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Supporters of NO ON 1
- American Nurses Association of Maine
- American Cancer Society Cancer Action Network
- The Bingham Program
- Central Maine Healthcare
- Community Health Options
- Community Concepts
- Dirigo Maine Geriatrics Society
- Harvard Pilgrim Health Care
- Health Equity Alliance
- Intermed, LLC
- Maine Council on Aging
- Maine Academy of Family Physicians
- Maine Association of Health Plans
- Maine Association of Physician Assistants
- Maine Association of Psychiatric Physicians
- Maine Association of School Nurses
- Maine Chapter, American Academy of Pediatrics
- Maine Chapter, American College of Emergency Physicians
- Maine Community Action Association
- Maine Council of Churches
- Maine Council on Aging
- Maine Dental Association
- Maine Family Planning
- MaineGeneral Health
- Maine Hospital Association
- Maine Medical Association
- MMA Public Health Committee
- Maine Nurse Practitioner Association
- Maine Osteopathic Association
- Maine Pharmacy Association
- Maine Primary Care Association
- Maine Providers Standing Up for Health Care
- Maine Public Health Association
- Maine Radiological Society
- Maine Society of Anesthesiologists
- Martin’s Point Health Care
- Millinocket Regional Hospital
- New Mainers Public Health Initiative
- Northern Light Health
- Penobscot Community Health Care
- Planned Parenthood Maine Action Fund
- Portside Learning Center
- York Hospital
On MARCH 3, Maine voters overwhelmingly rejected Question 1, a “people’s veto” that would have repealed a new law that protects public health and safety by eliminating non-medical exemptions for school-required immunizations. At a time when our state’s immunization rate is already dangerously low and the spread of some communicable diseases is on the rise, 74% of voters chose to protect this strong public health vaccine law. We created the guide below, in collaboration with Maine Families for Vaccines, as a resource to help voters better understand the law and referendum and to assist you in navigating the heated and sometimes confusing conversations about vaccines.
GET THE FACTS ON THE LAW
Why do we need this new law?
Last year, in response to reports that Maine’s whooping cough rate was the worst in the nation and that several outbreaks were reported in schools, the state legislature enacted public law 154, which alters a long-standing law by removing philosophical and religious exemptions to school-required immunizations. In a year when the number of measles cases in the US more than tripled the previous year’s count, Maine’s non-medical immunization opt-out rate was at an all-time high– more than triple the national average. More than 40 of our elementary schools had vaccination rates below 85%. Students in schools with low vaccination rates are especially vulnerable to disease outbreaks, because studies show that they are more likely to occur in communities with high numbers of unvaccinated people. Babies who are too young to be vaccinated and those who are immune-compromised and cannot be vaccinated for medical reasons are particularly vulnerable when vaccination rates drop below recommended levels.
What does the new law do?
Public law 154 removes philosophical and religious exemptions to the school-required immunizations. This law applies to all public and private day care and preschool facilities, K-12, and post-secondary schools. Medical exemptions are still allowed. Those seeking a medical exemption (including school employees) must provide a written statement from a licensed physician, nurse practitioner, or physician assistant, stating that a required immunization is medically inadvisable. It is up to the medical professional to determine the medical necessity for an exemption, not the state.
Who determines which vaccines are required?
The Commissioner of Maine’s Department of Health & Human Services and the Director of the Maine Center for Disease Control determine which immunizations are required to attend Maine schools. Making additions to that list requires a lengthy process overseen by the Maine legislature. You can see the immunization requirements for children and adults HERE.
Is the flu shot, rotavirus, or HPV vaccine required?
No. The only vaccinations required for K-12 students are DTaP/Tdap, Polio, MMR, Varicella, and MCV4 (meningococcal conjugate). The vaccinations required for babies and toddlers in daycare and preschool can be found here. Children who do not attend daycare or preschool and go on to enter the school system in Kindergarten are not required to receive the vaccinations unique to the baby and toddler immunization requirements (Hib, Hep A, Hep B, and PVC13).
Can I spread out vaccinations?
Yes, as long as your child is up to date by the time they enter each of the three milestone grades: Kindergarten, 7th grade, and 12th grade. How you spread the immunizations out between those milestones is between you and your child’s doctor. Children who enter the school system in kindergarten have about 5 years to acquire 4 required vaccines. The requirements for babies and toddlers in daycare and preschool can be found here.
Who decides if my child qualifies for a medical exemption?
Your child’s licensed physician, nurse practitioner, or physician assistant determines if receiving an immunization would be inadvisable for your child. The determination is not limited by any state or federal criteria. A statement from the medical professional must be provided in writing to your child’s school.
When does the law go into effect?
