Respectful Insolence

There’s a rather interesting bit of vaccine politics going on in Prince George’s County, Maryland being reported by the AP and The Baltimore Sun:

Scores of grumbling parents facing a threat of jail lined up at a courthouse today to either prove that their school-age kids already had their required vaccinations or see that the youngsters submitted to the needle.

The get-tough policy in Prince George’s County was one of the strongest efforts made by any U.S. school system to ensure its youngsters receive their required immunizations.

Two months into the school year, school officials realized that more than 2,000 students in the county still didn’t have the vaccinations they were supposed to have before attending class.

So Circuit Court Judge C. Philip Nichols ordered parents in a letter to appear at the courthouse today and either get their children vaccinated on the spot or risk up to 10 days in jail. They could also provide proof of vaccination or an explanation why their kids didn’t have them.

I’m of two minds of this. While I definitely support requiring vaccination against common childhood diseases before children are allowed into public school, I have to wonder if this strategy is a bit heavy-handed. Wouldn’t threats of barring unvaccinated children from public schools, coupled with threat of potentially large fines, be an adequate penalty for failure to vaccinate? Worse, this approach plays into the hands of the antivaccinationists in a big way. Indeed, over the weekend, the antivaccination blogosphere has erupted into a frenzy of stoked outrage over this case. Here are some examples:

  1. From The Age of Autism: Forcing parents to have their children vaccinated seems more like the tactic of a totalitarian state and not a representative democracy. Dr. Sherri Tenpenny put out an announcement about this with a frightening quote from presidential candidate Ron Paul, “When we give government the power to make medical decisions for us, we, in essence, accept that the state owns our bodies.” I wondered where the ACLU was in all this. Wasn’t this an issue dealing with individual rights?
  2. From antivaccinationist Barbara Loe Fisher: Whatever the reasons for parents not vaccinating their children with all state mandated vaccines, it is inappropriate for state officials to threaten parents with jail time. Reportedly, there are about 6,000 truant students in the state of Maryland. Are the parents of the other 4,000 students who are missing from school also being given deadlines and facing jail time their truant children? Or could this military action by what some parents are referring to as “The Vaccine Police” be simply a case of an eager State’s Attorney looking for a political platform teaming up with over-zealous health and education officials to achieve a 100 percent vaccination rate with all state-mandated vaccines in Maryland?
  3. From antivaccinationist Barbara Loe Fisher again: The big difference between being dragged into a Courthouse to get vaccinated and being dragged to church is that an hour of prayer rarely results in catastrophic brain injury or death. I still wonder how many of those children, who were injected with multiple vaccines in the Courthouse, are having vaccine reactions today. Their parents, many of whom are uninformed about how to recognize vaccine reactions, will never know what happened to their children if they regress into chronic poor health after the shots they were forced to get on Saturday.
  4. From antivaccinationist Dr. Sherri Tenpenny: At the beginnings of ‘Public Health’ policy, efforts were made to convince persons to participate through cooperation. Since that late 1960s, the pendulum has swung from education and collaboration to heavy handed coercion through advertisement campaigns designed to shame and terrorize parents into believing the are neglecting their children by questioning, and at times refusing, vaccines. The current example of heavy handedly slapping of parents into “compliance” is a further example of how far our freedoms have eroded. While we drop bombs and fire bullets around the world to ensure the freedom of others, we are incarcerating parents for doing what they believe is in the best interest of their children. Wake up, Americans. What will they be incarcerating us for next in the name of compliance?
  5. Über-crank Mike Adams at NewsTarget, who can’t resist going straight for the Nazi analogy (where’s the Hitler Zombie when you need him?): The State of Maryland has now turned to Gestapo tactics to force its medical will upon the People, stripping parents of any right to decide how they wish to protect their own children from infectious disease. Health authorities there have already announced their intent to essentially kidnap parents and throw them in jail, removing them from their children for up to thirty days if they continue to refuse to have their children vaccinated. This will all be conducted at gunpoint, with armed personnel and attack dogs at the ready, making sure nobody steps out of line, and suppressing any attempt at public dissent against the Orwellian vaccination policies.

