S.199 & HB.

527 Information Briefing

How Healthy is Vermont? Are Vaccination Rates Dropping? How do Philosophical Exemptions Work? Is Vermont at Risk? Are Philosophical Exemptions A Risk? Is There an Non-Vermont Agenda Driving this Legislation?

2010-11 Vermont Public School Vaccinations

100% 90% 80% 70% 60%

Does this really look like a problem?

Kindergarten
50% 40% 30% 20% 10% 0% Dtap Polio MMR Hep-B Varicella Exempt Exempt Exempt Medical Rel. Phil. Prov Admit Prov Admit No Rec

7th Grade

Are Vaccination Rates dropping?

There is some confusion over the vaccination status of Vermont children. This uncertainty is caused because there are

2 different vaccination schedules

being measured and referenced. There is the Vermont School Attendance Required Vaccine Schedule, the actual vaccines that will be affected by the proposed legislation. The vaccination rates for this schedule are higher than ever, well above 90% coverage for Kindergartners and over 98% for 7th Graders. The other schedule is the Advisory Committee on Immunization Practices, ACIPs, Recommended Schedule. This schedule, and the way it is measured, is the statistic that is lagging, not the compliance of Vermont children with the Vermont requirements. This rate is dropping not because fewer children are being vaccinated but because more vaccines are being added to the schedule.

The current ACIP schedule requires 39 injections and two oral doses. This is not the VT School Sched.

These are the Vermont K-12 Reqd Shots. 98%+ of Vermont 7th Graders Comply. Kindergartners are given 12 months after first enrollment to comply, called Provisional Admittance, but even so over 91% start school with these shots.
Pre-K have no requirements unless they are in a state licensed day-care or pre-school.

HepB and Chicken Pox (Varicella), were made requirements in 2008.

When Dr. Chen says only 65% of Vermont children are Fully Immunized for 14 vaccine preventable infections, he means they have every indicated vaccine on this list, by a milestone age. For example the first dose of HepB within 24 hours of birthon some surveys that child is not fully immunized even if he catches up later. Any infant 6 months or older who does not get an annual flu shot every year is not fully immunized, and is part of falling vaccination rates.

There is no wholesale abandonment of the traditional vaccines. Parents are considering if their personal situation warrants a vaccine for Diarrhea. Rotavirus is dangerous in third world countries but very treatable in the USA. HepA is not casually contagious but transmitted by fecal oral transmission, and prevented by proper hygiene. Chicken Pox was considered a routine childhood illness, and was not even a state reportable infection until after the vaccine was created.

When the VT DOH is talking about Low Rates, they mean under 35 month old toddlers getting all, or some combination of the shots on the list by certain age milestones. They are not talking about the VT school Vaccine schedule.

What is the source of the low rates claims?

VT DOH is citing all-inclusive CDC National Immunization Surveys (NIS) for the ACIP Recommended Schedule, (Not the VT School Vaccines). NIS can be so restrictive that a child fully compliant with VT regulations can be considered,unvaccinated.

VT K-12 Required & 2010/11 Rates

VT Kinder 95.49% 91.55% 91.89% 91.28% 88.38%

VT 7th 98.27% 98.00%* 98.55% 98.72% 88.62%

Vermont law does not dictate a dosing schedule. Vermont law only requires that vaccines be received prior to enrollment in Kindergarten,
(or licensed daycare or pre-school)

and grants a 1 year grace period to come into full compliance

Not required for VT K-12

Health Vermont Immunization Summary Sheet 2010/2011

Grade Kinder 7th Prov Ex 10.44%** 12.96%** Phil Ex 5.08% 2.43% Polio 91.89% 98.55% MMR Hep B 91.28% 95.49% 98.72% 98.27% DTaP 91.55% 98.25%* Varicella 88.38%^ 88.62%^

