How the Texas Legislature Reached a Dangerous Stalemate on Vaccines

Even as outbreaks of preventable diseases worry public health officials, anti-vaccination activists blocked legislation to address the problem.


Texas State Guard Captain Rexie Pajarillaga of Houston Medical Brigade administers one of four immunizations that Juan Carlos Martinez, 13, received at Palmview High School during Operation Lone Star, July 29, 2013.  Suzanne M. Carter/Texas Military Department/flickr

It was mid-April, more than halfway through the legislative session, and Texans for Vaccine Choice was finally getting the fight it had been spoiling for. On April 11, a bill to require schools to report the number of unvaccinated kids had been heatedly debated in a House committee. Doctors, public health experts, parents and others had testified in favor of House Bill 2249, calling it a transparency measure that would simply provide information about vaccination rates at individual schools. The matter was pressing, they said, because more and more parents were opting their kids out of vaccinations using a “reasons of conscience” exemption created by the Legislature in 2003. Without action, recent high-profile outbreaks of mumps and measles in Texas would only grow worse.

But Texans for Vaccine Choice has a radically different frame. While the pro-vaccination crowd appeals to legislators on the basis of science and public health, the anti-vaxxers have their own funhouse mirror version. Vaccines contain toxic chemicals, they say. They cause autism. They overwhelm the immune system. But more than that, the activists, many of them mothers, framed their position as one of parental choice and personal freedom — a message that commands attention at the Texas Legislature.

“The responsibility for my son does not fall on the state or any other family,” said one woman at the committee hearing. “And I would never rely on the herd to keep my son safe.”

Two days later, Texans for Vaccine Choice held a “Freedom Fight” rally on the South Steps of the Capitol. The event featured two prominent members of the far-right House Freedom Caucus, Jonathan Stickland and Bill Zedler, close allies of the anti-vaccination activists.

State Representative Jonathan Stickland, R-Bedford  Sam DeGrave

“Someone asked me the other day, ‘Why do you associate with those crazy vaccine people?’” said Stickland. “I said, ‘Because I am one’.”

Stickland went on to lay out a case for “choice.”

“Where there is risk, there must be choice,” he said. “It’s not government’s job to try to influence our behavior. … The state of Texas doesn’t own our kids. They should be looking for ways to protect parents because we know what’s best for our kids.”

The anti-vaxxers’ legislative agenda reflected this emphasis on “choice.” One bill, HB 1124, would’ve made it easier for parents to obtain exemptions from immunization for children in public school, reducing what was a weeklong process involving a signed affidavit to an instantly available online form.

Another proposal would’ve penalized health care providers who refuse to treat patients who won’t get vaccinated. And a third aimed to require health care providers to give parents what’s known as “vaccine excipient information” — a technical list of vaccine ingredients which, without context, can be misleading or worrisome.

The struggle over vaccinations at the Capitol largely centers on exemptions for “reasons of conscience.” Texas has allowed schoolchildren vaccine exemptions for religious and medical reasons since 1972. In 2003, legislators approved reasons of conscience, too. Until last year, California had a similar law on its books, but in 2015, the state experienced its worst measles epidemic in years. In an outbreak traced to Disneyland, more than 100 people were infected. Infectious disease specialists concluded that vaccine refusal helped fuel the outbreak, and California legislators quickly moved to outlaw all but medical exceptions.

“In 14 years we’ve increased nonmedical vaccine exemptions in Texas by 1,700 percent.”

In October, a Baylor College of Medicine study showed measles vaccination coverage in certain Texas counties was close to dropping below the 95 percent threshold necessary to ensure herd immunity. High rates of unvaccinated children cluster in geographical areas, and, according to the Texas Department of State Health Services, the number of children with “conscience” exemptions has risen dramatically from 2,314 in 2003 to 44,716 in 2016.

Of the six or so House and Senate bills that the anti-vaxxers supported, only one got a committee hearing. Authored by Representative Matt Krause, a far-right member of the House Freedom Caucus from Fort Worth, HB 1124, was designed to make it easier to obtain immunization exemptions. Currently, a parent who wants to opt out of vaccinating a child in public school must apply in writing for an exemption affidavit from the Department of State Health Services, which takes up to a week to process.

Krause’s bill would’ve done away with the written request — and the delay — by letting parents print out a blank exemption form from the health agency’s website.

Rekha Lakshmanan, of the nonprofit Immunization Partnership, told the Observer the proposal would put lives at risk because more families would choose not to vaccinate out of convenience. “In 14 years we’ve increased nonmedical exemptions in Texas by 1,700 percent,” she said, adding that if HB 1124 passed, that number would rise.