The law goes into effect September 1, 2021. Students who have an Individualized Education Plan (IEP) on or before Sep 1, 2021 that exempts them from immunizations for philosophical or religious reasons may continue to attend school as long as they provide a letter from a licensed physician, nurse practitioner, or physician assistant, which states that the parents or adult students have been informed of the risks of not being immunized.
What school can my child attend if I refuse to vaccinate?
Children who do not have the required immunizations at the start of the 2021-22 school year may be homeschooled. The law, as written, does not currently provide exemptions for accredited Maine online schools, but a legislative remedy has already been introduced and will soon be voted on.
What about adults?
Adults who work in preschools must show that they are vaccinated or immune to the diseases listed in the immunization requirements. Most vaccines, when administered according to the appropriate schedule, will last a lifetime. The booster shots you received as a child help ensure immunity. For some vaccines, like pertussis, an adult booster shot is recommended. Medical exemptions are available to adults as well as students, and require a written statement from a licensed physician, nurse practitioner, or physician assistant.
What is the exact wording of Question 1?
Question 1 reads: Do you want to reject the new law that removes religious and philosophical exemptions to requiring immunization against certain communicable diseases for students to attend schools and colleges and for employees of nursery schools and health care facilities?
A “no” vote keeps Maine’s strong public health vaccine law in place. A “yes” vote repeals the law.
Vote NO on 1 to protect Maine’s children!
LEARN HOW TO RESPOND TO VACCINE OPPONENTS
We understand that this topic has passionate defenders on both sides. Conversations can get heated. Many of the arguments coming from vaccine opponents tend to include discredited and debunked conspiracy theories and false information, and much of their concern is based on distrust and fear. Continuing to recycle false information can have serious consequences and put real lives at risk. It’s critical that we all know how to reply with accuracy, support the science, and build trust with facts and evidence. Click on the toggles below for information that will help you respond to some of the most common concerns we hear in opposition to this law.
IF YOU HEAR: “My rights are being violated.”
FACT CHECK: No current federal or constitutional law requires states to offer religious or personal belief exemptions from school immunization requirements. In fact, two U.S. Supreme Court decisions (read them here and here) made it clear that states possess the authority to require vaccination as a condition for school entry. A third decision established that religious freedom does not extend to actions that endanger others: “The right to practice religion freely does not include the liberty to expose the community or the child to communicable disease or the latter to ill health or death.”
It’s also worth noting that no major religion has explicit, doctrinal objections to vaccinations. Vaccination is endorsed by top Jewish and Islamic scholars, by the Vatican, and by other major Christian sects including Methodist, Lutheran, Presbyterian, Mormon, and Episcopalian. Even sects opposed to modern medicine, like Jehovah’s Witnesses and Christian Scientists, do not prohibit vaccines. Religious authorities have meticulously studied how vaccines are made and what is in them, and still have ruled that they do not violate Jewish, Islamic or Catholic law.
IF YOU HEAR: “My body, my choice.”
FACT CHECK: Unlike reproductive choices like birth control and abortion, choosing not to immunize your child puts others at risk of harm or death. Reproductive decisions are private, but decisions that enable the spread of dangerous contagious diseases are very much a public concern. Babies too young to be vaccinated and people who have medical conditions that prevent them from being vaccinated deserve the protection of their communities.
IF YOU HEAR: “You can’t force me to vaccinate my child.”
FACT CHECK: No one is being forced to vaccinate a child. Parents still have the right to refuse immunizations. At the same time, the state has a right and an obligation to create rules that protect public health and safety. Just as you have a right to smoke, the state regulates where you are allowed to smoke, to protect the public from being harmed by your choice. The education options resulting from the choice to refuse vaccinations will be severely limited. But options still exist.
IF YOU HEAR: “Herd immunity isn’t really a thing.”
FACT CHECK: Herd immunity is not a fringe theory. It’s established scientific fact that when a sufficiently large proportion of a population is immune to a contagious disease, the disease cannot easily spread from person to person. This roadblock protects individuals who cannot be vaccinated due to age or illness, keeping their already elevated risk of contracting a disease as low as possible. To see the devastating impact resulting from a loss of herd immunity, look to Samoa. This winter a measles outbreak in a population with only 30% immunized led to more than 5,600 cases and 80 deaths, most of them small children.
The vaccination rate required to achieve herd immunity depends on the disease. While experts say 80% is enough to protect against rubella and mumps, pertussis and measles spread far more easily and require a rate closer to 95%. In more than 40 of Maine’s elementary schools, the vaccination rate is below 85%. Although the health and safety of our community’s children are the primary source of concern when it comes to maintaining herd immunity, we shouldn’t forget that letting it lapse also comes with a massive financial risk. When a community in Brooklyn experienced a measles outbreak in 2013, it took 87 city health employees 10,000 staff hours and $400,000 to bring the outbreak under control.