^ Chicken Pox is still circulating, children who have had the infection do not require the vaccination. Chicken Pox is a recent addition to the schedule and it is also the most commonly exempted. * A 5th dose of tdap is a 7th grade requirement, the Provisional {Prov} Ex rate is students without documentation or late for their last of 5 doses. Percentage calculated using the FY08 chart listing all grades showing DtaP & tdap to be consistently within .5% of the other core vaccines, so the real rate is 98.25% +or.5. Parents who do Polio, MMR, & Hep B dont skip tdap. ** Students who are missing as little as one dose of a vaccine on the schedule require a "Provisional Admittance" to be enrolled in school. This report closes December 31 of each year, 9 months before the Provisional Admittance time period expires. V. Provisional Admittance- These kids will have missing vaccines within 12 months (2) A student may be admitted to school provisionally if a health care provider indicates a student is in the process of complying with all immunization requirements. Such provisional admission shall be for a reasonable length of time but shall not exceed one year.
http://healthvermont.gov/regs/documents/imm_regulations.pdf

2010-11 Vermont Public School Vaccinations

100% 90% 80% 70% 60%

Kindergarten
50% 40% 30% 20% 10% 0% Dtap Polio MMR Hep-B Varicella Exempt Exempt Exempt Medical Rel. Phil. Prov Admit Prov Admit No Rec

7th Grade

Does this really look like a problem?

How do exemptions work?

To enroll in school a child must file either a vaccination record or an exemption form for the required vaccines. A Exemption Form is needed for a student to opt out of even one dose of a School Attendance Required Vaccine.
Exemptors are excluded from school during an outbreak

Less than 1% of children avoid all vaccines. Most exemptions are for Chicken PoxAlmost NO exemptions are for all shots The double paperwork requirement of both vaccination records and exemption forms for children that are opting out of a shot make for confusing statistics. The exemption rate only measures the number of children with a form on file, it does not mean they are unvaccinated. A child with all of the core, traditional vaccines- DTaP, MMR, Polio, will show up as both vaccinated, yet also as exempt for the Varicella or Hep B. Vermont children have no vaccine requirements prior to Kindergarten, (unless enrolled in a daycare or pre-school). In recognition of this fact they are allowed to start school with a temporary Provisional exemption lasting up to one year to come into compliance.

Exemptions are granted by individual vaccine

Is the Philosophical Exemption Rate Climbing?

Vermonts Kinder PE rate jumped, from about 2.5% to 5% when Chicken Pox and Hep B were added as School Attendance Requirement, then dropped back and is stabilizing. These statistics are deceptive due to Vermonts small population. Parents are not abandoning the traditional schedule but are being thoughtful of new additions.
Ve rmo n t K in d er ga rt en Immu n iza tio n Exe mp tio n s a n d Pro v isio n a l Sta tu s
p hilosophic e xem pti ons (% ) p rovi si onal status (% )
V aric ella (2 dos es ) and hepat itis B requirem ent added to s c hool rules in 2008.

14% 10% 8% 6%
VT 7th Grade 2.43% PE
Percent of Students

12%

4% 2% 0%
'10-11

'00-01

'01-0 2

'0 2-03

'03-04

'04-05

'05-06

'06-07

'07-08

'08-09

'0 9-10

Yea r of Enrollm ent

Surveyed

Is Vermont at Risk?
This map full of red dots is misleading. The small enrollment size of many schools in Vermont leads to deceptive percentages. The state average of philosophical exemptions is only 5.08%.

The red dots on this map represent 71 individual schools with Kindergarten classes that have a greater than 6% Philosophical Exemption Rate. A single child with a Chicken Pox Philosophical Exemption in a school with 16 Kindergartners results in a 6% plus exemption rate. Two children with a Chicken Pox Philosophical Exemption in a school with 32 Kindergartners results in a 6% plus exemption rate

360 Children out of 6,695 Kindergartners have a Philosophical Exemption on file. There are 273 schools offering Kindergarten with enrollments from 1 to 130.

253 schools have 4 or fewer children with exemptions.

134 schools have ZERO children with exemptions. Vermonts small population distorts statistics.

One of these red dots is Brookfield Elementary, which in 2010/11 had a single 13 student Kindergarten class. All of the 13 children are fully vaccinated for DTaP, Polio, MMR, and Hep B. 12 of the 13 are vaccinated for Chicken Pox, with 1 student requiring a Philosophical Exemption to opt out. Because of the way VT DOH measures exemptions, this school has a 7.7% Philosophical Exemption Rate. In 2007 this school would have had a 0% exemption rate, because Chicken Pox was not a requirement until 2008. Is one child not receiving a Chicken Pox shot, which was not a requirement prior 2008, a threat to Public Health?

