Question 1 on the March 3 Maine special referendum ballot would overturn the law that removes religious and philosophical exemptions to immunization requirements.
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Maine voters on March 3 will decide the fate of a new state law that removed ‌philosophical‌ ‌and‌ ‌religious‌ ‌exemptions‌ ‌to‌ ‌vaccine‌ ‌mandates‌. A people’s veto campaign gathered enough verified signatures to put Question 1 on the ballot.

With‌ ‌less‌ ‌than‌ ‌two ‌weeks‌ ‌before‌ ‌the‌ vote,‌ ‌the‌ ‌Yes‌ ‌on‌ ‌1‌/‌Reject‌ ‌Big‌ ‌Pharma‌ ‌campaign and‌ opposition group ‌Maine‌ ‌Families‌ ‌for‌ ‌Vaccines‌ ‌‌are‌ ‌going‌ ‌full‌ ‌tilt.‌ Proponents‌ ‌‌raised‌ ‌$139,000‌ as of Dec. 31, 2019, while‌ opponents ‌‌raised‌ ‌$58,000. ‌‌It‌ ‌is‌ ‌an‌ ‌issue‌ ‌that‌ ‌pits ‌medical‌ ‌science‌ ‌‌against‌ ‌lack‌ ‌of‌ ‌trust‌ ‌in‌ ‌professional‌ ‌elites.‌ ‌ ‌

No‌ ‌on‌ ‌1‌ ‌campaign‌ ‌manager‌ ‌Bobby‌ ‌Reynolds‌ ‌declined‌ ‌to‌ ‌send‌ ‌a‌ ‌representative ‌to‌ ‌participate‌ ‌in‌ ‌a‌ ‌debate‌ ‌at‌ ‌the‌ ‌Portland‌ ‌Phoenix,‌ ‌so‌ ‌a Phoenix reporter ‌met‌ ‌with‌ ‌Yes‌ ‌on‌ ‌1‌ ‌campaign‌ ‌manager‌ ‌Cara‌ ‌Sacks‌ ‌and‌ ‌No‌ ‌on‌ ‌1‌ ‌spokeswoman‌ ‌Dr.‌ ‌Laura‌ ‌Blaisdell‌ ‌separately‌ ‌to‌ ‌discuss‌ ‌their‌ ‌campaigns.‌ ‌

Blaisdell‌ ‌said‌ ‌the‌ ‌bottom‌ ‌line‌ ‌for‌ ‌the‌ ‌No‌ ‌on‌ ‌1‌ ‌campaign‌ ‌is‌ ‌that‌ ‌there‌ ‌is‌ ‌a‌ ‌problem‌ ‌of‌ ‌outbreaks‌ ‌of‌ ‌diseases‌ ‌in‌ ‌schools,‌ ‌and‌ ‌the‌ ‌cause,‌ ‌with‌ ‌unequivocal‌ ‌evidence,‌ ‌is‌ ‌that‌ ‌fewer‌ ‌children‌ are ‌‌vaccinated.‌ ‌While‌ ‌the‌ ‌other‌ ‌side‌ ‌does‌ ‌not‌ ‌have‌ ‌a‌ ‌solution‌ ‌to‌ ‌that‌ ‌problem,‌ ‌because‌ ‌they‌ ‌are‌ ‌not‌ ‌public‌ ‌health‌ ‌experts,‌ ‌she‌ ‌said,‌ ‌the‌ ‌vaccine‌ ‌law‌ ‌that‌ ‌was‌ ‌passed‌ ‌is‌ ‌the‌ ‌most‌ ‌fair‌ ‌solution.‌ ‌

Dr. Laura Blaisdell, co-chairwoman of Maine Families for Vaccines, the organization behind the No on 1 campaign. (Portland Phoenix/Jordan Bailey)

Cara Sacks, campaign manager for the Yes on 1 people’s veto effort. (Portland Phoenix/Jordan Bailey)

