Massachusetts, Vaccinations and Pandemic Response

Sharon September 25th, 2009

I spent the better part of two decades living in Massachusetts, so when I saw several people linking to a Fox News report (this should be an alarm button right there) that Massachusetts had instituted forcible vaccinations, would be kidnapping people and instituting a “medical police state”, etc… I figured I ought to at least go read the language of the new law, senate bill 2028.  Now remember, this is not law, it has passed the state senate, but not the house.

What I found is troubling, but perhaps not quite what some of its critics are saying.  What’s most troubling about it is the idea that these policies could be enacted for a low-severity flu virus like the present form of H1N1.  I think that this is extremely disturbing – the level of hype about pandemic influenza is so high that it is extremely worrisome to imagine that the Massachusetts governor could apply these to a low-severity virus.   This bill *absolutely* must include clearer language about when a pandemic emergency can be declared, and about the number of medical agencies that must achieve consensus that there is just cause for such an emergency.  The absence of sufficient language in that regard should be enough to kill the bill.

That said, however, most of the most controversial requirements are medically appropriate for preventing the spread of disease, assuming that the disease was a high mortality, highly contagious disease such as Ebola, Plague, a very high mortality flu, etc….  It should not be applied to any medical emergency that doesn’t meet both the criteria of high mortality (in excess of 5%), and *also* high degrees of transmissability – ie, airborn or easily contact-spread virii only.  What the bill needs is a set of restrictive premises under which it could be enacted, and a lot more appropriate medical language.  There are also some real concerns, particular permission for law enforcement officials to deem appropriate arrest without a warrant, to enter buildings without a warrant, and the lack of parameters about what constitutes “decontamination of persons”.  Again, there’s a lot not to like here, and I think the bill should be killed and sent back for rewriting.

But I’d like for a second to talk about the medical realities of a real, high mortality pandemic – consider, for example, the outbreak of pneumonic plague that occurred in Ziketan in Northwest China over the summer.  Pneumonic plague is airborn, highly contagious, is often fatal as quickly as 24 hours after being contracted and has a mortality rate of nearly 100% without aggressive early treatment within 24 hours of symptoms, and mortality rates above 20% with aggressive antibiotic treatment.  7 days of heavy antibiotic treatment in advance will almost always prevent the spread of the disease.

Now we are all very fortunate that during the last outbreak of pneumonic plague, it occurred in very isolated northern china, and that no one got on a plane that was infected.  The total deaths were limited to three, only 12 people actually contracted the disease.  But this is the case *because* China enacted policies that are pretty much the ones described in the Massachusetts laws – they isolated the entire town, quarantined people in their houses, with strong penalties for leaving them, they treated anyone who might have been exposed with antibiotics, whether they wanted them or not, they commandeered facilities and enacted martial law.

Had they not done so, had a person carrying pneumonic plague, say hopped a flight to London and survived 48 hours touring that city, while his flightmates went on to New York, Paris and Johannesburg, we might have had a world-wide outbreak of pneumonic plague.  In that situation, any rational government would do what China did – quarantine, close the cities, ground the planes, mandate antibiotic treatment or quarantine for everyone exposed – period.  And quite honestly, it would be insane to do otherwise – the rights of other people stop well short of killing thousands of other people.

Everyone raise your hands who would be happy with a purely voluntary treatement and quarantine policy in this case?  Every parent who has ever known any other parent to send a sick kid to school, raise your hands?  Every adult who has ever had a co-worker come sick to work, even when they shouldn’t have, raise your hands.  Everyone who has ever met an illegal immigrant who would be unlikely to come forward to for any program involving “authorities” raise your hand.  Seriously, I think while it is deeply important not to overstate the risks of H1N1 or to allow them to constrain our freedoms, it is also important to recognize that in a world where people travel the globe, it is possible to imagine a situation in which the transmission of a major illness can only be constrained with the restriction of personal freedoms. 

I generally support the right of parents and adults to choose to be vaccinated or not – and much of the controversy focuses on the provision for vaccines - Fox News talks about forcible vaccinations. In fact, the bill provides for forcible vaccinations *or* quarantine – that is, if you are exposed to the disease or living in an area where a pandemic is rampant, if you decline vaccination, you must be quarantined.  I have no ethical problem with this, again, provided that reasonable provisions are made to make sure that pandemic response is enacted only in the case of a high mortality outbreak.  I think that given the limited testing of the H1N1 vaccine, it is perfectly reasonable, in a low mortality outbreak like the present one for everyone to have the right of refusal. 