And, of course, our old friends at the American Association of Physicians and Surgeons (AAPS), publishers of that über-crank journal, the Journal of American Physicians and Surgeons (JPANDS) can’t resist the opportunity to show their true antivaccination stripes in a statement released hot on the heals of the action in Prince George’s County:

Our fight now turns to Maryland, specifically, Prince George’s County (PG County) which is within spitting distance of Washington DC. And since this has developed quickly WE NEED YOUR HELP TODAY!!

In a scene reminiscent of cattle round-ups, the state’s attorney has issued summons to more than 1600 parents of children who have not provided certificates of immunization for their children. These parents have been told to appear in Court on Saturday, and either subject their children to on-the-spot state-mandated vaccines of up 17 vaccine doses, or face imprisonment.

Parents who ignore the court’s demands could face a $50 fine for every day their child is out of compliance or up to 10 days in jail.

“We can do this the easy way or the hard way, but it’s got to get done,” threatened Maryland State’s Attorney, Glenn F. Ivey. But Mr. Ivey apparently has no problem invoking his own right to informed consent and parental control. In a radio interview on Thursday, he admitted that he chose to refuse the hepatitis B vaccines for his own children.

Of particular note is that this mandate applies across the board to all schools, public and PRIVATE, and even daycare facilities – whether they receive government funding or not…

ALSO, WE WANT TO SPEAK WITH SOME MARYLAND PARENTS WHO WILL REFUSE THE VACCINES. We may be able to provide them with some legal assistance, and want to help them tell their story through the media. We have a number of reporters who are willing to report on the parents’ side of the story if parents are willing to go public. Otherwise, you know the story will be that of the state and school district “that a bunch of crazy anti-vax parents insist on endangering the lives of all of the children in PG schools.”

Of course, AAPS is not antivaccination. It’s just offering legal assistance and its publicity machinery to parents opposed to vaccination and complaining that they will be represented as “crazy anti-vax parents.” (Ironically, AAPS is unintentionally correct about such parents insisting on endangering the lives of all of the children in their children’s public schools, though. They do.) Still don’t believe the AAPS isn’t antivaccination? Just listen to it:

NOTE: As we have stated repeatedly, the Association of American Physicians and Surgeons and other members of the “Hands Off Our Kids” Coalition are not anti-vaccines. But we recognize that vaccines are a personal medical decision – a decision that should be made by parents with the consultation of their physician. A state- or school-mandated vaccine amounts to coerced medical treatment without consent. See the AAPS resolution against mandatory vaccines: http://www.aapsonline.org/testimony/vacresol.htm.

Here’s a bit of the rhetoric from this AAPS resolution:

WHEREAS: Safety testing of many vaccines is limited and the data are unavailable for independent scrutiny, so that mass vaccination is equivalent to human experimentation and subject to the Nuremberg Code, which requires voluntary informed consent; and

WHEREAS: The process of approving and “recommending” vaccines is tainted with conflicts of interest;

BE IT THEREFORE RESOLVED: That AAPS calls for a moratorium on vaccine mandates and for physicians to insist upon truly informed consent for the use of vaccines.

When a group like the AAPS compares mass vaccination to being human experimentation, particularly when coupled with a claim for “informed consent” (never mind that “informed consent” is indeed required for vaccinations), and even mentions the Nuremberg code, in my book it’s clearly a bunch of antivaccination nuts. All claims to the contrary are clearly just the standard smokescreen that all antivaccinationists with a modicum of intelligence hide behind.

So, right from the beginning, it’s clear that the antivaccination forces were intentionally trying to make hay of the judge’s order and to whip up a bunch of hysteria. In fact, so good a job did the antivaccination activists do that they managed to slip in a ringer, so to speak. As was reported at Autism News Beat, AP reporter Matthew Barakat appears to have fallen for it, too, as he reports:

Several organizations opposed to mass vaccinations demonstrated outside the courthouse. While the medical consensus is that vaccines are safe and effective, some people blame immunizations for a rise in autism and other medical problems.

“People should have a choice” in getting their children immunized, said Charles Frohman, representing a physicians’ group opposed to vaccines.