Another red dot is Sudbury Country, a school with a 33.33% Philosophical Exemption Rate! Sudbury has 3 Kindergarten students. All 3 are fully vaccinated for DTaP, Polio, MMR and Hep B. Only 2 of the 3 are vaccinated for Chicken Pox, with 1 student using a Philosophical Exemption, resulting in the schools 33.33% Philosophical Exemption rate. In 2007 this school would have had a 0% exemption rate, because Chicken Pox was not a requirement until 2008.

Is this really an honest representation of this issue by VT DOH? Does using percentages in populations this low properly communicate the impact of Philosophical exemptions on the vaccination rates? This is the second misleading map recently produced. VT DOH submitted a map to the Senate committee that used the temporary, Provisional Exemption rate, which is double the Philosophical Exemption rate, and implied without clarification that it was the Philosophical Exemption Rate.

Very few Philosophical Exemptions are for all shots.

No school in Vermont has more than 13 Kindergarten students with Philosophical Exemptions. Vermonts population distorts statistical measurements.

Examine these schools to see why percentages are misleading.

Total DTap School Name Enrollment Met Thatcher Brook Primary US #45 73 71 Champlain 43 42 Hinesburg Community 67 65 Highgate Elem. 46 46 Sudbury Country 3 3 North Bennington Graded School 14 13 Dover Elem. 15 15 Leicester Central 10 10 Brookfield Elem. 13 13 Polio Met 72 41 64 46 3 13 15 9 13 MMR Met 72 41 64 45 3 13 14 9 13 Hep-B Varicella Exempt Exempt Exempt Met Met Medical Religious Philosophical 68 68 1 0 6 8.2% 41 40 0 0 6 14.0% 66 62 1 0 6 9.0% 46 40 0 0 4 8.7% 3 2 0 0 1 33.3% 13 11 0 0 7 50.0% 14 13 0 0 3 20.0% 9 8 0 0 2 20.0% 13 12 0 0 1 7.7% Prov Admit 3 4 3 2 0 0 1 0 0

This subject is much more nuanced than Exemptions equal unvaccinated children. Consider North Bennington Grade School: 13 of 14 have DTaP, Polio, MMR, and HepB; 11 of 14 have Chicken Pox, and 7 have Philosophical exemptions. That means 3 Chicken Pox exemptions, and one exemption each for the DTaP, Polio, MMR, & HepB vaccines.

Not 7 completely unvaccinated children

Vermont Kindergarten Averages

Vermont Public Schools Kindergarten Enrollment Immunization Data Rounded to Whole Numbers
Average 2010-11 223 Schools Percentage 91.6% 91.9% 91.3% 95.5% 88.4% 0.5% 0.1% 5.1% 10.4% 0.8% 28 Prov Admit NO IZ Rec

DTap Met

Polio Met

MMR Met

Hep-B Met

Varicella Met

Exempt Medical

Exempt Exempt Religious Philosophical

Prov Admit

26

26

26

27

25

0.1

0.0

0.2

2010-11 Above 6% 71 Schools

Average Percentage

27

24 88.7%

24 87.8%

24 87.6%

25 91.3%

23 83.7%

0.3 0.9%

0.0 0.1%

3 12.6%

3 10.3%

0.4 0.0%

Average 2007-08 226 Schools Percentage

27

26 97.4%

26 96.0%

25 92.2%

0.1 0.2%

0.0 0.1%

0.5 2.0%

2 6.1%

2007-08 Above 6% 32 Schools

Average Percentage

22

21 93.5%

20 90.7%

20 88.9%

0.1 0.3%

0.0 0.0%

2 9.3%

0.8 3.8%

Adding Chicken Pox in 2008/2009 more than doubled the number of schools with 6% exemptions

VT 7th Grade Averages

Vermont Public Schools 2010-11 7th Grade Immunization Data Rounded
Average All 126 Schools Percentage 89.9% 98.6% 98.7% 98.3% 88.6% 0.3% 0.2% 2.4% 13.0% 0.1% Enrollment DTap Met Polio Met MMR Met Hep-B Met Varicella Met Exempt Medical Exempt Exempt Religious Philosophical Prov Admit Prov Admit NO IZ Rec 0.1