The‌ ‌Maine‌ ‌Centers for Disease Control and Prevention ‌reports‌ ‌that‌ ‌immunization‌ ‌rates‌ ‌have ‌fallen‌ ‌to‌ ‌93.8‌ ‌percent‌ ‌among‌ ‌school-age‌ ‌children‌ ‌–‌ below‌ ‌the‌ ‌95‌ ‌percent‌ ‌herd-immunity‌ ‌level‌ ‌required‌ ‌for‌ ‌all‌ ‌vaccines‌ ‌except‌ ‌varicella.‌ ‌Non‌-‌medical‌ ‌exemptions‌ ‌‌increased ‌to‌ ‌5.6‌ ‌percent‌ ‌in‌ ‌the‌ ‌2018-2019‌ ‌school‌ ‌year.‌ ‌At‌ ‌the‌ ‌same‌ ‌time,‌ ‌Maine‌ ‌has‌ ‌the‌ ‌highest‌ rate of ‌pertussis‌ (whooping cough) ‌‌in‌ ‌the‌ ‌country.‌ ‌ ‌

When asked about the primary message of the Yes campaign, Sacks said the issue has been misrepresented as pro- versus anti-vaccine. She said the real goal of the people’s veto is to preserve parents’ rights to make their own medical decisions with their doctors.

A theme in her answers was that people could make their own decisions despite the pronouncements of medical organizations, political party leadership, and religious authorities.

Trust in medical professionals

Sacks said patients should be able to discuss with their doctors the risk of the disease versus the risk of the vaccine, and determine for themselves or their children if vaccination is the right decision at that time. She said the side effects listed in vaccine documentation are alarming.

Blaisdell said people choose to go into pediatrics because they care about the health and well-being of children and that no pediatrician wants to give children vaccines if they’re going to be harmed by them.

“It’s preposterous to think that we would be acting against the good faith of our Hippocratic oath to do no harm,” she said. “The big issue is, do we trust our professionals? Do we trust doctors? And if you needed a second opinion, do we trust every single doctor in Maine, every single major health organization, every major medical group?”

The No on 1 coalition includes the Maine Medical Association, the American Nurses Association, the Maine Association of School Nurses, pediatricians, family practice doctors, anesthesiologists, radiologists, psychiatrists, hospitals and health-care networks.

But with the democratization of knowledge accelerating in the digital age, some people are becoming less inclined to trust the authority of professionals.

“If I have a medical issue happening, I very often know more about it than my doctor because this is the information age,” Sacks said. “I can read everything under the sun about it. The No campaign is really running this patriarchal ‘We’re doctors in white coats; we know what’s best for you and your child; do what we say’ (campaign), which is kind of surprising to me – that doctors would be taking that approach of overriding patients’ informed consent.”

Politics of vote timing

The bill in question, LD 798, passed 79-62 in the Maine House of Representatives with only five Democrats opposed, and 19-16 in the Senate with only three Democrats opposed. Just one Republican senator and three Republican representatives voted for the bill.

Some have speculated that since the March 3 vote is the same day as the presidential primaries, and Democrats have a contentious, multi-candidate slate while Republicans have an incumbent candidate, more Democrats will go to the polls and vote against Question 1.

There is also speculation that a large turnout of anti-establishment, left-leaning Democratics could benefit the Yes on 1 campaign. But both Sacks and Blaisdell believe the issue has bipartisan support, in their favor.

Sacks said Yes on 1 had hoped the question would be on the June ballot. But she said she is not concerned. “What we find in talking with people, and then in the polling calls that we’re doing as volunteers is that we actually poll a little bit better with Democrats anyway,” she said. “We’re really a multi-partisan group.”

Sacks added that her main concern is that people may not know that the election is happening, so volunteers are putting their efforts into a get-out-the-vote campaign involving literature, phone calls and door-to-door outreach.

Blaisdell said that since close to 95 percent of parents vaccinate their children, she believes there will be a strong showing of No on 1 voters.

Fear of disease: Propaganda?

Blaisdell warned against forgetting about the dangers of the diseases vaccines protect against.

“We have this sense that we should be able to live a life free of disease,” she said. “People forget the dreaded summers of polio, (and) that measles once kept communities paralyzed.  It’s that short-sightedness that I think is really so devastating for those of us who are the ones who intubate babies (who have) pertussis and try to watch as they struggle to breathe. … Infectious diseases like measles don’t care if we forget. If we forget and we don’t vaccinate, they’ll come back and they’ll hurt and kill many children.”

Sacks argued that the No on 1 campaign uses propaganda and fear to support its cause, and said the media is complicit.

“I think it gets reported as though if you get measles you die in an hour kind of thing,” she said. “It’s exaggerated. The treatments are all different now. So it’s confusing for people because, when we had polio, in the ’50s, the treatment and our understanding of it was really different then. When people are getting these impressions from the media, it’s not grounded in the science and understanding of what typically happens. It’s usually the worst-case scenario, like that a child’s going to die if they get measles.”