But that is not the case were the H1N1 documentably to mutate into a high mortality disease – I agree that even in those cases, no one should be forced to take the vaccine.  But if you aren’t going to take it, *in a situation where there is a high mortality virus to which you could expose others*  you do have an obligation not to infect others – ie, to accept quarantine.  This cannot cause undue hardship because the Massachusetts law explicitly provides for unemployment payments for anyone who either is in quarantine themselves or who is required to tend a quarantined child, and prohibits with legal penalties the firing of anyone because they have been put into quarantine.  IMHO, this is about as just an arrangement as can possibly be made – my family might well refuse a vaccine I believed to be dangerous or ineffective, but I don’t believe that the quarantine obligation is then unfairly onerous – again, assuming that the regulations are enacted only in situations of great exigency.

The reality is this – there are occasions in which personal freedoms are subsumed in a crisis.  I understand that all Americans have excellent reason to fear, in the years since 9/11, the use of a crisis as excuse to limit our freedoms – this is legitimate, and it is right. But it is also the case that there are times when all of us using our own personal judgement to make decisions are unacceptable – and we know this.  It is a difficult thing to balance these, but I think it is important for Massachusetts residents to oppose senate bill 2028 *on the correct grounds* – not because the state never has the right to subsume individual rights the rights of the public not to die, but because they only rarely, and in extreme exigency do.

I think that Senate Bill 2028 is a failed bill, that it should not pass the House in Massachusetts and it needs to be rewritten and amended.  That said, however, it is also necessary at times for us to be able to constrain the spread of disease – because the odds are excellent that sooner or later, some of us will need someone to articulate the rights of other people not to be exposed.

Sharon

14 Responses to “Massachusetts, Vaccinations and Pandemic Response”

  1. Grandma Mision 25 Sep 2009 at 12:02 pm

    Well said Sharon! I agree 100% (and as a person who would normally never get a “flu shot” or any other vaccination due to safety and efficacy concerns)

  2. Adrienneon 25 Sep 2009 at 12:12 pm

    Sharon, have you ever read a book called “World War Z” by Max Brooks? It’s about, quite literally, the zombie apocalypse. I just finished reading it last night. Funny as it sounds, this book brings up some of the same issues of how to deal with a disease outbreak as those that are currently being considered regarding H1N1. In the book, since being infected by a zombie is 100% fatal (you don’t exactly die, you become “undead”) only the governments that take the harshest containment tactics are successful, but most governments are too hesitant to step in and remove freedoms. It’s been interesting contrasting literature with reality.

  3. ctdaffodilon 25 Sep 2009 at 1:01 pm

    Our town has said they will only cause school if 50% of students (or higher) is out sick with H1N1 – but due to privacy they won’t even tell the parents of at risk students if there is a case in that child’s grade. Meaning I’m most likely homeschooling for the winter since I live with 3 high risk people.

    oh and our school will be used as a vacination site.

    The whole mess is just that a MESS

  4. Robyn M.on 25 Sep 2009 at 2:24 pm

    Sharon, thank you for being sane.

  5. Eminently sensible. I do wonder how many frothing…er, I mean *differing opinion* comments you’ll get on this post.

  6. kateon 25 Sep 2009 at 3:51 pm

    “In fact, the bill provides for forcible vaccinations *or* quarantine – that is, if you are exposed to the disease or living in an area where a pandemic is rampant, if you decline vaccination, you must be quarantined.”

    Just to clarify, is there no ambiguity in the bill that it’s the person that gets to make the choice between the two, not the state? (I haven’t read it)

    I have no problem if that is the case. Quarantine seems very sensible, and at the risk of inducing frothing ;-) , more sensible than vaccinations that have a failure rate.

  7. Sharonon 25 Sep 2009 at 4:01 pm

    There is no ambiguity that people are pemitted to decline the vaccinations, and choose quarantine. And again, if they choose quarantine, there is also no ambiguity that I can see that they are eligible for unemployment benefits and job protection – that is, they can’t be pressured by employers into choosing the vaccine by the threat of economic harm.

    Sharon

  8. NMon 25 Sep 2009 at 7:52 pm

    An excellent piece, thank you.

  9. kateon 25 Sep 2009 at 11:25 pm

    Thanks for confirming that Sharon. It’s good to have this post to refer people to.

  10. Dianaon 26 Sep 2009 at 12:53 pm

    Glad you’re keeping up with all this stuff, Sharon! Hate to just get the Faux News version circulating.

  11. karynon 26 Sep 2009 at 1:47 pm

    I wonder how much the effectiveness of quarantines relies on the compliance of the people. I picture the Chinese people being more conscientious about reporting their illness and complying with the quarantine because they have a greater sense of the importance of the community’s wellbeing (this may be my own faulty assumption of Asian behavior). On the other hand, I picture Americans disregarding the health of others if it impinges on their schedule.

