August 18, 2019
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Maine’s new vaccination law balances democracy and public health

Marina Villeneuve | AP
Marina Villeneuve | AP
Kate Herrold, of Falmouth, holds her daughter with other mothers in a hallway, Thursday, May 2, 2019, at the Statehouse in Augusta, Maine, where the Senate passed a bill ending non-medical vaccine exemptions. The bill would end religious and philosophical opt-outs by 2021 for public school students, as well as employees at nursery schools and health care facilities.

Let’s praise Maine’s legislators both for the way they conducted the hearing on a bill to reduce exemptions from school vaccination requirements and for the decisions they made in passing the bill.

Part of government’s job is to protect people, especially kids, from dangerous infectious diseases; vaccinations are the best tool science has found to do that. We’ve known for a long time that diseases easily spread in schools. It was back in 1857 that the Maine Legislature first decided that unvaccinated children could be excluded from school when ordered by the local school committee.

Vaccines work to prevent outbreaks when a high percentage of a community is vaccinated; for vaccine-preventable diseases like measles this “herd” immunity figure is 95 percent. In recent years, an increasing number of parents have decided against vaccinating their children as misinformation has spread about vaccines. The World Health Organization has called “vaccine hesitancy” one of 10 serious health threats of 2019.

The Maine Legislature in 2019 faced a risky situation. Vaccination rates had been dropping. Use of philosophical and religious exemptions had been climbing. Maine’s average kindergarten vaccination rates in five counties were lower than the 95 percent needed for ‘herd’ immunity, per the More than half of kindergarten classes fell below that 95 percent threshold. Maine had the highest pertussis rate in the nation. Measles outbreaks were occurring in many states.

In response, a bill was introduced to tighten Maine law on vaccinations required for students, as well as some other groups. The revised law still allows students to be excused from vaccination if a vaccine would be “medically inadvisable” for them, such as students who are immunocompromised because of cancer treatments, but opting out for philosophical or religious reasons will not be allowed. California, West Virginia, Mississippi and New York (as of June 13) all have laws like Maine’s that allow exemptions only for medical reasons.

Maine lawmakers made this decision after careful consideration of testimony from all sides. At the March hearing on the bill, LD 798, members of the Education and Cultural Affairs Committee, led by Sen. Rebecca Millett, D–South Portland, and Rep. Victoria Kornfield, D–Bangor, respectfully listened to more than 14 hours of testimony on all sides of the issue. Vaccines and vaccine laws have always had their critics as well as supporters; fierce opposition is nothing new.

I testified in support and submitted written testimony making the point that the bill would be constitutional. After all, the U.S. Supreme Court has repeatedly supported states’ power to require and regulate vaccinations since 1905. In fact, no court has ever found a vaccination law unconstitutional.

After the March hearing, legislators extended the effective date of the new requirements to September 2021 and allowed licensed nurse practitioners and physician assistants as well as physicians to decide if a vaccine is “medically inadvisable.” These changes and others probably will not satisfy opponents. In fact, some opponents recently filed paperwork for a referendum campaign to repeal the new law. And even supporters of the bill may not be happy with all the amendments. But the revisions show that legislators listened carefully to all of the testimony and heard the concerns of bill opponents.

This year’s changes are part of a long line of vaccination laws in Maine going back to our early statehood when the first vaccination law (aimed at smallpox) was passed in 1821. Vaccination against smallpox was initially dangerous and burdensome, a far cry from the stringent safety and quality standards of today.

The current school vaccination law framework stems from a 1977 law enacted when measles outbreaks swept through Madawaska and Kennebunk. That law allowed religious and philosophical exemptions as well as medical exemptions.

But much has changed since 1977. Measles, thought to have been eradicated in the U.S., is back. Lower vaccination rates mean greater risks for others, including people who are sick, old, or young. Some vaccine-preventable diseases can cause permanent damage (mumps can cause deafness, for example) or even death (measles kills almost 100,000 young children per year). The Maine legislature had excellent reasons to limit exemptions.

Many strongly support the new law. Many strongly object. But let’s be very clear: the new law is not an insidious unprecedented attack on freedom; school vaccination laws have been in place for over 100 years and are well-grounded in the Constitution.

The Maine Legislature listened and did its job to protect the public’s health after carefully considering the evidence presented to it. The new law is part of a long tradition of protecting public health based on science going straight back to Maine’s first days as a state.

Jennifer Wriggins is a professor at the University of Maine School of Law in Portland. These are her views and do not express those of the University of Maine or the University of Maine School of Law. She is a member of the Scholars Strategy Network.

 



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