Exemption-gate in Oregon?

Understanding the misuse of vaccination data to create hysteria and remove medical freedom. (March 8, 2015)

(Please check the bottom of this article for a very important update!)

The news in Oregon is relentless when it comes to vaccinations:

  • Oregon has the highest “exemption rates” in the country
  • “Exemption rates” in Oregon are rising! This is dangerous to all!
  • The only way to stamp out this pernicious trend is Senate Bill 442 which would remove all religious and philosophical vaccine exemptions from Oregon’s parents, making vaccines mandatory for any child who wants to attend school in Oregon!

Unfortunately, almost everything you think you understand about exemption data in Oregon is wrong.

One week ago, we wrote a lengthy article titled “The Truth About Oregon’s Vaccination Rates,” a portion of which dealt with vaccine exemptions. The article, using CDC and Oregon Health Authority data, showed clearly that Oregon’s children met or exceeded national vaccination averages for every shot, and that OHA was very proud of this.

Because this topic is so confusing and because we’ve learned even more about exemptions in the last week, we are providing a complete article solely addressing the topic (some of this is a repeat, some of it is new).

We’re being played, and this is a technique

We thought it was just us.

That is, we thought this misuse of exemption rate stuff was unique to Oregon, until we heard more about Vermont and Washington.

From Vermont:

Early in 2012, the Department of Health [in Vermont] falsely claimed a dangerous decline in Vermont’s vaccination rates. Media buzzed with the manufactured crisis, inciting fear of imminent epidemics in the minds of legislators and the public. Bills were introduced in the legislature to eliminate the philosophical exemption to vaccines, and for months parents fought to retain the right to make medical choices for their children. The House eventually voted 133 to 6 to keep the philosophical exemption.

And more:

Since 2011, starting in Washington State and extending to more states every year, erroneous information about vaccine exemption rates has been used to attack parental choice regarding children’s health. Vermont was targeted in 2012 and is under assault once again, as bills are introduced to eliminate its philosophical exemptions.

Let’s highlight one statement from the above because it is so important:

“erroneous information about vaccine exemption rates has been used to attack parental choice regarding children’s health”

Moreover, the rise of exemption rates has birthed a new and disturbing trend on the part of legislators advocating bills that remove medical freedom from parents: armchair psychology and mockery of parents making individualized decisions about vaccines. These proponents, of which we have our own local Paul Offit—State Senator Elizabeth Steiner Hayward—know that they have a challenging task ahead of them. They know parents who file exemptions are typically well-educated and have higher income levels than the averages. This means these parents have researched the topic of vaccines extensively. Their choices and behaviors are typical rational and reasonable. How do you castigate such a formidable group?

By portraying them as elitist, irrational freeloaders:

“These parents are mostly affluent,” says Susan Wickstrom, an Oregon Health Authority spokeswoman who spent six months in 2012 traveling to schools with high exemption rates. “They’re white, well-educated people. Some of them think getting the disease is healthier than getting the vaccination.”
State Sen. Elizabeth Steiner Hayward (D-Portland/Beaverton) introduced legislation last week to end the choice to opt out. She says she’s willing to buck her wealthy constituents.
“They need to be challenged,” Steiner Hayward tells WW. “I think people of more affluent lifestyles have been buffered from the effects of poor medical care. I’m a firm supporter of a healthy diet and a natural lifestyle. But none of those things will protect you from the measles.”

Senator Steiner Hayward has taken it a step further, referring to constituents who are sensitive to losing their medical freedom as “howlers.” This is a blatant attempt to paint the opposition to her bill as emotional and irrational (never mind that they put you in office):

Oregon Vaccine Exemption Data: Double-Counting, Unreliable, and Confusing

Fact: There are 23 vaccines that are required for children to attend school in Oregon. The parent of a child who has received 22 out of 23 vaccines has to sign an exemption for the 23rd shot, and their child is counted by the OHA as “exempt.” A parent whose child receives 0 out of 23 vaccines is also counted as exempt, as is a child who receives 12 out of 23 shots. Because shots are given as a series — for example, Oregon requires six separate DTaP shots — the data runs amok. Children who are mostly vaccinated are then misconstrued as “unvaccinated.”

There are a number of ways to support Fact #1. The first way is to look at the confusing form that has caused most of this misunderstanding. It’s a form that shows every shot and every shot within the series that every school-attending child in Oregon is required to receive. Numbers have been added in so you can easily see the number of shots recommended (23 as of 2015, a total number that has grown from 15 since 2000). The front of the form includes all the “mandatory” shots:

As you see on the form above, there are 23 “required” shots for children to attend school in Oregon.

There’s an easy way to show all this by looking at four theoretical examples of how this form could be filled out:

Todd receives 100% of his shots — 23 out of 23 — and is therefore not captured as an exemption. The problem is that Vanessa, Sarah, and Lucas — one of whom received 21 out of 23 shots and one of whom received 20 out of 23 shots— are all classified by Oregon Health Authority as “exempt” and misclassified by proponents of SB442–3 as “unvaccinated.”