50

45

50

50

50

45

0.1

0.1

Average Above 6% PE 21 Schools Percentage

40

36 89.2%

39 96.8%

39 96.8%

38 95.4%

36 89.8%

0.0 0.1%

0.0 0.0%

4 9.0%

3.0 7.5%

0.0 0.1%

Average Above 0% PE 56 Schools Percentage

72

66 91.3%

71 98.3%

71 98.4%

70 97.7%

65 89.4%

0.2 0.3%

0.1 0.1%

3 3.8%

8 10.5%

0 0.1%

Average 0% PE 70 Schools Percentage

33

29 87.5%

33 98.9%

33 99.4%

33 99.2%

29 87.3%

0.1 0.3%

0.1 0.3%

0.0 0.0%

6 17.2%

0 0.2%

Over 98% of 7th graders have 4 of 4 DTaP. There is a TDaP booster scheduled in 7th grade, and the report closes on December 31, before all students get the booster. Notice the schools with 0% Philosophical Exemptions share the gap, and have 17.2% Provisional Admittance while the kids catch up.

Is a Parent Unscientific or Irrational for Using a Philosophical Exemption to Modify the Schedule?
The following slides detail the increase in Febrile seizure risk, and Febrile emergency room visits associated with various combinations of the MMR and Chicken Pox Vaccine, and the Flu and PCV13 Vaccines. A Febrile seizure is a fever so high that it interrupts neurological function. According to the AAP Practice Parameter: The neurodiagnostic evaluation of the child with a first simple febrile seizure Pediatrics Vol. 97 No. 5 May 1, 1996 pp. 769 -772

A lumbar puncture should be strongly considered in a child younger than 12 months and should be considered in children between 12 and 18 months of age.
This spinal tap is to rule out bacterial meningitis.

Beyond the general unpleasantness of an infant requiring a spinal tap is that every interface with an emergency room is the risk of contracting a difficult to treat hospital acquired infection, or the adverse reaction to a therapeutic treatment. For example an unknown sensitivity or allergy to an anaesthetic, antibiotic, or other drug prescribed to treat the condition.

The United Kingdom does not recommend universal Chicken Pox vaccination.
Studies showed that the incidence of severe complications in children following chickenpox was less than 1 per 100,000 children and ataxia was the complication in less than a quarter of these cases.. In summary, the available research says that in children acute cerebellar ataxia may follow chicken pox and other viral infections and whilst there is some variability in the time it takes, complete recovery does occur. There is no specific therapy indicated.

The following slides look at seizure rates of the MMR alone, the VZV Chicken Pox alone, the MMR and Chicken Pox in separate injections in the same visit, and using the MMRV Pro-Quad 4 in 1 Combo injection

Excess Chicken Pox Vaccine Seizures Over MMR Alone Which vaccine would you choose for your child? Keeping the MMR and delaying or skipping the Chicken Pox dramatically reduces the possibility of a febrile seizure without affecting Public Health.

MMRV---------- , MMR+V-------------, MMR alone -------------------, Yellow-----

VZV Chicken Pox alone--------------

189 / 83,107 = 1 / 439

598 / 376,354 = 1 / 629

Which vaccine would you choose for your child?

Excess Chicken Pox Fever Visits Over MMR Alone

3000 / 100k = 3 / 100 Vaccinated Children Require Outpatient Fever Visits

Yellow----MMRV---------- , MMR+V-------------, MMR alone -------------------,

VZV Chicken Pox alone--------------

Influenza Vaccine, PCV13, and Febrile Seizures Both influenza vaccine and PCV13 can
cause fever Some children with fever may have a febrile seizure most common in children 12-23 months of age VSD data (2011) indicate about 1 febrile seizure for every 2,225 children who receive both vaccines ACIP recommends both vaccines be given at the same visit if indicated
36