This is sort of true, but what was left unsaid is far more revealing. You see, Charles Frohman is a paid lobbyist who lists as one of his clients a group known as Health Freedom USA. As you may recall, we’ve recently encountered Health Freedom USA. It appears to be somehow affiliated with the Natural Solutions Foundation, which is the group that first sent out the e-mail spreading what is almost certainly an urban legend, a story of a youth with melanoma who is supposedly being forced by the court in Orange County, California to undergo therapy, a story whose many inconsistencies and dubious claims I have been deconstructing. Clearly, Mr. Barakat was snookered, as simply Googling Mr. Frohman’s pulls up his website on the first page of results. Also painful is the way that Mr. Barakat fell for the false “balance” issue. While he correctly cites that the medical consensus is that vaccines are safe and effective, he can’t resist citing “some people” blaming immunizations for a rise in autism. This is not that much different from citing advocates of “intelligent design” creationism as “balance” in discussions of the theory of evolution. At least the New York Times managed to be less easily taken in when interviewing Mr. Frohman:

Among them was Charles Frohman, who represented the Association of American Physicians and Surgeons, a group opposing mandated vaccinations. Mr. Frohman said the county should have done more to make parents aware of their options. “Reports are that very few folks are really hearing about exemptions,” he said.

Interesting. It does make sense that Mr. Frohman, in addition to representing the Natural Solutions Foundation/Health Freedom USA, would also represent that über-crank physician group, AAPS, though. Its house organ, JPANDS, routinely publishes the most amazing cornucopia of medical crankery, ranging from the mercury militia antivaccination stylings of père et fils Geier, to the even more vile antivaccination claims that the shaken baby syndrome is in reality due to “vaccine injuryrather than physical trauma, to rants about how “vaccine dissent” is dangerous. And these are just examples of how nutty the AAPS is when it comes to vaccines. When it comes to other medical issues, the AAPS is just as nutty, if not more so. For example, it opposes any form of government regulation of physicians, is utterly opposed to Medicare and Medicaid, publishes racist anti-immigration screeds in its pages, and publicizes truly awfully done epidemiological studies purporting to show a link between abortion and breast cancer.

So what do we conclude? To me, it’s very clear from the rhetoric about this court action in Prince George’s County emanating from so many antivaccination websites that there was a concerted effort to bring organized antivaccination forces in to protest. Very likely, the AAPS and Health Freedom USA are at the forefront of this, based on the presence of Mr. Frohman, a paid lobbyist for Health Freedom USA (and now apparently the AAPS, if the NYT account is correct), as the spokesperson of the protesters. No doubt these antivaccination nutjobs saw Judge Nichols’ order as a golden opportunity that they just couldn’t pass up.

In the end, I’m skeptical about just how effective the court’s tactics will be. Personally, if I had been in charge, I probably would have simply instructed the school to send home any children whose vaccination records were not up to date with a letter instructing the parents that their children would not be permitted back until they provided proof that their children had received the required vaccinations. As it is now, although there’s no doubt that remaining unvaccinated children are receiving the recommended vaccinations as a result of this campaign. The problem is that most of these children were probably not unvaccinated as a result of their parents’ being opposed to vaccination, but rather due to sheer laziness or forgetfulness of the parents, and bringing down the heavy hand of the state in such a manner on them concerns. me. It’s why I have to wonder if this success in Prince George’s County doesn’t come at too high a price, namely a major propaganda victory for antivaccination groups like AAPS and its antivaccination allies.

Coming soon: How antivaccinationists have been misrepresenting a recent study.

Comments

  1. #1 Nan
    November 19, 2007

    One thing that intrigues me is what’s missing from the news accounts: why are the kids not vaccinated? The reaction by the school and the county is to suggest the parents are deliberate scofflaws, but is that true? Does Prince George’s County hold free vaccination clinics open to any child or does the local public health dept means test families? Is cost a factor?

  2. #2 Laser Potato
    November 19, 2007

    Anti-vaxxers, robots in disguise.
    In between this and the rape laws, this makes me truly ashamed to be a Marylander.

  3. #3 DLC
    November 19, 2007

    AAPS . .. knock out the P and you’d get a better acronym for them. But, I agree with you on this one, Orac.
    Better to send the kids home until they can bring in a vaccination record. I have no children myself, but I would not want any child of mine going to a school where a significant percentage of the other students had not been vaccinated.
    Is irrationality really this ingrained that people will follow any pied piper of pseudoscience or crankery ? If so, then this level of credulity is another reason to worry about the state of the nation.

