Three Victories for Disease

As of the time of writing, a survey of bills listed by the National Conference of State Legislatures shows there are at least nine bills pending in seven states that weaken or outright bar vaccine mandates for diseases beyond coronavirus, while three such bills have already been signed into law. Two of those are in Montana, long a hotbed of vaccine hesitancy — ironically, given that the state produced one of the world’s most prolific and important vaccine creators.

The most sweeping is Montana House Bill 702, which became law in May and effectively turns vaccination status into a protected class, barring businesses and government entities from “discriminating” against the unvaccinated by refusing to serve or employ them. By barring even private sector employers from requiring any type of immunization, Montana is unique in the country. The law has already caused consternation among the state’s hospitals, who, until the bill’s passage, required their employees to get the suite of vaccines recommended by the Centers for Disease Control and Prevention (CDC), including for the flu, measles, and chickenpox.

Medical professionals and entities like the Montana Hospital Association (MHA) have warned that the law will make doctors and patients less safe, given that places filled with sick people are prime spots for the transmission of various diseases, and they fear it hampers the out-of-state recruitment of workers that Montana’s health sector relies on. Besides this, with the Centers for Medicare and Medicaid Services (CMS) requiring health care facilities to vaccinate their staff in order to get federal funding, MHA president Rich Rasmussen warned that all of the state’s hospitals are in financial peril, depending on how the CMS chooses to navigate the issue.

Another bill signed into law one month earlier, HB 334, makes it easier for students to get medical exemptions for public school mandates by expanding which health care providers can issue them, barring the disclosure of a student’s exemptions, and precluding the state’s public health authority from putting any more restrictions on those mandates. The same Republican legislator, Jennifer Carlson, is the leading sponsor of both.

This isn’t something that cropped up with the emergence of COVID. During a 2015 measles outbreak, Montana’s Republican-controlled house of representatives passed a bill making it easier for parents to opt their kids out of compulsory vaccines; four years later, three more bills aimed at weakening these requirements were defeated. It seems that the onset of the pandemic, which has killed more than two thousand of the state’s one million residents, paradoxically helped Montana Republicans finally get such provisions over the line, thanks to a successful nationwide effort by GOP officials to turn surviving the pandemic into a partisan issue, complete with a deluge of right-wing propaganda against vaccines.

The other law that takes aim at mandates for vaccines beyond COVID was passed in Kentucky in March. Passed at the last moment before the Democratic governor could step in and veto it, the law adds a “conscientiously held belief” exemption to mandatory vaccinations of any kind, specifically during an epidemic. Believe it or not, this is a more “moderate,” compromise version of the original bill, which left out the epidemic clause and gave wider leeway to parents to get their kids into school without getting the required vaccinations — the reason it was fiercely opposed by alarmed medical experts and health agencies.

Oregon, meanwhile, is way ahead of the rest of the country: It passed a law prohibiting health care facilities from mandating vaccines for employees all the way back in 1989. One of its legislative sponsors now says he regrets supporting it, because “the context has changed dramatically” — a chilling cautionary tale for the current legislative efforts to weaken immunization requirements.

Live Free to Die

Several other states are seeing similar, concerted pushes to roll back vaccine mandates more broadly.

In Idaho, Republicans have been brainstorming anti-mandate ideas, ranging from banning all vaccine requirements even in emergencies and defining and treating them as assault to barring all immunizations and other medical procedures as conditions of employment. One proposal, to require private employers to include an opt-out for any vaccine policies, supposedly has the backing of anywhere between twenty-three and thirty-five state house members, according to the GOP legislators behind the proposal. Meanwhile, HB 140, a bill barring state and local governments from contracting with companies that “discriminate” against unvaccinated workers, passed the house forty-nine to twenty-one in February and has been sitting in a senate committee ever since.

In Nebraska, residents filled out a legislative hearing room and hallway in February in support of  Legislative Bill 643, a bill giving all citizens the right to turn down a government-mandated vaccine order, including the right for parents to opt their dependents out of vaccination and employers to do the same for their workers. The then president of the Nebraska Medical Association, Dr Michelle Walsh, was a lonely voice against the measure, as speaker after speaker railed against vaccines and their supposed dangers.

