My name is Gretchen LaSalle and I am a family physician in Spokane, Washington. I am unable to attend the hearing on House Bill 1638 in person but wanted to express my strong support. While you may not see as many white coats outside of your chambers as you do people gathering to claim a rite to deny lifesaving interventions to themselves and their children, I hope that you will recognize that our more limited numbers do not represent a limited interest in this very important matter. We physicians and other medical providers are extremely devoted to the health and wellbeing of our patients. It is our life’s work. In fact, most of us, at the moment that you are reading this letter, are caring for patients in clinic or in the hospital and cannot take time off to attend the upcoming hearing without sacrificing the care of those patients. The growing anti-vaccine and anti-science movement is very personal to us. We know that the decision not to vaccinate not only puts our children at risk but also limits the freedoms of those who desire to participate in society without constant fear of disease. We are all part of a community. We do not live in isolation. We owe it to each member of society to protect each other and to protect those more vulnerable in our midst. My patients who have leukemia or are on immune suppressants for autoimmune disease or who are pregnant cannot get live-attenuated vaccines, like the MMR vaccine. Our infants are too young to get certain immunizations, such as the pertussis vaccine. Yet these are the very people who would see the most harm and have the highest likelihood of dying if they were to contract a vaccine-preventable illness. They rely on the rest of us who can get vaccines to keep them protected. This is herd immunity in action. And even for those of us who can be vaccinated, herd immunity is vital to our health as well. While vaccines are highly effective, they do not work 100% of the time. We all rely on the immunity of others to keep us healthy and safe.
Due to a decrease in vaccination rates around the country and around the world, we are seeing the return of some frightening diseases. Because of the success of vaccines, many diseases, that previously sickened and killed hundreds of thousands of children around the world each year, have been beaten back. But our collective memory is short and the generation of people who remember what life was like before vaccines is passing away. Today’s parents are less aware of how serious these diseases can be and may wrongly assume that these illnesses are mild or that modern medicine will be able to heal any disease that comes their way. Even with advances in medicine, we still see the deaths of tens of thousands in this country due to vaccine-preventable disease. In the United States last year, 80,000 people died from flu, 185 of those were children. Europe saw nearly 60,000 measles infections with upwards of 40 deaths last year, primarily in unvaccinated children. Those who lost their lives to these terrible infections were sons and daughters, fathers and mothers, siblings and grandparents. Each of those lives was precious and each a great loss. Some may comfort themselves in thinking that only those with chronic illness or immune suppression are at risk, that they can somehow escape illness with organic eating and supplements. But vaccine preventable diseases do not discriminate. Review of pediatric flu deaths from years past show that nearly 50% of children that died from the flu were totally healthy. And what about those who have chronic illness or immune suppression? Are their lives any less valuable, less worthy of protecting? I talk to my elderly patients about the anti-vaccine trend happening in our country and around the world and they can’t understand how we can treat life and health so cavalierly.
And while I am exceedingly frustrated and angry with the anti-vaccine movement and their methodical efforts to misinform the public, unnecessarily putting my patients in harm’s way, I am not frustrated with parents. I know that parents who decide against vaccines love their children just as much as those who choose to vaccinate but they are being led astray and taken advantage of by a misguided group of individuals who, at best, are deluded into thinking that they alone have somehow found the truth that all of science and medicine cannot see or, at worst, intend to profit from their misinformation campaigns, convincing patients to buy expensive supplements, ionic waters, and detoxification regimens that have no scientific proof behind their claims of effectiveness.
We physicians and legislators, as servants of the public, are responsible for protecting the health and safety of those we serve and for always acting in the public’s best interest. We have to consider the welfare of the masses over an individual’s claim of freedom to make a choice that puts others and themselves at risk. And when it comes to our children, who have no say in the decisions being made on their behalf, we have a responsibility to ensure the safest action, that which will protect their health and minimize risk of harm. And that action is to vaccinate. Over the decades, billions of vaccines have been administered and millions of lives have been saved and very few serious adverse events have occurred. No vaccine is completely without risk, just as walking down the street or eating are not completely without risk. But the benefit of vaccination to life and health far outweighs the very rare risk of serious reactions (which occur in only one to two in one million individuals vaccinated). As we continue to work on making the most effective and reliable vaccines possible, our current vaccine supply is one of the safest in the world and we have a very robust system of checks and balances to ensure that safety and efficacy.