Vanessa and Sarah, like the overwhelming majority of children who are classified as “exempt,” are what makes the exemption data useless. Vanessa only missed her Varicella shot (chicken pox), so she would be captured in state and CDC data as “vaccinated” for DTaP, MMR, Polio, Hep B, etc. while also counted by Oregon Health Authority and proponents of SB442 as “exempt” and than further twisted into “unvaccinated.”

In short, she is double-counted.

Sarah is a similar case. Her parents skipped Hep B (because they learned no other country on Earth mandates Hep B for children not born to HepB-positive moms and felt the shot had more risks than benefits), but got every other vaccine. So she’s counted for getting DTaP, MMR, Polio, Hep A, etc. but also counted as “exempt” and then confused by some to also be “unvaccinated” which she most assuredly is not.

(Of the three authors of this articles, all three of us have children who are selectively vaccinated and counted by the OHA as “exempt” and referred to by SB442 proponents incorrectly as “unvaccinated.”)

Think of this another way:

If there’s a pediatrician’s office in a small county somewhere in Oregon and they pretty much see all the children in that county. If they have been giving children in their practice 4 doses of DTaP, but not six, then every child in their practice would be counted as “exempt.”

Hopefully, this misuse of exemption data now makes logical sense. We confirmed that this is the correct way to look at the data through three means:

  • (i) The Oregon Health Authority confirmed it to us.
In preparing this article, we called the OHA and were directed to the expert on exemption data who will remain nameless. We took notes during our conversation and here’s how it went:
Us: “If someone gets 5 out of the 6 required DTaP shots, do they just sign an exemption for the final shot”
OHA: “Yes”
Us: “So is this child, who got 5 out of 6 DTaP shots and whose parents signed the exemption for just one shot, counted as ‘exempt’ on the county-level exemption data?”
OHA: “Yes”
Us: “So does that mean a child who received their MMR would be counted as vaccinated for MMR but then counted as exempt for DTaP even though they got 5 out of 6 shots. And that they would contribute to the ‘exempt’ classification in exactly the same way as a child who received zero shots?”
OHA: “Yes.”
“The Nonmedical Exemption County number includes children with a nonmedical exemption for all required vaccines, and children with a nonmedical exemption for one or more vaccines who are up-to-date or complete for vaccines for which they do not have exemptions,” according to the Oregon Health Authority.
  • (iii) The Oregon Department of Health data on vaccinated children and exempt children often exceeds 100%, which means children are being double-counted

There is a single document, available from the OHA here, that is the source of 99% of the confusion about exemptions, and contains the data that proponents of SB442–3 have interpreted with the consequence of imagining a problem that doesn’t exist. We’re going to pull out data from one page of this 7-page document so you can see how it double-counts partially vaccinated children and counts them as “exempt.”

Source: Oregon Department of Health

As you can see, because it is rife with double-counting, the exemption data from the OHA makes it nearly impossible to understand the true vaccination status of Oregon children. Luckily for all of us, there are two ways to find data about the vaccination status of Oregon’s children: One set of data comes from the OHA and one set of data comes from the CDC.

Why haven’t you heard more about these rates, which are all well within the national averages? That’s easy:

Because they don’t help support the fictional narrative created to support SB442.

(For complete detail on Oregon’s actual vaccination rates, which are well within the range of national averages, please refer to, “The truth about Oregon’s vaccination rates”)

We often hear, “7% of Oregon’s children are unvaccinated”? That 7% number comes from this map available on the Oregon DOH website:

Source: Oregon Deparment of Health

By now, hopefully, you realize this data tells us almost nothing because the vaccination data of each child isn’t being accurately captured or reported.

To repeat:

“Exempt” in Oregon does not mean “unvaccinated.” Because of how data is captured, it’s rife with double-counting and inaccuracies. This is a product of the form used and the system utilized for capturing the data. We’ll give a simple example: We talked to a friend the other day about this form. They recollected having to fill out this form. They were busy that night, couldn’t locate their child’s shot records, realized they could just sign the exemption, and did so. So, their almost completely vaccinated child ends up being counted as “exempt” by the State of Oregon and “unvaccinated” by Lynne Terry of the Oregonian, and then the 7% number of exempt children is used by proponents of SB422–3 to declare a state of emergency.

Exemption rates are rising! The sky is falling!

There’s also a secondary talking point used by the proponents of SB442–3 that must be addressed: the idea that exemption rates are rising over time.

Proponents of SB442 argue that this pernicious trend must be snuffed out before epidemics start happening, and the only way to do this is to take away parental rights and make vaccination, a medical procedure, mandatory.

Because this is a “health emergency”, the otherwise fairly obvious civil rights violation of removal of informed consent can be justified because, according to them, public health is in imminent danger. However, a close look at the numbers shows a far more likely reason for the increase in exemption rates over time.