IF YOU HEAR: “I won’t risk an adverse reaction to a vaccine.”
FACT CHECK: Let’s look at benefit versus risk. Vaccines have eradicated or brought under control seven major human diseases—smallpox, diphtheria, tetanus, yellow fever, whooping cough, polio, and measles. According to the World Health Organization, the elimination of smallpox saved an estimated 40 million lives. The polio vaccine saved more than 18 million people from paralysis. In contrast, severe adverse reactions resulting from vaccination are extremely rare. For vaccines with the most reported adverse reactions, the rate is about 1 in 1 million vaccinations. In other words, you are more likely to be struck by lightning than to have a serious adverse reaction to a vaccine.
IF YOU HEAR: “Getting measles or whooping cough would be better than having an adverse reaction to a vaccine.”
FACT CHECK: While the chance of severe adverse reaction or death resulting from the MMR vaccine is less than 1 in 1 million, the risk to unvaccinated children is far greater: About 1 in 1,000 unvaccinated children who contract measles will suffer a serious outcome, such as encephalopathy or death. Measles, considered eliminated in the U.S. in 2000, is now resurging in serious outbreaks, with cases spreading to 31 states, including Maine. Worldwide, measles killed more than 140,000 people in 2018, most of those children under age 5. The 2019 data is expected to be far worse.
Maine’s pertussis rate is 8 times the national average, and we reported 12 outbreaks in 2019. All but one of the outbreaks occurred in a school. Pertussis can be deadly to babies: of those that are hospitalized with pertussis, 1 out of every 100 will die (see what a baby with whooping cough looks and sounds like). Since the introduction of the safer DTaP vaccine in 1999, severe adverse reactions have declined dramatically. The chances of a child having a severe allergic response today is about 1 in 1 million.
IF YOU HEAR: “Vaccines contain poisons like formaldehyde, mercury, and aluminum.”
FACT CHECK: There are no “poisons” in vaccines.
- Formaldehyde: Some required childhood vaccines contain formaldehyde to inactivate or detoxify viruses. Formaldehyde is already a naturally-occurring substance in our bodies; it’s essential in human metabolism and required for the synthesis of DNA and amino acids. Infants already have about 1,500 times the amount of formaldehyde found in a vaccine in their circulation.
- Mercury: No required childhood vaccine contains mercury. Thimerosal, an organic compound preservative containing ethyl mercury, was used to prevent bacterial and fungal contamination of vaccines beginning in the 1930s. Today, it is only found in rarely-used multi-dose vials of influenza vaccines. Ethyl mercury does not accumulate in our bodies, unlike the forms of mercury used in thermometers or found in fish.
- Aluminum: Some required childhood vaccines contain aluminum salts, which activate the immune response. Children and adults regularly ingest far greater amounts of aluminum simply by eating and drinking. A breastfed infant, for example, will ingest almost twice as much aluminum as they receive in vaccines in their first six months. Infants fed soy formula will ingest 26 times the amount.
IF YOU HEAR: “Vaccines cause autism.”
FACT CHECK: There is NO causal link between vaccines and autism, even among children who have an increased risk for autism. The cause of this pernicious and dangerous rumor was a single 1998 study of just 12 children. The study was later proven to be fraudulent, retracted from the journal that published it, and the author stripped of his medical license. Opposing that discredited theory are several large scale, long-term, peer-reviewed studies. The largest was published in 2019, studying 657,461 children born in Denmark from 1999 through 2010.
So how to explain the rise in rates of autism? Experts say the bulk of the increase stems from a growing awareness of autism and changes to the condition’s diagnostic criteria and availability of supportive services. Autism did not appear in the DSM until 1980, despite the term being coined as early as 1943. Until that time, many people with autism were diagnosed with an intellectual disability, institutionalized, and rendered invisible. As the diagnostic criteria expanded, so did the number of cases reported. In 1991, students diagnosed with autism qualified for special education services, making a diagnosis an avenue for support instead of stigma. Since then, the definition of autism has further broadened to include Asperger’s. Research indicates that genetics are involved in the vast majority of autism cases, along with parental age and premature birth.
IF YOU HEAR: “Big pharma only cares about big profit.”
FACT CHECK: A product that requires mass production, regulation, and distribution requires massive infrastructure to maintain consistent quality, availability, and pricing. It’s not a job small manufacturers could or should take on. While there is profit in vaccines, it’s slim compared to other drugs. Live vaccines are difficult to work with, regulations are cumbersome, and pricing is often capped by law. A few decades ago, manufacturers were dropping out of the vaccine business at a steady clip. Today, demand for vaccines from developing countries has made vaccine manufacturing more lucrative. Globally, the vaccine industry generates about $24 billion each year, but that’s only about 2-3% of the worldwide pharmaceutical industry. There is certainly an argument to be made for lowering the cost of vaccines, but industry profit is not a reason to avoid vaccinating. In fact, the cost of treating disease outbreaks (many involving diseases that have no cure), is far higher than the profit gained by big pharma. A study released in 2014 estimated that fully immunizing babies resulted in $10 saved for every dollar spent, about $69 billion total.
