But Swanson said that's not the case.
"It's very clear in the public health code -- a child entering a program needs to have an immunization record at the time of admittance or a waiver," Swanson said.
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