What is unscientific or unreasonable about a parent doing everything they can to reduce the risk of discomfort and injury to their child? Isnt that a parents primary responsibility?
The previous slides show that a parent can cut the seizure risk to their child by half simply though product selection and using the MMR and a separate Chicken Pox shot, versus the MMRV combo shot. A parent can then again achieve another significant risk reduction by either delaying, or opting out of, the Chicken Pox vaccine. Chicken Pox was not even a requirement until 2008. According to the British UK Health Service a normal child has a less than 1/100k chance of a serious complication from Chicken Pox. This compares to a 12 to 24/100k seizure risk increase adding the Chicken Pox to an MMR visit or using the MMRV. Some parents are wondering what was the criteria to make Chicken Pox a requirement? The U.S. stands alone in recommending universal Chicken Pox vaccination. Was there a public outcry by parents requesting this vaccine? This medical, scientific documentation illustrates that there are very rational, reasonable, and fact-based reasons to modify the schedule to any individual childs or family's needs. While it is a given that the majority of children may tolerate the vaccine schedule without incidence, it is a irrefutable fact that some children experience catastrophic harm. Just like some kids can eat peanut butter, while for others it is a life-threatening substance.

Why the Preservation of the Philosophical Exemption is critical to the continuing excellent health of Vermont citizens
The previous slides document that it is a scientific, statistical fact that vaccine associated seizures are occurring in Vermont children. All of the Vaccine Information Sheets list a seizure as a contra-indication for further doses of that vaccine. About 7,000 Vermont children receive their first MMR, MMR+V, or MMRV vaccination every year. We know with scientific, statistical certainty that these vaccinations alone are resulting in some 2 to 5 or more seizures annually, depending on which combination of vaccines is administered. The PCV & Flu = 3 seizures. Yet even with this type of documentation it is almost impossible to get a Health Care Provider to concede that any adverse event following a vaccination is, or even could be, caused by or related to the vaccination. Ask Vermont DOH how many confirmed vaccine associated seizures are reported to them every year? If the number is zero, is that because Vermont is somehow magically protected from this medically confirmed phenomenon, or is it because of an inability or unwillingness by Health Care Providers to identify that a drug they administer is the cause of an Adverse Event?

It is in this context that the importance of the Philosophical Exemption becomes paramount for a parent to make the best health care decisions for his child.

The Medical Exemption alone is an Inadequate safeguard to avoid further injury

Should a parent whos son or daughter is one of the unfortunate children that suffers a vaccine associated seizure, a known and recognized event as described in these statistics, be required to plead his case to an Health Care Provider for a Medical Exemption to avoid further doses of that vaccine? Should he be forced into a debate about causality, probability, and necessity? This is the way in which the Philosophical Exemption acts as a Parent Administered Medical Exemption. The Philosophical Exemption guarantees a parent the right to make an educated risk/benefit calculation on his own and then make appropriate health care decisions for his child.

Mandates, Injuries and the Greater Good Principle

The Greater Good principle is the concept that at times it is appropriate to withhold assistance from, or cause intentional harm or death to, some group of people in order to save another larger or culturally selected group. On a sinking ship a captain may order a watertight door closed, intentionally drowning the sailors behind it to save the rest of the crew. When loading the lifeboats it is women and children first. This is the ethical basis for requiring individuals to undergo a medical procedure, vaccination, that is known to cause injury in some people. What is the ratio of vaccine injury versus infection injury our society is willing to accept? Should the vaccine be 100 times safer? 10 times safer? 2 times safer? When vaccination was restricted to truly deadly diseases this calculation was self evident. Can we say the same for Chicken Pox? Should the state be able to force a vaccination that is more dangerous than the infection?

Are the unvaccinated a threat to the vaccinated?

In the discussions surrounding vaccination mandates it is commonly asserted that the unvaccinated are a deadly threat to the vaccinated. Is this assertion supported by actual science, or is it asserted to promote vaccination percentage policy goals?
The immediate question that comes to mind is If vaccines are truly effective at preventing the contraction and transmission of infection how can it be that an unvaccinated person could be a threat to a vaccinated? Isnt that the whole point of being vaccinated--to protect you from the unvaccinated? Consider what happens when an American travels internationally to an area where the vaccination rates are much lower than the US, or even non-existent. Does the State Department or CDC give you a pamphlet that says, Warning--you are travelling to an area with endemic diseases and no vaccination program. Every unvaccinated person is a mortal threat to you, just like in the US. Since you will be in an area with no vaccine herd immunity you must consider your vaccines to be virtually worthless. Please put your papers in order before travelling. Of course not. You are reminded that vaccines can be very effective at suppressing infection, and encouraged to either get booster vaccines or a test to be certain you still have coverage.