The U.S. Centers for Disease Control and Prevention and the World Health Organization estimate that more than 140,000 people died worldwide from measles in 2018. There have been no deaths from measles in the U.S. since 2015, according to the CDC.

Blaisdell pointed out a recent measles outbreak in Samoa between September and December 2019 killed 81 people, most of them babies and young children, and infected more than 5,600 others. Immunization rates dropped to 31 percent there after two children died from vaccines that were found to have been contaminated by nurses who later pleaded guilty to manslaughter.

There is still no cure for polio, according to the World Health Organization.

Medical exemption too narrow?

A major argument from the Yes on 1 campaign is that the philosophical exemption is used by those who believe they have legitimate medical concerns but have been unable to get a medical exemption from their doctor under existing law. Medical exemptions account for 0.6 percent of exemptions in Maine, according to the state CDC.

During consideration of LD 798, the medical exemption language was broadened to cover cases where a vaccination was “medically inadvisable,” as determined by a medical professional.

But Sacks said people are still being told they would be denied medical exemptions under that expanded language.

“I think that’s why we have such an unprecedented grassroots showing,” she said. “We’ve had parents literally be told by their doctor, I’m a member of the American Academy of Pediatrics, so I’m not allowed to write a medical exemption.”

Blaisdell, vice president of the Maine chapter of the AAP, said the organization worked to ensure that the language was broad so the government would not dictate what constitutes a medical exemption. If a child has what could be a reaction to a vaccine, a physician would look at the situation and take into account such things as what vaccine it was and how many times the child had that vaccine, to determine whether the reaction was caused by the vaccine.

“The law that was passed is much more lenient and liberal in allowing physicians to write medical exemptions,” she said. “You have to be (a medical doctor, doctor of osteopathic medicine, nurse practitioner or physician assistant), and in your professional opinion, it has to be ‘medically inadvisable.’ There is no other way to ensure that a medical exemption is true than to write it in that fashion.”

Religious exemptions

Vaccine ingredients forbidden by some religions – for example, gelatins derived from pigs and cell lines derived from aborted fetuses – are the main cause for the religious exemption.

But Blaisdell said that no major religion opposes vaccinations, and the Maine Council of Churches recently joined the No on 1 coalition.

The National Catholic Bioethics Center has said one is morally free to use a vaccine, despite its historical association with abortion, if there is a proportionately serious reason for doing so. It points to risks to personal and public health as sufficient reason, stating “this is especially important for parents who have a moral obligation to protect the life and health of their children and those around them.”

In August 2018, the Indonesian Ulama Council, the supreme Muslim authority in Indonesia, issued the first fatwa against a vaccine, declaring the measles and rubella vaccine “haram” (forbidden) because of its ingredients derived from pigs. However, the council then revised its position, saying the prohibition was superseded by the risks to public health of failing to vaccinate against the diseases.

The pork gelatin used in some vaccines was previously declared pure and thus permissible to eat by more than 100 Islamic scholars at 1995 Islamic Organization for Medical Sciences seminar where the Eastern Meditteranean Regional Office of the World Health Organization was represented.

The orthodox Jewish position has been that guarding one’s health is a mitzvah – a good deed done from religious duty. When the smallpox vaccine was introduced, Rabbi Yisroel Lipschutz, a leading 19th-century rabbi, ruled that despite the one in 1,000 risk of death from the vaccine, one should still get vaccinated. When the polio vaccine was introduced, Rabbi Menachem M. Schneerson, considered one of the most influential Jewish leaders of the 20th century, said the axiom “do not set yourself apart from the community” applies, so children should do as the majority of children in their classes with regards to vaccination. Recently the chief authority of medical law at Shaare Tzedek Medical Center in Jerusalem, Rabbi Asher Weiss, endorsed vaccines and said mandatory vaccination is justified.

However, despite such pronouncements, Sacks said that some members of those and other religions may choose to opt out of vaccines for religious reasons.

Balancing herd immunity, personal choice

Sacks expressed skepticism at how the immunization rates are calculated and how the 95 percent community-immunity goal was set, pointing out that some vaccines are less effective than others, that there are many groups not taken into account in that figure, and that it only applies to schools, not society as a whole.

“We are already at a voluntary 95 percent vaccination rate without using coercion,” she said. “If the goal of the legislation is to increase the strength of our herd immunity, we would argue that the way to do that would be through a voluntary collaborative relationship, rather than by forcing people into participating.”

