Next week, Mainers vote on a People's Veto referendum that will affect vaccination requirements. Question 1 seeks to overturn a new state law that prevents parents from refusing to have their children vaccinated, except for medical reasons. The Yes on 1 campaign says the new law is unnecessary and infringes on personal freedom. The No side says the law is needed to preserve public health.
On a recent cold winter morning, Molly Frost, of Newcastle, sends her 11-year-old son Asa and his siblings out the door to catch the bus for school.
"It's 7:30," Asa says.
"Seven-thirty!" his mother says. "Alright. Bye, sweetie. Have a good day."
"Bye," he says.
"Take the bus home," she says.
Frost says Asa is finally returning to school and a normal childhood. He was diagnosed with Hodgkin's lymphoma when he was five years old and relapsed three times. His illness put him in and out of the hospital for several rounds of chemotherapy and radiation, and most recently, a stem cell transplant.
Frost says the treatments obliterated Asa's immune system. "He, at this point, has no immunity against any of the things he was vaccinated for in the past and could get very sick from those diseases were he to catch them."
That's a worry for Frost because her family lives in a county with one of the highest school-age vaccine exemption rates in the state. She says she was relieved when Maine passed a law last year intended to protect kids like her son.
It eliminates religious and philosophical reasons from the list of exemptions for vaccinations that children need to attend school. But next week's statewide referendum could repeal the law.
"We feel that it's very important to repeal the law because we feel that there's no provided documentation that the law is necessary," says Cara Sacks, co-chair of the grassroots Yes on 1 campaign, which put the referendum on the ballot.
Sacks says the law is an infringement on personal and medical freedom. "I would think for a mandate this severe, we would need to see like a 10% drop in an immunization rate. Or we would need to see some constant outbreaks."
Average immunization rates for kindergarteners in Maine have been slipping in recent years. With the exception of the chicken pox vaccine, last year Maine dipped below the 95% target for herd immunity - that's the threshold at which enough people are vaccinated to prevent the spread of disease.
Meanwhile, Maine’s non-medical exemption rate climbed to 5.6 percent, more than double the national average. And the vast majority of those exemptions were based onphilosophical grounds.
Angie Kenney of Hermon is among those who chooses not to vaccinate her children. She says her older daughter had an adverse reaction after receiving the chicken pox vaccine when she was 18 months old.
"She could not crawl. She couldn't walk," Kenney says. "She couldn't even feed herself, she could not sit on the sofa without tumbling over. And this went on for almost a year."
Her daughter was diagnosed with ataxia, a brain injury that the U.S. Centers for Disease Control lists as a reported rare adverse event after chicken pox vaccination. Kenney says she was compensated by the National Vaccine Injury Compensation Program. Though her daughter, who is now 13, recovered, Kenney hasn't vaccinated her since, using the philosophical exemption.
"I cannot get a medical exemption for her," Kenney says. "She is only exempt from the chicken pox vaccine." And Kenney says she also can't get a medical exemption for her younger daughter, who will enter kindergarten in the fall.
Kenney recognizes that vaccines have done a lot of good, she says. But not for everybody. "And I also understand what they're saying about the herd immunity. But listen, I am not sacrificing my child for the greater good of the community."
But pediatrician Dr. Laura Blaisdell, the co-chair of the No on 1 campaign, which seeks to block the repeal, says Maine’s new law offers more flexibility than before for medical exemptions.
"It’s not mandatory vaccination," Blaisdell says. "Those who can’t be vaccinated can work with their medical providers to get a medical exemption."
The No on 1 campaign is backed by major health organizations in Maine. The reason for that, says Blaisdell, is that they're on the front lines and witness the effects of dropping vaccination rates.
Even though Maine hasn’t seen outbreaks of measles, as Washington state, New York, and California have in recent years, she says the millions of tourists who visit the state could bring it in with them. "That sort of traffic is exactly the sort of traffic that diseases like measles would just love," Blaisdell says.
Pediatrician Dr. Andy Russ, at Lincoln Health in Damariscotta, says immunization is the one issue he receives the most pushback on from parents. He says he was initially ambivalent about the law because his practice works hard to educate parents about vaccines, but he now hopes it stays in place.
"I will say to families, you know, you trust me to give you advice about growth and development. You trust me to give you advice about feeding. You know, you trust me to call me in the middle of the night if you have a, you know, a crisis situation," Russ says. "But yet when it comes to this particular issue, that trust for some reason seems to break down."
Molly Frost, whose son has a compromised immune system, says she understands why some parents might be hesitant, as she herself once was. But after doing research, she decided to vaccinate, and hopes others will too.
"I think the families that don’t vaccinate have this privilege because the rest of us do," Frost says. "If we didn’t have this herd immunity that we’re starting to lose, we could find ourselves where we were not so long ago, when disease was a major part of childhood. "
Four other states prohibit non-medical exemptions for vaccinations. Maine's referendum on Question 1 is next Tuesday, March 3, the same day as the state's new presidential primary.
Updated 3:21 p.m. Feb. 25, 2020