The argument that the unvaccinated are a threat to the vaccinated has little merit.

Is it true that Everyone must be vaccinated because sometimes vaccines dont work?
It is a scientific fact that all vaccines have an efficacy failure rate. A certain percentage of people who receive the vaccine do not develop antibodies. That is why some vaccines require multiple doses, because one dose does not sufficiently induce antibody response in a majority of the population. Vaccine immunity can also wear off, unlike the permanent immunity from a naturally acquired infection. These are some of the reasons is why outbreaks occur in highly vaccinated populations. It is not the fault of the unvaccinated. Antibody response is something that is easily tested. As an alternative to forcing vaccination of those who dont desire it, the protection of a vaccinated person could be confirmed through testing, and then if the vaccine recipient has not developed antibodies he can receive another dose. This insures his protection, just like an American travelling in an under-vaccinated foreign country. It also respects the right of his fellow citizen to avoid an unwanted medical procedure.

Is it true that Everyone who can be vaccinated, must be, to protect those who cant be vaccinated?
Anyone who is so vulnerable that contracting a Vaccine Preventable Disease would be a life threat is also susceptible to a wide variety of other infections and conditions for which there are not vaccines. What level of risk may one citizen require of another to theoretically protect his personal interest? Previous slides demonstrate that the Chicken Pox vaccine has a greater risk profile than the contraction of the infection. Is it appropriate that Citizen A should expect Citizen B to involuntarily subject his child to a Chicken Pox vaccination with a risk greater than Citizen Bs child would experience by naturally contracting the infection, in order to theoretically protect Citizen As immune compromised child?

Is that reasonable?

Is requiring vaccination for school attendance equal to enforcing safeguards that prevent students from bringing weapons to school?
This is a flawed argument because the process by which weapons are kept out of school, student searches and metal detectors, do not pose a threat of physical harm to the students being screened. This analogy would only hold true if the metal detector failed in some way, on a regular basis, harming students so that 3 per 100 each year would require outpatient emergency room visits (analogous to the Fever visits in the VSD slide), and 1/1250 suffered a seizure requiring a hospital admission and spinal tap. What would the acceptable injury rate be if searching for weapons caused harm in those being screened?

Abuse of School Mandates

The HPV and Hepatitis B vaccines raise another serious question. Should a child be barred from school for missing a vaccine that suppresses an infection that cannot be transmitted or contracted at school? The original, rational intent of school required vaccines was to prevent schools from being contagion hubs for highly infectious, dangerous diseases that are easily contracted in the classroom setting. HPV and Hepatitis B have infective profiles equal to HIV, all are blood borne pathogens. The risk of student to student transmission of HIV is considered so low that the law allows known HIV positive students to attend school. Yet without a philosophical exemption it is being proposed that a student who is simply is not vaccinated for Hepatitis B be excluded from his constitutionally guaranteed, tax financed public education. Even though he is no infection threat to anyone, whether Hepatitis B positive or not. Doesnt the inclusion of infections that cannot be contracted in the course of a normal school day represent an abuse of the School Attendance Requirement? It is perfectly appropriate for Public Health to encourage use of vaccines, but should it be able to keep a child out of school for not getting a shot for something he can neither transmit nor contract without engaging in intimate, probably illegal behavior?

Hepatitis B in Vermont
Hep B cases Acute Chronic >14 years age 2011 0 0 2010 2009 2008 2007 0 0 0 0 2 3 2 4

http://healthvermont.gov/pubs/IDB/

Hepatitis B is not spread through food, water, kitchen utensils, breastfeeding, kissing, coughing or sneezing

Are All Government Agencies Unified in the Support of Vaccination Mandates?

No
The US Department of Labor Occupational Health and Safety Administration, OSHA, does not support mandated influenza programs that do not include Personal and Philosophical Exemptions

State Health Rankings by Infant Mortality

*2011 values: http://www.americashealthrankings.org

Do Philosophical Exemptions Harm Public Health? No.