There is legal precedent for your decision to limit exemptions to vaccination. As far back as the late 1800s and early 1900s when smallpox ravaged continents and killed millions of people, individuals tried to claim that personal choice to vaccinate or not outweighed the right of the masses to remain healthy and free from risk of illness. In 1902, after an outbreak of smallpox in Cambridge, Massachusetts, the U.S. Supreme Court oversaw the case of Jacobson vs Massachusetts in which a man named Henning Jacobson refused smallpox vaccination on the grounds that it violated his right to control what happened to his body. The Court, in its wisdom, decided in the state’s favor with Justice John Harlan, Associate Justice presiding over the case, stating
“[T]he liberty secured by the Constitution…does not import an absolute right in each person to be…wholly freed from restraint…. On any other basis organized society could not exist with safety to its members…. [The Massachusetts Constitution] laid down as fundamental…social compact that the whole people covenants with each citizen, and each citizen with the whole people, that all shall be governed by certain laws for the ‘common good’ and that government is instituted ‘for the protection, safety, prosperity and happiness of the people, and not for the profit, honor or private interests of any one man…’”
In order to achieve herd immunity to the degree that it is effective in limiting spread of disease, we must maintain high levels of vaccination. In the case of measles, a highly contagious and serious disease that, at its mildest leads to the hospitalization of 1 out every 4 people affected and, at its worst, can lead to deafness, brain damage, or death, 95% herd immunity is required to prevent outbreaks. Washington and neighboring states have some of the highest rates of non medical exemptions in the country, in some communities as high as 26% (which means vaccination rates are far below that required to maintain herd immunity). The current measles outbreak that we are dealing with in the states of Washington and Oregon are a direct result of this failure to vaccinate. Conversely, we know that limiting the ability to claim a non-medical exemption has the potential to significantly improve immunization rates. Following the Disneyland measles outbreak in 2014/15, California passed Senate Bill 277, disallowing all non-medical exemptions to vaccine requirements for entry into private or public elementary or secondary schools. The passage of this legislation resulted in an increase of school age immunization rates to 95.1% by 2017, a level high enough to achieve herd immunity and limit disease.
As legislators, you are responsible not only to the health and safety of your people but also to the fiscal repercussions of your decisions. Not only is the expansion of vaccine-preventable illness through lax public health laws costly in terms of human life, it is also exceedingly costly in terms of dollars. A study done in 2013, looking at the cost of adult vaccine-preventable illnesses (influenza, pneumococcal disease, shingles, and whooping cough) in the United States estimated the annual cost for these illnesses in adults over 50 to be 26.5 billion dollars. Imagine the cost if we looked at childhood illness as well!
There is a reason that the World Health Organization listed the anti-vaccination movement as one of its top 10 threats to global health in 2019. The decision you are undertaking is a decision of utmost importance. Our actions in Washington state will have repercussions across the United States and around the world. Following in the footsteps of California, we have a chance to set the tone for a movement against pseudoscience. We have a chance to show the world that we have confidence in our scientists, doctors, and other healthcare providers to offer the best preventive care possible for our citizens. We have a chance to promote facts over fear and to put the health and welfare of our children front and center.
Vaccination is a passion of mine. I truly believe it is one of the most important things we can do to keep our communities healthy and safe. I am happy to make myself available to you if you have any further questions or concerns about vaccines or about what you are hearing from the anti-vaccine community.
Please vote yes to pass House Bill 1638 into law. Preserve our children’s future and ensure that each child gets the chance to live a healthy life and to realize their wondrous human potential.
Gretchen LaSalle, MD