What’s the Matter With Vermont?
Anti-vaccine activists derailed a bill that could have blunted the whooping cough epidemic.
Vermont's State House in Montpelier
Photo by Jordan Silverman/Getty Images
Imagine coughing so hard and for so long that you turn blue and stop breathing. Pertussis, or whooping cough, can do that to an infant. The disease is caused by the bacterium Bordetella pertussis and occurs in three stages. The catarrhal stage, characterized by runny mucous, is highly contagious. It’s followed by the paroxysmal stage—unstoppable, sustained, violent coughing accompanied by a “whoop” when you inhale. (Listen to a baby with whooping cough here, or see a video of a boy with whooping cough here.) In the final, convalescent stage, a cough can linger for several weeks. Pertussis can affect anyone, but it poses the most danger to infants.
A pertussis vaccine became available in the 1940s, and incidence of the infection dropped from around 200,000 per year to barely over 1,000 by 1976. But today the United States is in the middle of a pertussis epidemic. According to the Centers for Disease Control and Prevention, more than 41,000 cases of pertussis were reported nationwide in 2012. At least 18 people have died, mostly infants younger than 3 months of age—too young to be fully vaccinated. There hasn’t been such a major outbreak since 1959. The states with the most cases per capita are Wisconsin, Minnesota, and Vermont.
The epidemic is due in part to the reduced effectiveness and the shortened duration of immunity conferred by a relatively new vaccine. But the epidemic is also spreading because of a low vaccination rate.
Vaccination needs a critical mass to effectively confer “herd immunity” on a population. When vaccine rates fall below 90 percent, diseases spread readily enough to endanger people who can’t be vaccinated because of illness or because they are too young. In parts of Vermont, the vaccination rate is only 60 percent. It is one of 20 states that allow a philosophical as well as religious exemption to vaccines, and it has one of the highest philosophical exemption rates in the country.
George Till, a state House representative and a physician, tried to change that last year by proposing a bill to eliminate the philosophical exemption to vaccines. Instead, Act 157, which became law on July 1—when the current pertussis epidemic was already raging—turned into a complicated, compromise vaccine bill that preserved the philosophical exemption.
Till lives and practices near Burlington, Vt., and was elected to the House four years ago. In his re-election campaign, he spent $18.55 for dog bones. With dog treats in hand, this soft-spoken doctor went door to door and asked his neighbors to vote for him. Till, an OB-GYN and a Democrat, did not accept donations to his campaign from any group—he even sent back a check from Planned Parenthood.
Act 157 originated when a pediatrician neighbor of Till’s came to him with a concern. In a local kindergarten class, 75 percent of students were not fully vaccinated. Till researched the issue and thought it was reasonable to get rid of the philosophical exemption in order to increase vaccination rates. Till proposed a bill in the House, and state Sen. Kevin Mullin proposed an almost identical bill in the Senate.
The Senate bill passed quickly, but not so in the House. Delays sometimes happen in Vermont’s “citizen legislature,” where lawmaking is a part-time endeavor by ordinary people for just 18 weeks of the year. The bill languished in the health care committee. Then the Legislature was off for a week because the first Tuesday in March is reserved for town meetings in communities across the state.
Helena Rho, a former assistant professor of pediatrics, lives and writes in New York. You can read her work at helenarho.com.