Who should decide which vaccines a child must have before attending public school: The state’s public health officials or the state’s elected officials?
That question is being raised by a bill that would prevent the commissioner of the state Department of Health and Human Services from changing the list of vaccines required for enrolling in school or child care facilities, as is currently allowed after a public hearing and hearing before a legislative committee.
If the bill becomes law, any change to the 10 diseases on the list would require a law passed by the full Legislature.
At a hearing Tuesday on this bill, House Bill 361, proponents argued that the change would better allow people to participate in a process that affects tens of thousands of children but is largely unknown to the public.
“There is a perception of secrecy,” said Valerie Fraser, a New Hampton Republican who co-sponsored the bill and the related HB 362. “New Hampshire needs to include, not exclude, parents in creating a … vaccine program that will have the trust, confidence and support of the public.”
In response, Beth Daly, chief of the Bureau of Infectious Disease Control, argued that public participation in the process already exists. A public hearing is required before the DHHS commissioner can make what is known as a rule change to alter the list of vaccine-required diseases, as is a hearing before the Joint Legislative Committee on Administrative Rules.
The bill, she said, would merely slow down a system that may need to respond quickly to new outbreaks or new vaccines.
“While changes are infrequent, it’s important that the department have a flexible and nimble ability to change requirements through administrative rules, so we can protect the public health,” Daly said.
Tuesday’s two-hour hearing before the House Health, Human Services and Elderly Affairs Committee also saw questions raised about whether New Hampshire’s citizen legislature is the right group to make medical decisions for the public.
“Is it your contention that the process of (people) in this room, with a number of individuals of varied backgrounds, listening to testimony, are more likely to perform a good ration, evidence-based scientific decision than a group of trained epidemiologists and physicians?” asked Rep. Jerry Knirk, a physician and Democrat from Freedom.
“That is my contention,” said Michael Plache, an attorney from Wolfeboro who said he had represented large corporations before rule-making government bodies. “It has to do with what form the (doctors’) training takes, and what the incentives are.”
Similar suspicions of the medical establishment were reflected by many of the dozen people who showed up Tuesday to speak in favor of this bill and a related one. Their testimony dealt as often with their opposition to vaccines as with the process by which New Hampshire requires them in schools. More than one speaker, for example, referenced the belief that vaccines cause autism, which has long been discredited by medical authorities.
Supporters of the bills, who included a registered nurse and a pharmacist, argued that vaccines were inherently unsafe and largely unnecessary, the product of a system skewed by pharmaceutical companies’ payments to doctors and its manipulation of regulators and the federal Centers for Disease Control and Prevention.
“The CDC is a broken agency, with a history of ignoring vaccine injury,” argued Jack Shimek, representing an anti-vaccine group called Health Freedom New Hampshire.
Opponents of the bills, including a representative from March of Dimes and a physician, noted that vaccines have saved thousands of lives in New Hampshire and millions around the world, and have wiped out or almost eliminated many diseases that were once a scourge of daily life, such as smallpox and polio.
As an example of the current process in action, Daly said that when medical research found that a second dose of the chicken pox vaccine was needed to make it effective, the state added that booster as a requirement.
“Back in 2006, before we implemented the second-dose requirement, we had 419 cases of chicken pox, including one death. That dropped to 75 last year – so it has been very successful,” she said. “Chicken pox is not just a nuisance disease.”
State law mandates vaccinations for seven diseases including measles, mumps and tetanus, while the DHHS has used its rule-making authority to add two diseases for school enrollment – chicken pox and hepatitis B – and one – haemophilus influenza or Hib, which only affects small children – for child care.
The CDC recommends that vaccines be given for a total of 16 diseases, but it is up to states to mandate the shots. Exemptions from vaccinations are allowed in New Hampshire for medical or religious reasons, but the legislature has rejected attempts to allow exemptions based on parental preference.
The bill debated Tuesday, HB 361, would prevent the addition of vaccines for “non-communicable diseases” to the mandated school and child-care list.
Although this bill does not mention any specific disease, speakers said it targets hepatitis B, which is transmitted through contact with some bodily fluids such as blood. It was unclear Tuesday whether hepatitis B would be defined as noncommunicable under current state definitions.
“It is not communicable in a classroom setting,” said Laura Condon, state director of advocacy for the nonprofit National Vaccine Information Center.
Mandatory vaccination for hepatitis B is often controversial because while the disease can cause serious health problems in adults, it rarely shows up in children. It is most often acquired in teenage years or later through sexual conduct or such activities as sharing of needles in drug use.
Public health advocates say that vaccinating all children against hepatitis B is the best way to reduce the cost of the disease showing up in the population, since high-risk adults often don’t get vaccinated. Opponents argue that all children shouldn’t be exposed to possible side effects of the vaccine merely because of activities by some adults.
If passed, this bill would likely prevent New Hampshire from mandating vaccines for other diseases that show up later due to lifestyle choices, including the HPV vaccine, which protects against cervical cancer and genital warts. HPV is common among sexually active adults.
(David Brooks can be reached at 369-3313 or email@example.com or on Twitter @GraniteGeek)