  4. #4 Bob O'H
    November 19, 2007

    Coming soon: How antivaccinationists have been misrepresenting a recent study.

    Does this mean you have a post almost ready, or is it just a prediction, like predicting the sun will rise tomorrow?

  5. #5 Orac
    November 19, 2007

    It means that I have the article and antivax blog posts in hand and just need to write it up…

  6. #6 BronzeAger
    November 19, 2007

    The NYT Sunday had a slightly different, and more expansive, version of this article. It said students who were not vaccinated would be withdrawn from school, and implied that this was the reason parents might be fined or jailed (presumably under local truancy laws, since it notes that the fine accrues per day of absence). So they are not technically being jailed for not vaccinating, or at least it is only indirectly, as you noted above. It also says that the letter “strongly encouraging” appearance at the courthouse for vaccinations or documentation is a followup to an earlier letter informing parents of requirements per the judge’s Nov. 1 verdict. Link to article below under “BronzeAger”.

  7. #7 AnnR
    November 19, 2007

    State law requires that children be vaccinated and these children have not been — does any more need to be said?

    Most of these families have known this for some time.

    I think it is safe to assume that families where the vaccinations have not occurred need a bigger stick to get things moving. That’s just the way things are in PG County.

  8. #8 bcpmoon
    November 19, 2007

    Two months into the school year, school officials realized that more than 2,000 students in the county still didn’t have the vaccinations they were supposed to have before attending class.

    When I read that, I immediately thought that the story stinks. I bet, the chain of events was: a) Whenever a child gets registered at a school, the parents get a to-do-list, stating the need for vaccination, b) the new school year starts, parents with un-vaccinated children get a warning letter with a deadline (4 w I guess), c) deadline missed – another letter, another 4 w time, d) Judge comes into play.

    I´d love to argue about the need for vaccinations, but arguing with liars? Waste of time.

  9. #9 agnostic
    November 19, 2007

    For those not from the DC metro area, you can still tell what the demographics are of the people written about in the article, just by looking at names: Territa Wooden, Veinell Dickens, and Aloma Martin & her sons Delontay and Taron. Stanley Lieberson’s book *A Matter of Taste* shows what naming trends have been, and within the past 40 or 50 years, Black and White American first names have diverged considerably, so that you can accurately predict the person’s ethnic background based on names — as in this case.

    Given that person X’s name is Delontay, what’s the probability that they’re from any other background than Black? Zero. Moreover, what’s the probability that he’s lower-class Black vs. upper-class Black? Pretty clear.

    I’m going through this song and dance because it requires deliberate effort not to notice key details like this. If a district is mostly made up of poor Blacks, do you think that a stern warning that their kids can’t come to school will work? That namby-pamby approach may work with upper-middle class White kids from Bethesda, but not in PG County. I dare someone to teach in PG County or its equivalent if you disagree.

    The same would be true if the story took place in Poolesville, MD, where there are a lot of poor, lower-IQ Whites, btw. IQ predicts all sorts of real-life outcomes, including ability to follow prescription label instructions — this isn’t exactly that, but is pretty similar. The less-than-bright do need more supervision, again regardless of whether they’re Black or White.

    That’s another powerful predictor of IQ — how much supervision a person requires on the job: lots of supervision and rote tasks for lowers, self-management for uppers. All of this is on Linda Gottfredson’s website, where she has PDFs of her review papers.

  10. #10 The Crack Emcee
    November 19, 2007

    “State law requires that children be vaccinated and these children have not been — does any more need to be said?”

    Nope. Get some backbone, people.

  11. #11 Clare
    November 19, 2007

    Excuse me, but what does IQ have to do with this?

  12. #12 jre
    November 19, 2007

    Excuse me, but what does IQ have to do with this?

    Not much, actually. The best reporting I’ve found on this subject is Arthur Allen’s Vaccine. Allen spends a good portion of the book interviewing vaccine opponents, exploring their backgrounds and discussing their motivations. Most are upper-middle-class, well educated folks who happen to share an idee fixe about the evils of vaccination.


    It seems to me that agnostic is trying to reframe this issue within a particular ideology — and not a very sweet-smelling ideology, at that.

