DENVER — Governor John Hickenlooper has recently made a strong case for the need to raise Colorado’s bottom-of-the-barrel vaccination rates, but he has fallen short of outlining a specific plan to make it more difficult to obtain vaccination exemptions or to address widespread public skepticism toward the science of immunization and fears about its safety.
“Kids that can be vaccinated should be vaccinated,” Hickenlooper told the Independent earlier this month. “There are these urban myths — and in many cases these are now suburban myths and rural myths — that somehow vaccinations increase the probability of autism or other unnamed maladies. But there is no science to support this. The science clearly states that having more and more people unvaccinated puts other children at risk.”
He echoed warnings public health experts have been sounding for years.
“One of the basic principles of community is that we look out for each other,” Hickenlooper said. “In places where we’re clearly not taking on an additional risk but providing greater safety to our neighbors, that’s generally how we should act.”
The point Hickenlooper and so many others have been trying to make is that immunization science is about protecting the health of the community and its weakest members — infants, seniors and immune-compromised people. Vaccinations work in concert to form a larger bulwark against stalking diseases. The point is to prevent fast-moving outbreaks.
‘Live and Let Live’
But Colorado is in many ways still a culturally libertarian “live and let live” state, and that is reflected in its loose rules around immunization. The Centennial State is among 20 that allow parents to cite any personal opposition to immunization in order to opt-out their children. Vaccination rates here for infants and preschoolers have ranked near the bottom nationally for years. In 2013, nearly 550 reported cases of vaccine-preventable illness among Colorado school children lead to hospitalization that cost $29.2 million, according to a report by Children’s Hospital Colorado and the Colorado Children’s Immunization Coalition.
Colorado experienced a whooping cough outbreak beginning in 2012, where the number of reported cases hit epidemic levels two years running. Yet Colorado still has the lowest vaccination rate in the nation among kindergartners for measles, leading many to believe it’s just a matter of time before that highly contagious and dangerous disease enjoys a run in schools across the state.
It doesn’t have to be this way.
California, home to a popular “alternative medicine” movement that dates back decades, was home to a measles outbreak earlier this year. Facing high vaccine opt-out rates there, Gov. Jerry Brown is supporting lawmakers who are pushing to write new tougher vaccine exemption policies. Five members of the legislature there have said they planned to introduce legislation to abolish all religious and other personal-beliefs exemptions for parents who do not want their children vaccinated before starting school, leaving only exemptions for medical reasons in place.
Such a move seems highly unlikely in Colorado. The legislature here has wrestled with the vaccine question for years to no effect, and this legislative session, the Republican majority in the Senate has voiced sympathy for the wing of the anti-vaccination movement that sees immunization requirements as the kind of state intrusion on personal decision making that it is better in the long run to resist.
Bring on the Quirky
Given the apparent gridlock on the issue, the thinking among state politics watchers has been that Hickenlooper will mount a public-interest education campaign, the kind he has been so good at undertaking in the past, where he makes himself the face of the message. As Mayor of Denver, he famously appeared in winningly oddball public service TV ads, including one that saw him parachute from an airplane, touting the benefits of a proposed unpopular tax increase. “Voting yes … will help lift us up,” he said as he floated away into the ether.
Denver Congresswoman Diana DeGette doesn’t possess the same kind of oddball charisma and she’s not as well known as Hickenklooper, but she took it upon herself earlier this year to campaign for vaccinations. She taped a public service announcement in her offices and gave it to Colorado television and radio stations.
“She recorded [it] after the measles outbreaks became especially worrying,” said DeGette spokesman Matt Inzeo. “She is the top Democrat at the Energy and Commerce Oversight and Investigations Subcommittee, which oversees public health, and, after bringing in several top Centers for Disease Control and National Institute of Health officials, she thought it was worthwhile… We were grateful so many [broadcasters] have been willing to share it and get the word out.”
But in reply to several requests for comment on the vaccination issue, the governor and his staff — while always clear that the administration fully believed the state’s low vaccination rates were unacceptable — never hinted at plans for a larger advocacy campaign.
That seems out of character. Hickenlooper has shined as a leader when public health and safety in the state have been at risk. His calm and inclusive leadership during the historic floods of 2013 made national news. He was everywhere in the waterlogged regions and all over the media. He successfully tapped local and national officeholders to help green-light material and financial assistance and he encouraged politicians across the aisles to work together — and to be seen working together — to support constituents.
Reacting to floods and fires is the business of disaster relief. Colorado’s Chief Medical Officer, pediatrician Larry Wolk, said Colorado has to begin to work toward vaccine-related disaster prevention.
“We already have the evidence,” he said. “Cases of whooping cough are 200 percent higher here in Colorado due to our below-average immunization rates.”
Wolk would like to see the state tighten the rules around immunization exemptions, but he said the department of public health can’t do that alone. It would take legislation to make it happen.
And that’s where things get complicated.
Even though there has been no bill introduced this session targeting vaccine opt-outs, passionate citizen testimony in favor of broad exemption policy has filled committee hearings on other measures, such as the “Parent’s Bill of Rights,” introduced by conservative Sen. Tim Neville, R-Littleton. His bill aims to elevate parental-power in relation to the state in the public sphere.
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Indeed, hours before Hickenlooper argued in favor of vaccination as a community value, Neville took aim at a bill that would have required naturopaths to notify patients or their parents about the Centers for Disease Control’s recommended vaccinations.
“I want to make the point that, if we can do this as a body, what are we doing to dictate next that our doctors or naturopaths must do?”
Democrats and three swing-district Republicans killed the amendment. But the chamber’s Republican leaders all voted with Neville.
Even in the Democratic-controlled House, tightening vaccine exemptions is an uphill battle.
Freshman Rep. Susan Lontine, D-Denver, has been poring over the Centers for Disease Control report that puts Colorado last in the nation for early childhood vaccinations.
“It’s an accident waiting to happen,” she said. “If you put ten people in a room where someone with measles has been, nine of them will catch it.”
Lontine was chief of staff for physician-senator Irene Aguilar, D-Denver, two years ago when the state legislature started its most recent debate about immunization rates, and she watched with interest last year as the debate continued.
Last year’s vaccine bill, HB 14-1288, garnered headlines and fueled debate even though its proposed changes to existing law were fairly modest. The measure would have required parents seeking exemptions to provide a doctor’s note or take a 45 minute online course about the medical science of immunization. It also required schools to report student-vaccination rates. The bill would not have removed any existing exemptions.
The measure, co-sponsored by Aguilar and Rep. Dan Pabon, D-Denver, was pilloried as government overreach, a form of enforced group-think and an assault on individual rights. It passed the House and was gutted in the Senate. The final law requires only that school vaccine rates be made available online.
Throwing up Hands and a Winking Opportunity
Lontine said that that history at the Capitol and the partisan edge that characterizes politics in the state more generally presses hard against launching any new efforts on the issue.
“I think people outside of this building want something to be done. But here, at the Capitol, it seems like that really loud vocal minority is the one that gets their way,” she said. “What would work is getting rid of the personal exemption, but that’s a huge battle — and actually getting rid of the religious exemption, too, but that would be an even bigger battle…
“I’m throwing up my hands here,” she said at last. “I really, literally, don’t know the answer.”
But Rep. Pabon isn’t ready to give up. He said he thought all the recent coverage in the state and national media has set opportunity winking on the horizon.
“There are more conversations happening,” he said.
Image of Colorado Gov. John Hickenlooper via Flickr.