    When my friend went home to Japan during the first H1N1 outbreak, she said the health department called her every day for a week to see if she or her children had any symptoms. I’m not saying that is a great policy, but it seems the Japanese are more accepting of this infringement than most Americans would be.

  12. Annon 28 Sep 2009 at 12:10 pm

    Something else to consider is that vaccinations are not a cure for colds and flus, or a way of preventing them, as many people who get vaccinated will attest to. Vaccinations lessen or decrease the intensity and the duration of the flu.
    I think the drug companies often forget to tell us that the vaccination won’t stop you from getting the flu. Strange, huh?

  13. Ed Strakeron 29 Sep 2009 at 2:39 pm

    Sharon, you failed to directly address that there is large streak of doomers who believe one or more of the following:

    * Swine flu is a manmade genocidal conspiracy
    * Swine flu VACCINE is a manmade genocidal conspiracy
    * _Both_ of the above (as contradictory as that may seem)
    * Vaccines cause (fill in whatever disease you want)
    * Vaccination is always a threat to civil liberties (Typhoid May? Who’s Typhoid Mary?)

    There is a lot of ideological baggage that tends to come along for the ride with doomers and this is one of them.

    I find it ironic that doomers who presumably are all-consumed with avoiding risk might actually expose themselves and others to more risk by taking an anti-vaccination stance.

    It’s doubly ironic considering that many doomers feel the major vector for die-off will be pandemics. Such pandemics will have a much easier time of doing Gaia’s dirty work if we do not vaccinate.

  14. Ellaon 11 Oct 2009 at 9:35 am

    A random google search lead me to your page, and I really commend your ‘talking sense’ about an issue that a small minority in the Commonwealth actually knows about– which I think is one of my main concerns surrounding this bill. This was one of those hush-hush jobs that was passed in the wee hours, and one has to wonder why they wanted it to fly under the radar.

    I have a correction for your piece and an added tidbit. The correction is that MA doesn’t require people in quarantine to receive their full salary, but that people in quarantine qualify for unemployment benefits during the time of their quarantine. Often times, you’re not receiving the full amount of your salary while receiving UE. The tidbit of information is that there will be fines of $1000/day plus 30 days of jail for people who refuse to be immunized/quarantined. But looking at the date you posed this, I’m not sure that information was public at that point.

    Most of the people who have responded seem fairly educated and know the difference between when they should comply and when they should put up a fuss. You throw something like ebola out there, and I have a hard time seeing anyone that would refuse either quarantine or immunization in that case. But H1N1? Come on, people. Overall you have a better shot at dying from the normal flu than dying from H1N1. Yet that is the vector that people are worried about this applying to.

    With the public fear of H1N1 mixed with the high number of people who refuse to get H1N1 immunization, I honestly wouldn’t be surprised if Deval truly believes he’s acting in the Commonwealth’s best interest by forcing immunizations to certain demographics if not the entire state. Let’s keep in mind that the same state that is passing this is also the same state that went into a state of emergency for the sole reason of the governor being able to hand-pick the successor to Ted Kennedy rather than having it go to a vote (I won’t get into the mess that is how we’re supposed to pick our senate if a seat is emptied mid-term, but as I said–it’s a mess). I don’t know why we entered state of emergency. There was no flood. No impending doom. Just the chance that someone who potentially followed a different set of political beliefs as Ted Kennedy could be placed into the Senate. Apparently that was scary enough for people that the entire state needed to be in a state of emergency. Bottom line- I don’t have faith that Deval Patrick would have the composure to handle such a decision that teeters on the fringe, such as H1N1. I do have faith that he could make the call on ebola. And as I believe the bill is written, it seems to be HIS decision.

    I would be one of those people refusing the vaccination (in the case of H1N1), paying thousands of dollars in fines and possibly being jailed. Why? I work in the pharmaceutical/biotechnology field in drug discovery. I know how long it *should* take a drug or vaccine to pass FDA regulations. In my opinion, the current H1N1 vaccine is a rush job. I believe they’ve only tested it on 100 pregnant women and a handful of others not nearly in numbers comparable to a traditional drug study. Yet they’re forcing it down everyone’s throat. I realize it’s just a flu shot. If that’s the logic, then why when the normal flu shot is optional to most people in most occupations, would we ever require THIS type of flu shot other than to stifle potential public outcry. At least now it looks like something is being done about it. And that’s not good enough a reason for me to get one even if the governor thinks it is.

    Bottom line- you’re right. There are a lot of things that seem silly about people getting their panties in a wad over this bill. But after reading it a few times (http://www.mass.gov/legis/bills/senate/186/st02pdf/st02028.pdf) I have to wonder why the timing of it coincides with H1N1 paranoia.

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