  13. #13 flynn
    November 19, 2007

    It seems to me that agnostic is trying to reframe this issue within a particular ideology — and not a very sweet-smelling ideology, at that.

    We all know where this one is going, don’t we? –>

    I dare someone to teach in PG County or its equivalent if you disagree.

    “My ideology cannot be unsweet-smelling! I have met actual people with names like Delontay, (nudge nudge knowhatimean)!”

  14. #14 usagi
    November 19, 2007

    Orac, you ask, “I have to wonder if this strategy is a bit heavy-handed.” Wrong question. Is it necessary? Sadly, the answer is quite probably yes.

    Inertia in educational settings is a powerful force. Sometimes to overcome it, extreme measures are needed. Discussions about this sort of action always come down to the question, when do you stop the student from attending (ultimately, the only power the school really has). It’s never pretty, but periodically it becomes necessary to play this kind of hardball. Look at the district’s side if there were a sudden outbreak of measles or (FSM forbid) polio in the district. Any bad publicity over this would be trivial compared to the consequences of a worst case scenario.

    That the antivax crowd gets a propaganda “victory” is incidental. People concerned with public health need to seize the initiative to push the overriding common good need for universal vaccination. Yeah, it sucks to have to keep refighting that battle, but you have to regardless. As you’re well aware, if there weren’t a real case like this happening, one would just be made up.

  15. #15 marcia
    November 19, 2007

    I live in PG County.
    I’m not always happy with the administration here, but this is the right thing to do.

    Before the court notices went out, 2,300 students were lacking immunizations and barred from attending classes. That number dropped to 1,100 afterward.

    ’nuff said.

  16. #16 khefera
    November 19, 2007

    sorry agnostic, but i actually live in p.g. and if you’ll hit up the census bureau you’ll see it’s actually, per-capita, one of the richest predominantly-minority regions in the nation.
    but don’t let facts stand in the way of your unsupported ignorance.

  17. #17 Cain
    November 19, 2007

    I was going to reply to agnostic, but khefera beat me to it. I live in DC. PG is not the ghetto, it’s one of the richest black counties in the nation. It’s where most of the black middle class that fled DC has gone. Additionally, white people also live in PG. This must blow agnostic’s racist mind.

  18. #18 PalMD
    November 19, 2007

    Ignoring the bizarre racial aspect that snuck in here, in general direct coercion doesn’t play well. It tends to make people feel rebellious, and people who feel that way often stop thinking straight.

    Community outreach and education, yes.
    Requiring vaccines for enrollment, yes.

    Rounding up those who disobey, not so much.

  19. #19 TheProbe
    November 19, 2007

    C’mon you wimps, let’s call it the way it is written…agnostic is a bigot.

  20. #20 Rjaye
    November 19, 2007

    Count me as another person with mixed feelings about this situation…

    Unfortunately, I don’t think this county is an isolated example of unvaccinated kids. It’s happening here in Washington State, and know what my nieces have done in rationalizing why they haven’t gotten certain things done for their kids, I’m afraid the radical approach may be the only way to get them to get stuff done, like vaccines, teacher meetings, filling out forms, etc.

    It’s something that gets put off, and I don’t get it. Aren’t these kids seeing doctors for wellness checks? I can nag about why aren’t the kids getting their vaccines or getting dental care, but that works as well as a buzzing mosquito in my nieces’ ears…

    We may see more of this radical tough love…

  21. #21 James
    November 19, 2007

    Threatening to imprison parents seems like a bad idea – heavy-handed and potentially counter-productive. I don’t have a problem with them excluding the little germ magnets until they get a vaccination though.

  22. #22 isles
    November 19, 2007

    I think it was justified and necessary to make the penalty come down on the parents here because they were all notified, many times, of this requirement and how they could fulfill it at no cost to themselves. The fact that they weren’t diligent enough parents to do so is a clue that they’re not the kind of parents who are going to care very much about their kids getting barred from school. It was only a threat to their *own* liberty that was going to motivate them. With parents like these, the students are better off in school than at home.

    I am all for the Maryland action. We don’t convey the message that vaccines are vital by ignoring the laws that require them.