Indiana is likewise seeing ongoing attempts to weaken its immunization requirements more broadly. A bill banning employee mandates for any vaccines was killed by legislative leaders earlier this year, but five hundred of the bill’s supporters rallied in front of the statehouse in September calling for new measures — with three Republican legislators in attendance, two of them speakers. One of the movement’s leaders, former attorney Leah Wilson, called for a bill to turn vaccination status into a protected class in the state.

It’s not only solidly red states where Republicans are taking aim at vaccine requirements. In Pennsylvania, the Right to Refuse Act has been making its way through the state house of representatives, a bill that would outlaw hospitals’ long-running requirements for vaccination as a condition of employment, along with those of any other employer. A more obscure bill, Senate Bill 471, or the Medical Freedom Act, abolishes vaccine mandates as a condition of employment, accessing public schools, and more, and was introduced at the start of this year.

This is by no means an exhaustive list of Republican-led attempts to weaken successful and long-standing immunization measures. In Tennessee, a bill barring school districts and other government entities from putting in place vaccine requirements was deferred to the 2022 legislative session. In Texas, two separate bills barring employment discrimination against the unvaccinated were introduced in September. And in Florida, the GOP’s top-ranking senator on health care policy has recently called for a “review” of all mandates, including those for polio, mumps, and rubella, while one of his colleagues in the state house filed a bill in August to repeal state laws allowing for mandatory vaccinations during an emergency.

Try and Try Again

Other states have seen near misses, with similar efforts gaining momentum before being thwarted.

Ohio saw a tug-of-war throughout the year over an expansive GOP bill that would have abolished employer mandates for all vaccines, repealed an existing law requiring college students living in on-campus housing to be vaccinated for hepatitis B and meningitis, and forced schools and childcare centers to tell parents about exemptions to immunization requirements. Those exemptions would have been significantly broadened by the bill, which called for only a written or verbal declaration from the parent that their child has natural immunity, a medical contraindication, or simply “reasons of conscience” to avoid the vaccine.

As in other red states, hundreds of the bill’s backers came to the statehouse in August as the bill was being debated, even as horrified health care professionals and institutions warned it could “reverse decades of immunity from life-threatening, but vaccine-preventable diseases such as measles, mumps, hepatitis, meningitis and tuberculosis.” Even after legislative leaders paused the bill’s progress, its right-wing backers tried to force a floor vote in September via discharge petition, ultimately getting only seven out of the necessary fifty signatures. Leadership then put forward an alternative, narrower bill taking aim only at the COVID vaccine, which has also now stalled.

In North Carolina, hundreds of supporters of a similar bill barring employer- and government-enforced mandates likewise rallied outside the state’s general assembly in May, with one speaker comparing those who refuse vaccines to African Americans who were discriminated against under Jim Crow. That bill would have ended the state’s long-standing vaccine mandate for public schools, as well as barred any employer mandates and allowed anyone to opt out of any other vaccine mandate without detailing their objections. It was eventually watered down, and a narrower anti-mandate bill focusing only on the COVID vaccine was signed into law.

Similarly, in New Hampshire, a bill originally banning any form of compulsory immunization was steadily watered down, adding exceptions for schools and childcare facilities, and for employer mandates under certain conditions. The final version signed into law narrowed the mandate ban to the COVID vaccine.

The Pro-Disease Party

On the one hand, the small number of bills that have actually passed and the far greater number that have been defeated or simply stalled is an encouraging sign, even though one has to wonder if this outcome would have been the same without the concerted local business opposition to many of them.

On the other hand, the number, variety, and geographic spread of such bills, as well as the not-insignificant legislative and grassroots support they have garnered, is a troubling sign for the direction of the country’s shifting center of political gravity. Republican officials and the powerful oligarchic propaganda machine behind them have taken the previously fringe anti-vax movement and are slowly turning it into a mainstream position within the GOP. Paradoxically, these mounting efforts to roll back long-standing public health measures responsible for suppressing a variety of vicious diseases have only been possible thanks to a pandemic that has killed nearly 720,000 Americans and counting.

Maybe most appalling, the lawmakers behind these bills openly say they believe in the science of vaccines, and that they’ve gotten their COVID shots, even as they work to help this pandemic and other infectious diseases tear through the country. They’re fully aware they’re assisting a movement opposed to centuries of medical science and devoted to undermining decades of national public health consensus, but for craven political reasons have decided it’s worth it. You can’t get a better summary of the deadly nihilism at the heart of the modern Republican project, and the threat it poses to all ordinary working people, than that.