Below is a slide from a presentation in 2012 given by Lorraine Duncan, the Oregon Immunization Program Manager at that time. It shows, quite clearly, that exemption rates have been rising. What’s also true is that exemption rates by shot have not been captured by the OHA until 2012 (and then only for kindergarten), so no one could be certain what’s driving the increase.

The most likely reason is pretty simple:

When new vaccines get added to the mandatory schedule, exemption rates rise.

Source: Presentation by Lorraine Duncan, Oregon Immunization Program Manager, 5/12/12

As you can see in the graph, the OHA has added shots to the schedule over time, and growth in exemption rates tends to match these additions. Since 2000, the following vaccines have been added to Oregon’s schedule:

  • Hepatitis B: 3 shots
  • Varicella: 2 shots
  • Hepatitis A: 2 shots
  • DTaP: additional booster, 1 shot

2000: 15 vaccines for school.

2015: 23 vaccines for school

It makes sense: Whether a parent simply fell behind on knowing the new vaccine requirements, had a doctor who advised them to hold off before adding a new vaccine, or perhaps they simply had a general wariness about adding a shot like hepatitis A , which is mandated in only 20 states — and in zero European countries.
The data simply doesn’t exist to tie this all together, but the rise in exemption rates is certainly far less “pernicious” than people think.

The 7% Number

A final point we want to bring up is the 7% exemption number the media continually repeats. If you look closely at the chart above from Lorraine Duncan, what you see is that the exemption rates tend to fall as children get older. Said differently, the exemption rate for 7th graders in Oregon is lower than the exemption rate for kindergartners. Particularly with a vaccination schedule that OHA keeps adding to, this makes sense: between kindergarten and 7th grade, parents catch up on vaccines, particularly new ones.

7% is actually the exemption numbers for kindergartners in Oregon, not all K-12 students, as this data set shows . By 7th grade, the exemption rate in Oregon is down to 5.1% for all students—but why talk about a lower number?

Thinking about 5.1% for a second:

  • Only 5.1% of children in Oregon, by the time they reach 7th grade, are filing exemptions
  • If 5.1% of children are filing exemptions, that should mean 94.9% of Oregon’s children are 100% vaccinated, well above herd immunity thresholds
  • Furthermore, we know that it’s highly likely the overwhelming majority of exempted children are either selectively vaccinated and/or have parents who can’t find their vaccine records…which leads, really, to the point of this whole article:

Exemption data is being misused in Oregon, as it has been used in other states, to create hysteria and confusion for a problem that doesn’t exist.

If you’re still not sure if this is all plausible, that really who knows about all this exemption stuff, consider that, back in 2012, Lorraine Duncan, former head of Oregon’s Immunization Program, knew clear as day what all the exemption stuff really means because she wrote about it in her own presentation (with editorializing in the boxes). Note that “religious exemptions” means religious or philosophical exemption, since in Oregon those have been combined:

We hope you will consider sharing this information with your legislator in your district. It feels like the proponents of SB442 are trying to ram this bill through before people have enough time to understand the facts. The facts are, and OHA has known this for years, Oregon’s vaccination rates are consistently high, as Lorraine Duncan, head of the Oregon Immunization Program, bragged less than 2 years ago:

Important Update:

Friends and members of the No On SB442 coalition have been reaching out to journalists in Oregon asking them to cover this topic honestly. On March 9, 2015, The Statesman Journal became the first publication to accurately address the issue:

What school immunization rates actually mean

Some great quotes from the article:

But what does that 7 percent actually mean?
First of all, it does not mean that 7 percent of Oregon’s kindergarteners are not vaccinated. It does mean, however, that they have been opted out from at least one vaccine.
Many parents who have nonmedical exemptions from school shots are selective about vaccines. They don’t commonly reject all vaccines…
They show that statewide, 90.8 percent of Oregon children enrolled in schools or daycare have all of their required childhood vaccines. However, the vaccination rates for individual vaccines, such as the polio or Haemophilus influenzae type B (Hib) vaccines, are higher — up to 95.1 percent.
In Multnomah County, the rates of immunization of individual childhood vaccines hover between 89.8 percent and 93.5 percent.
Overall, the hepatitis B three-shot series appears to be the least popular in Oregon, with the statewide immunization rate at about 93.5 percent.

Thank you Statesman Journal for accurate reporting!!

This article was written by several well-meaning Oregonians who are big fans of medical freedom and informed consent who apparently have nothing better to do than crunch numbers. We have nothing to gain or lose financially from the passage of this bill. We have proudly joined a movement of a few thousand Oregonians fighting this legislation, the organizing website can be found here: www.NoOnSB442.com. We have written a series of articles on this topic, in chronological order they include:

Part 1: The truth about Oregon’s vaccination rates

Part 2: Who cried wolf in Oregon

Part 3: What’s NACCHO got to do with Oregon’s vaccine exemption fight?

Part 4: Exemption-gate in Oregon?

Part 5: No mas, Senator Steiner Hayward, no mas

Part 6: Oregon Senator Steiner Hayward: Blameshifter in Chief