  23. #23 Prometheus
    November 20, 2007

    As is their habit, the “health-care freedom fighters” are reducing a complex issue to one or two television-friendly sound bites.

    The public health people in Prince George’s County have an ethical and legal obligation to ensure that children in the public schools are either vaccinated or have a signed statement from their parents that they have a medical reason to not be vaccinated or have religious, moral or philosophical objections to vaccination.

    As pointed out above, the place to note your religious, moral or philosophical objections to vaccination is right on the form the schools send home.

    Once all of the forms are filled out showing that the children are either vaccinated or have a reason (however questionable it might be) to not be vaccinated, then the school district and public health folks are off the hook. Any outbreak of vaccine-preventable disease can’t be blamed on their failure to act, since they have done all that they are required (and allowed) by law to do.

    Are the Prince George’s County officials being heavy-handed? I would say “yes”, but I don’t know what they’ve tried in the past. Perhaps this was what it took to get a response.

    Is this an issue of people being vaccinated “forcibly” or “against their will”? Not really – except to the extent that the people actually being vaccinated (the children) would probably say so. In fact, all that the county officials are trying to do is get people to either get their kids vaccinated or state a reason (medical, religious, etc.) why they aren’t.

    If the parents don’t want their kids vaccinated, all they have to do is fill out the form (the one their kids brought home) and sign it.

    It’s really as simple (and as complex) as that.

    So, the reason why 2000 or so children out of the 174,000 children ages 6 – 18 years in Prince George’s County (US Census Oct 2007 estimate) didn’t have documentation of either vaccination or a medical, religious, philosophical exemption is the real question.

    And why is it that so many disparate anti-vaccination groups broke cover to be heard on this issue, when the real issue is about complying with documentation and not about “forced vaccination”?

    I suspect it was because they saw an opportunity in the poorly-thought-out (probably due to exasperation) response of the Prince George’s County government.

    Not a “cause”; an “opportunity”.

    Prometheus

  24. #24 Harriet Hall
    November 20, 2007

    Instead of trying to coerce people to get vaccinated, how about giving them a choice between vaccination and living in a quarantined location where their non-immune status would not threaten the public health of the rest of us?

  25. #25 Jud
    November 21, 2007

    Orac wrote: “Personally, if I had been in charge, I probably would have simply instructed the school to send home any children whose vaccination records were not up to date with a letter instructing the parents that their children would not be permitted back until they provided proof that their children had received the required vaccinations.”

    As already pointed out above, this would lead to truancy on the part of the children, which would then subject the parents to the threat of jail.

    Regarding general principles rather than the facts of the specific case, vaccination requirements are not blog discussions that school districts and judges are trying to “win” – they’re not exercises in (if I may use the dreaded f-word) framing. Such requirements are matters of urgent concern regarding public health. To that end, I am sure the threat of imminent imprisonment, as someone once said of a more severe penalty, “concentrates the mind wonderfully.”

    P.S. Kudos to khefera. agnostic, to use technical language, makes me wanna puke. Re perceived importance of education, I remember an African-American female law school classmate taking a final exam late one week, giving birth over the weekend, and back in school to take the next final the following week. That anecdote isn’t statistically significant proof, but it does serve to quite simply show the absurdity of any attempt to identify an individual’s attitude toward education using the single data point of ethnicity.

  26. #26 brook
    November 21, 2007

    Having played the bureaucracy game for a number of years (I homeschool my kids), my instant reaction was that this was a case of the newspaper only taking notice when events got “dramatic”. I’m not surprised to find that letters had been sent out but letters from the superintendent of schools don’t make good newspaper reading.

    I hope the school/public health department try to find out why the kids weren’t vaccinated and make it easier for them to be vaccinated. Poor record keeping by parent or doc – I’m certainly guilty of the first and I’ve had to deal with the second, confusion over when vaccinations are due – easily possible particularly if the pediatric practice you go to doesn’t recommend annual physicals for kids over 6 or 7, or financial barriers, I can think of lots of reasons why a kid might end up not vaccinated.

    One possibility: sending out a “no-blame” letter to the parents and offering them the opportunity to have their kids vaccinated at the school nurse’s office. Make it easy to get your kid vaccinated.

    I’m glad the county is trying to be pro-active about this even if it’s in a rather ham handed way.

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