Vermont is currently the Number One Healthiest State according to the United Health Foundation. The UHF grades the states every year on more than 20 criteria. In this summary of the Top 15 states for Infant Mortality rates it is notable that more than 50% of these Top states offer philosophical exemptions to vaccination. It is also notable that only 2 of this Top 15 Best Infant Mortality are in the Top 15 for vaccination rates, (next slide), and actually 8 of the Top 15 Infant Mortality states score 30 or lower in Immunization Rank . This illustrates that there are many factors that determine health outcomes, and vaccination status is only one of them. High vaccination rates do not guarantee health, and lower vaccination rates do not mean sickness.

Infant Mortality Rank*

1 2 3 4 5 5 7 8 8 10 11 12 12 12 15

State
New Hampshire Vermont Utah Massachusetts California Washington New Jersey New York Oregon Iowa Minnesota Maine Nevada New Mexico Hawaii

Immunization Rank*
2 22 47 5 40 39 45 41 27 17 24 36 49 44 29

Philosophical Exemption Allowed?

No Yes Yes No Yes Yes No No Yes No Yes Yes No Yes No

State Health Rankings by Immunization Ranking

*2011 values: http://www.americashealthrankings.org

Vaccination Status is Not a Magic Bullet

Vaccination only one factor of many determining Health outcomes. Only 2 of the Top 15 most vaccinated states are also in the Top 15 best infant mortality rates. 6 of the Top 15 most vaccinated states rank in the bottom 7 states for infant mortality, including the 50th rated Mississippi. Only 4 of the Top 15 most vaccinated states are also in the Top 15 best infectious disease rates. 10 of the Top 15 most vaccinated states rank in the bottom 30 for Infectious disease rank. High vaccination rates do not guarantee health, or the prevention of infection, and lower vaccination rates do not mean sickness.

Immunization Rank*
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

State
Connecticut New Hampshire Florida Rhode Island Massachusetts North Carolina North Dakota Tennessee Michigan Mississippi Alabama Nebraska Pennsylvania Georgia South Carolina

Philosophical Infant Exemption Mortality Allowed? * Rank

No No No No No No Yes No Yes No No No Yes No No 20 1 29 22 4 46 22 45 39 50 49 16 35 43 46

Infectious Disease* Rank

3 14 28 29 42 15 7 32 31 37 43 44 19 41 24

Is Every Vaccine Manufactured Perfectly?

Vaccine vials with visible particles of charred shrink wrap evaded all quality control points and were only discovered by an astute Health Care Provider who noticed them when preparing to administer the vaccine. While it may be safe to inject burnt plastic into children, if Mercks Quality Control is incapable of detecting visible contaminants, what does that say about the ability to detect invisible viral, bacterial, and chemical potential pollutants?

Is Every Vaccine Administered Perfectly? Medication Errors are a Known Risk

Not every Injection intended to be a Vaccine is actually a Vaccine. Medication Errors are a measurable Healthcare occurrence.

How safe are drugs in general?

This study documented that Adverse Drug Reactions to FDA approved, MD properly prescribed, properly dosed, properly administered drugs in the clinical setting is the 4th to 6th leading cause of death in the United States.
This does not include medication errors
Is it truly reasonable to think that Vaccines can somehow be a special category of pharmaceutical products? A category that is magnitudes safer than the other product categories developed by the same scientists, in the same labs, manufactured by the same companies, and regulated by the same Government Agencies?

Errors Excluded

Deaths from avoidable medical error more than double in past decade, investigation shows Preventable medical mistakes and infections are responsible for about 200,000 deaths in the U.S. each year The precise number of these deaths is still unknown because many states lack a standard or mandatory reporting system for injuries due to medical mistakes.

Did vaccines really save us?

2010-11 Vermont Public School Vaccinations

100% 90% 80% 70% 60%

Kindergarten
50% 40% 30% 20% 10% 0% Dtap Polio MMR Hep-B Varicella Exempt Exempt Exempt Medical Rel. Phil. Prov Admit Prov Admit No Rec

7th Grade

Does this really look like a problem?

Oppose S.199 & HB.527

Vermont is Very Safe High Vaccination Rates Philosophical Exemptions Improve Health Vaccination is not a Magic Bullet Vermont is Very Healthy National Vaccine Agenda is being played out on Vermont Citizens