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Will Trump Administration Seek to Weaken Vaccine Requirements?

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President-elect Donald Trump has expressed some skepticism about vaccine requirements in the past. Will that skepticism be reflected in the work of his administration?

Concerns among vaccine supporters flared up again Tuesday when, after visiting Trump, Robert F. Kennedy Jr. said he agreed to "chair a commission on vaccine safety and scientific integrity"  at the president-elect's request, according to press pool reports. Kennedy, the son of the late Robert F. Kennedy and nephew of President John F. Kennedy, is an attorney and vocal vaccine critic.

The purpose of the commission would be "to make sure we have scientific integrity in the vaccine process for efficacy and safety effects," Kennedy told reporters.

"President-elect Trump has some doubts about the current vaccine policies and he has questions about it," Kennedy said. "His opinion doesn't matter but the science does matter and we ought to be reading the science and we ought to be debating the science. And that everybody ought to be able to be assured that the vaccines that we have—he's very pro-vaccine, as am I—but
they're as safe as they possibly can be."

Critics of vaccine requirements for school attendance, which are set at the state level, rely on disproven claims that link them to autism. As my colleague Christina Samuels wrote after the subject was raised at a Republican primary debate last year, vaccines do not cause autism. Not even receiving multiple vaccines at one time.

At that debate, Trump said "autism has become an epidemic" and that it's gotten "totally out of control." He believes that vaccines should be given on a different schedule. "I am totally in favor of vaccines. But I want smaller doses over a longer period of time," Trump said.

As Samuels wrote:

"As a percentage of the entire student population, children and youth with autism have increased from 0.2 percent in 2000-01 to 0.9 in 2011-12, according to the Department of Education.

But what is behind those numbers? As I explained in a blog post earlier this year, scientists believe diagnostic substitution accounts for at least some of the increase in autism prevalence. Doctors are diagnosing as autism what might have been classified as intellectual disabilities in previous years. Doctors are also better at spotting autism behaviors that might have gone undiagnosed in the past."

Who decides vaccine requirements? And who decides what children are exempt?

Every state sets its own vaccine requirements for school attendance, relying on federal recommendations. The greatest difference in these requirements lies in how and why families can claim exemptions based on religious, personal, or philosophical reasons.

" Almost all states grant religious exemptions for people who have religious beliefs against immunizations," according to the National Conference of State Legislators. "Currently, 18 states allow philosophical exemptions for those who object to immunizations because of personal, moral or other beliefs."

ExImmunMap15-Tuesday.gifAs I've written previously, several states have made efforts to tighten those loopholes in recent years. Supporters of those efforts argue that philosophical exemptions are too broad. As I wrote in 2014:

"Requiring vaccines before school admission has been a key component of a decades-long campaign that had nearly rid the United States of some of its most severe illnesses, from the measles to whooping cough, public-health experts say. But they also warn that broad "personal belief" exemptions that don't relate to a child's medical condition or a family's religious beliefs have made it too easy to bypass vaccines, poking a sizable hole in the public-health safety net.

While some parents act out of a sense of personal conviction, others do so simply because they don't have time to schedule an appointment, said Stephanie L. Wasserman, the executive director of the Colorado Children's Immunization Coalition, an Aurora, Colo.-based group that seeks to increase vaccine coverage in the state.

"We want to close that convenience loophole," she said. "When you choose not to immunize, there are consequences not only to your child and your family; there are consequences to your community as well.""

So how could the Trump administration affect vaccine efforts?

For one, the very creation of such a commission lends credibility and a pretty big voice to vaccine skeptics. 

As president, Trump will also appoint officials to high positions in agencies that set vaccine recommendations and fund research, including the Centers for Disease Control and Prevention.

And the presidential megaphone can influence both the behavior of individual families and the political will to pass policies at the state and local level in support of vaccines.

Photo: Nurse Catherine Craige draws a chickenpox vaccination in Berlin, Vt. -Toby Talbot/AP-File


Related reading on vaccines:

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