IF YOU HEAR: “Big pharma can’t be held accountable.”
FACT CHECK: A different liability system was set up for vaccine makers precisely because of the critical public health role they play and the vast populations they serve. Endless lawsuits (whether legitimate or frivolous) could drive up the costs of vaccines, and discourage companies from making them altogether. Injured parties without means could be too intimidated to take on a deep-pocketed pharma company. To ensure that vaccines remain affordable and available, Congress established a trust fund for damage awards, financed by a 75 cent tax on every vaccine administered. Under the no-fault system, the goal is to settle matters quickly and fairly. If petitioners don’t like the outcome, they can still take their case to the traditional civil court system. Since 1988, when the National Vaccine Injury Compensation Program began, trillions of vaccines have been administered in the US. In those 30 years, 20,000 claims have been filed and $4 billion has been awarded to about 6,400 claimants, with the small number of severely impacted people receiving the bulk of the funds.
IF YOU HEAR: “I don’t trust big pharma to conduct safety testing.”
FACT CHECK: You don’t have to. The Clinical Immunization Safety Assessment (CISA) project was established in 2001 to conduct and review clinical research on vaccine safety. CISA is a national network of vaccine safety experts from the CDC’s Immunization Safety Office, seven medical research centers, and other partners. You can also find an exhaustive list of vaccine research on the CDC’s website. There are no less than 18 studies under the tab for 2019 alone.
IF YOU HEAR: “I don’t trust the CDC, either.”
FACT CHECK: There are several conspiracy theories that have gained traction in recent years, resulting in many years and millions of dollars spent in conducting legitimate research to debunk them. Some researchers describe fighting misinformation as more difficult than fighting disease. The MMR vaccine received a lot of attention from researchers precisely because of the amount of dangerous misinformation spread since the fraudulent Andrew Wakefield study from 1998, as well as from the similarly discredited and retracted “CDC coverup” conspiracy theory pedaled by William Thompson.
IF YOU HEAR: “How can I trust vaccine research that doesn’t include human control groups?”
FACT CHECK: The reason that there are no large scale, long-term, double-blind studies conducted with control groups is because it would be completely unethical. Researchers cannot purposefully withhold vaccines from tens or hundreds of thousands of children without informing their parents if they have been vaccinated. No research review board would allow such a study to even be proposed.
IF YOU HEAR: “Vaccine injuries are underreported.”
FACT CHECK: The National Childhood Vaccine Injury Act requires health care providers to report serious health problems following vaccination to the federal Vaccine Adverse Events Reporting System (VAERS). There are no recent definitive studies that show the rates of reporting. Because anyone can report any kind of adverse reaction, whether mild or severe, and whether they know the reaction to be a result of the vaccine or not, the system is primarily used to spot trends. Reports to the VAERS system of the adverse effects of the first rotavirus vaccine helped remove the vaccine from the schedule and replace it with a safer one. You can see examples of VAERS reports informing vaccine safety research by looking through the list of studies on the CDC’s website.
IF YOU HEAR: “I don’t trust anyone who tells me something is safe. People once said lead paint, tobacco, asbestos, thalidomide, and DDT were safe, too.”
FACT CHECK: Each of these cases represents a product that was determined through sound research, reporting, and oversight to pose greater harm than benefit. In the case of required childhood vaccines, decades of sound research, reporting, and oversight have demonstrated that the public health benefit of vaccines far outweighs the risk. The other issue that has been studied in depth is whether laws that require school children to be vaccinated reduce rates of disease. The evidence not only shows that these requirements work, but also that communities with high vaccination opt-out rates have higher rates of disease.
IF YOU HEAR: “I’m more concerned about getting measles from someone who was recently vaccinated.”
FACT CHECK: A common claim by vaccine opponents is that disease outbreaks are caused by recently-vaccinated people “shedding” the disease and infecting others. Shedding refers to the process by which a live virus spreads from one person to another, and determines how long an infected person is contagious. Vaccines that contain live viruses, like those used to prevent measles and chickenpox, are designed to be just strong enough to prompt an immune response without triggering an infection. Without an infection, the virus does not shed and does not infect others. While there have been isolated cases in which immune-compromised individuals developed viral infections after being vaccinated, only a handful of cases in which others have been infected by those individuals have been reported. It is these immune-compromised people that medical exemptions are intended to benefit.