In an effort to better protect against diseases like measles, mumps and rubella, Oregon legislators have passed a law making it more difficult for parents to get an immunization exemption for their kids.
The law goes into effect next month, but it probably won't be an issue for parents until the beginning of the new school year in September.
Last year, about six out of every hundred Oregon kindergarteners got an immunization exemption, for diseases like whooping cough, polio, diphtheria and hepatitis.
Portland pediatrician Jay Rosenbloom says it was too easy for parents to get an exemption.
"All they had to do was turn the form over and there was a box on the back and if they just signed that they could then exempt their child from standard vaccines," he says. "It was the easiest of any state. And there's been studies to show that there's a direct correlation between how easy you make it for parents to exempt and the likelihood that they will just withhold the vaccines. It's a matter of convenience."
Rosenbloom and the Oregon Pediatric Society made this case to the Legislature and it changed the law.
Parents now have two options.
First, they can schedule a meeting with a health care practitioner to talk about the benefits and risks of immunization.
"The second option is to watch an online interactive educational module," says Stacy de Assis Matthews with the Oregon Immunization Program. "And print a certificate at the end of that, turn it into their child's school or child care and claim an exemption."
She understands that parents have concerns. But, she says, the new law is needed to fight disease.
"Immunizations are one of the most important and effective ways that parents can protect their children and we can protect our communities as a whole," she says.
Matthews says the video lasts about an hour and starts with an introduction about how immunizations work and what they are.
Then, she says, it talks about the benefits and risks for each of 11 different diseases.
The video is still being finished..
Matthews believes Oregon is the first state to use video to provide this kind of information, and she thinks it'll sway parents.
"A couple of years ago, Washington passed a law that requires parents who are claiming a non-medical exemption to get education from a practitioner, and they saw their exemption rate decrease by about 25 percent a year or two after that law was passed," Matthews says.
But Emily Gonzales, a student nurse and mother of three, doesn't believe she's going to be swayed by the new requirement.
Her six-year-old son, Noah, has been diagnosed with autism.
He was immunized against Hepatitis B when he was a newborn.
She says she knows that any link between immunizations and autism has been widely rejected by mainstream science. But she's still wary.
"I don't think that it's a single smoking-gun factor," Gonzales says. "We might never know, for sure, what contributed to Noah."
She says for now, she'll be getting exemptions for Noah and his two little sisters.
"What we decide to do in the future is a decision that we will make," said says. "But it should be a decision made between us and our child's doctor, not being influenced in a bully-type style from the CDC or the state of Oregon."
Gonzales says her two daughters recently contracted whooping cough. But, she says, they weathered it fine. She says she treated them with antibiotics and kept them home from school for three weeks.
"I feel like the CDC's job is to worry about the population as a whole. But my job is to worry about my child," she says. "And the CDC may feel that an adverse reaction to a vaccine is acceptable in a small amount of the population. But it's not acceptable to me for my kids."
Portland pediatrician Paul Thomas isn't pleased with the new law either.
He says he gives almost every vaccine to his patients, but on a different schedule from the CDC.
That makes him think twice about signing the new exemption certificate, because it requires he follow CDC recommendations.
Thomas says for that reason, and because it can take a long time to educate a parent about all the different childhood immunizations, many physicians will refer parents to the video.
And he's worried about the objectivity of the video.
"The problem is, we haven't seen this video yet, right?" he says. "I'm pretty sure, I'll go over it in fine detail, that it'll be very lacking in mentioning potential side effects."
Among the audio clips sent to OPB from the video was this warning about the Hepatitis B vaccine: "Some mild problems have been reported, such as soreness at the sight of the shot, among one in every four people. And about one person in every 15 will get a temperature of 99.9 degrees or higher. Severe allergic reactions occur about once for every 1.1 million doses of Hepatitis B vaccine administered."
Dr. Thomas says he's not anti-vaccination, but that the CDC vaccination schedule doesn't fit everyone.
For example, the CDC recommends the first of a series of Hepatitis B vaccines start at birth.
But, Thomas says, the main ways Hepatitis B is transferred is through sex and IV drug use - not something young children tend to get involved with. So, why not wait a few years before starting the vaccine?
"None of us are at risk as long as our moms don't have Hepatitis B, until we do those risky behaviors, lets say teenagers," he says. "So I definitely think the Hep B vaccine makes a lot of sense in the early pre-teen years, before there's any likelihood of them becoming sexually active or IV drug use."
Across town, Jay Rosenbloom, the doctor who lobbied for the new law, says Hepatitis B is a serious disease that is transmitted in ways other than just IV drug use, sex or via an infected mother. For example, he says, it can be transmitted when kids bite each other.
He says delaying immunization or spreading the vaccines out leaves kids vulnerable.
"You increase the number of visits, you increase the number of days the kids get poked," Rosenbloom says. "If an infant gets two pokes or three pokes, they're irritable. If you give then one poke, then one poke, then one poke, that seems downright mean to me. But if parents insist that's how they want to do it, we'll do that to humor the parents, but it's not safer for the children."
In a statement, the CDC says chronic Hepatitis B infections are more likely to occur in people infected as young children. It says the vaccination strategy is to eliminate the virus in the entire country and that means universal vaccination of infants.
Meanwhile, the day Oregon kids will be excluded from school if they aren't immunized and don't have an exemption is Wednesday. But the way the new law is written, childhood exemptions are grandfathered-in.
That means the law's main impact won't actually be felt until September, when the new crop of kindergarteners enroll for their first school year.