Blaisdell said that non-medical exemption rates have gone up at half a percent a year, and are currently at 5.6 percent, and that including medical exemptions the rate is 6.2 percent, which means the immunization rate is currently less than 95 percent.

Blaisdell said the 95 percent rate established for community immunity factors in individuals who are either not vaccinated, cannot be vaccinated, or have insufficient passive immunity, and accounts for the different infectivity rates of different diseases.

Measles is so infectious and virulent, she said, that it requires 95 percent of individuals to be immunized in order for it not to catch fire in the community, while other diseases have less infectivity.

“When we are operating in terms of public health, and making sure that schools are safe for everyone, we don’t get into the nitty-gritty,” she said. “When it comes to what we need to do for our schools in terms of protecting them for all children who are there, we set the bar high.”

Setting that bar at 95 percent, she said, ensures that schools are safe for all students and staff, including those with cancer, or those on immunosuppressive therapy.

“Those are the individuals that are increasingly part of our communities and what is their right?” she asked. “They have the right to attend a safe school and they have no choice in the matter.”

Sacks argued that using vaccination as a condition for school attendance discriminates against healthy children, many of whom are opting out of vaccines for legitimate medical reasons or who would be barred from school for missing just one dose of one vaccine.

“Telling them, ‘well, you can just homeschool your kid,’ is an unfair burden on kids that are healthy,” she said.

Blaisdell said vaccination is not mandatory, that homeschooling or online schooling is the option for parents who choose not to vaccinate their children.

“If they don’t like the social contract that we’re making, they still have a choice to not vaccinate,” she said, “but the rest of us who are playing by the rules and caring for our communities by vaccinating our children, we are saying no. Enough is enough.”

Big Pharma’s role

The Yes on 1 campaign slogan is “Reject Big Pharma.”

Sacks said the pharmaceutical industry influences the vaccine debate, and benefits from vaccine mandates. She pointed to a $476,000 TV ad for the No on 1 campaign, paid for by the pharmaceutical industry. She said parents question the aggressiveness of the U.S. CDC’s vaccine schedule that recommends 69 doses, and why pharmaceutical company Merck is lobbying to require Gardasil, the HPV vaccine it developed, to be added to school-mandate in various states. (It is not mandated in Maine.)

Sacks referenced Merck’s third-quarter report, which lists Gardasil as its second-highest-selling pharmaceutical product.

“The industry has all this influence and then we’re just going to mandate that all kids have to participate in this system,” she said. “And it’s a really hated industry across the board. It always profits over patients, which we see with the opioid crisis.”

Further, she said that a lack of competition in the industry leads to poor accountability. The WHO reports that relatively few vaccine manufacturers meet international standards of quality, that 80 percent of global vaccine sales come from five multinational corporations, and that many vaccine markets are monopolies or oligopolies.

Blaisdell said she thinks that it is “disingenuous and cynical” to say that vaccines are a money-making scheme. She said the state purchases vaccines on behalf of everyone under the age of 18 and uses collective bargaining practices to bring down the costs.

“I for one am so glad that pharmaceuticals are making vaccines,” she said. “Who else is going to make vaccines? In whose world is it going to be made by a nonprofit? It just is unrealistic, and frankly, naive to think that anybody else is going to make these.”

As for the TV ad, she said the message is too important to not accept such donations.

“It’s a dangerous concept that we should continue to let our opt-out rates rise, kids will die and we will continue to fight outbreaks,” she said. “And so we are very appreciative of anybody who will step in and amplify our message, even vaccine manufacturers.”

Sacks said she feels that the Yes on 1 campaign is misunderstood. Supporters have been called “flat earthers” and some of their signs have been altered to say “Reject Science.” She said she resents these labels and charges because while vaccines and the vaccine mandate are a one-size-fits-all solution, the future of medicine is individualized, based on each person’s genetics.

“I’m not anti-science; science is always evolving,” she said. “They say the science is settled. Science is never settled.”

Question 1: People’s Veto

“Do you want to reject the new law that removes religious and philosophical exemptions to requiring immunization against certain communicable diseases for students to attend schools and colleges and for employees of nursery schools and health care facilities?”

According to the Maine secretary of state, a “yes” vote rejects the new law and keeps the religious and philosophical exemptions to immunization requirements.

A “no” vote approves the new law, which removes religious and philosophical exemptions to immunization requirements.