By Steven Ross Johnson Some physician leaders are pushing the American Medical Association to take a firmer stance on regulating non-medical vaccination exemptions, saying a new report appears to backtrack on policy meant to contain diseases that had been controlled or eliminated. Doctors lined up on Sunday for a chance to reject findings of a joint report from the AMA's Council on Ethical and Judicial Affairs and its Council on Science and Public Health. Opponents say the report weakened the organization's policy that urges eliminating all exemptions based on religious and philosophical beliefs. The proposed revision recommends state medical associations lobby for state laws that offer “clear definitions of accepted grounds for non-medical exemptions that prudently limit such exemptions,” and implement “...fair, reasonable procedures for granting non-medical exemptions.” “This is an emerging public health crisis, and we feel that the AMA needs to be firm in our opposition to non-medical exemptions,” said Dr. Charles Barone, delegate for the American Academy for Pediatrics. Pressure for the AMA to more forcefully oppose non-medical vaccine exemptions comes as states push to repeal or limit such allowances because of recent outbreaks. In December, a measles outbreak that began at Disneyland in California spread across 16 states, infecting 131 people. The outbreak has driven lawmakers in the state, which has vaccination exemptions rates as high as 20% in some areas, to introduce legislation aimed at eliminating personal belief exemptions. The bill passed the Senate in May. As many as 11 other states have introduced similar legislation, which physicians at the meeting said could be undermined if the AMA's message is in any way ambiguous in its opposition against non-medical exemptions. “We do feel that it weakens current AMA policy, which actually encourages state medical associations to seek removal of such exemptions,” said Dr. Mark Kogan, a gastroenterologist and a member of the AMA's California delegation. “We are very concerned if this is accepted as AMA policy that will significantly weaken the chances of getting that bill passed.” Not every delegate at Sunday's meeting spoke against passing the revised policy. “If we really want to change the debate the solution to bad speech is good speech,” said Dr. Ryan Hall, who spoke in favor of the report. “I think anybody who doesn't get vaccine is foolish, but people sometimes have the right to be foolish.” Cases of disease such as measles and whooping cough have increased over the past five years as the number parents who opt out of vaccinating their children has increased. The national vaccination rate for the U.S. remains about 91%, but the rise in exemptions has raised concerns among public health experts that vaccination rates have the potential to dip below 90%. Many consider 90% to be the threshold for a population to maintain what is known as “herd immunity,” where a high immunized populace reduces the chance for outbreak in the overall community. A vote of the revised policy can come Monday at the earliest. The AMA House of Delegates meeting runs through Wednesday. Source: AMA faces pressure to reject non-medical vaccination exemptions
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