She pointed to a 2013 measles epidemic at the Kenneth Copeland Ministries megachurch in Fort Worth as evidence of the consequences. Twenty-one people — most of them unvaccinated — were infected. The church leadership has a history of questioning vaccination, though Copeland offered free vaccinations to his members after the outbreak.

Lakshmanan said it was astonishing that the authors of all the anti-vaccination bills were from North Texas, scene of the worst measles outbreak in years, and that three — Bill Zedler, Krause and Fort Worth Senator Konni Burton — are from Tarrant County.

Joe Lastinger, whose daughter died in 2004 after contracting influenza, told the committee, “just like restaurant workers have to wash their hands, there are lots of common-sense things we do … and anything that weakens our vaccine safety net for convenience is a mistake.”

“I’m sorry for your loss,” Zedler replied. “It’s entirely different from washing your hands — that doesn’t negatively impact anybody. But people do die as result of adverse reactions to vaccinations. And as far as flu is concerned there are people who get a flu shot and who get flu.”

“If [the flu vaccine] was as good as other vaccinations, it would be a dream come true,” Lastinger answered. “It’s imperfect but better than doing nothing.”

Krause’s bill died in committee, but pro-vaccination forces also found their proposals stuck in a legislative logjam.

Only one pro-vaccine bill made it out of committee. Designed to expose any potentially dangerous gaps in herd immunity, HB 2249, authored by Representative J.D. Sheffield — a Republican doctor from Gatesville — would’ve required the state health agency to collect and publicly report the number of vaccination waivers for each school.

Sheffield’s bill was voted out of committee 7-3 and set for debate on the House floor in May, but ultimately fell victim to a chaotic end to the session.

Sheffield is perplexed at how deep-seated anti-vaccine sentiment has become. “There’s such a distrust these days of government in particular, and some organized medicine,” he said. “It’s illogical. In underdeveloped countries, they’re desperately trying to get their populations vaccinated. We’re in one of the most developed countries and people are fighting to be unvaccinated.”

Sheffield told the Observer he’ll file his bill again next session, and would like to ultimately see Texas eliminate the “reasons of conscience” exemption, but he isn’t optimistic. “It’ll take “the death of innocent children before we can eliminate this exemption of conscience,” he said.

In the final days of the 85th legislative session, it looked like the pro- and anti-vaccine lobbies were going to have to make do with a draw. But at the 11th hour, a discussion over a bill authored by Representative Gene Wu, D-Houston, requiring Child Protective Services to give new children in its custody medical exams, suddenly turned into a feverish argument about vaccines.

Urged on by Texans for Vaccine Choice, Zedler proposed a surprise amendment that would exclude vaccinations from those checkups. Vaccines, he insisted, “do not qualify as emergency care.” He was joined by several Republican members of the Freedom Caucus, with Representative Tony Tinderholt, R-Arlington, arguing that it was an “issue of liberty.”

Democrat Gene Wu and Republican Sarah Davis vote no on the Zedler amendment.

A plea from Representative Sarah Davis, R-West University Place, a cancer survivor, failed to move the majority of Republicans. Davis proposed a measure that would at least require foster children to be vaccinated against cervical cancer. Her proposal was defeated in a 74-64 vote. Zedler’s amendment, meanwhile, was adopted 74-58.

Though Wu’s bill died in the Senate, a similar version of Zedler’s amendment found its way onto another child welfare bill and was signed into law by Governor Abbott.

Texans for Vaccine Choice considered the session a win. In early June, the group held a victory party that featured a fajita buffet and “chips fried in a dedicated gluten free frier.“) Photos on the group’s Facebook page show Tinderholt posing with an American flag hat while Zedler opted for a crown.

Pro-vaccine lobbyist Jason Sabo is anxious that mainstream Republicans, who might ordinarily have voted against potentially harmful anti-vaccination legislation, now see it as a primary issue.

“Only the extreme of the extreme show up to vote in the primaries: the anti-vaxxers, the pro-gun people, and the anti-annexation guys. Get four or five of these groups together and you have a bloc. And it’s really smart,” Sabo told the Observer. “So next session we have a choice: We either do the same thing and get the same results, or we come back with a different strategy.”

Meanwhile, as Texas comes to terms with what is a potentially dangerous stalemate, the number of measles cases in a huge outbreak in Minnesota, mostly among unvaccinated children, has surpassed those across the entire U.S. in the previous year.
Correction: The original version of the story referenced a Baylor University vaccination study; however, the study was conducted by the Baylor College of Medicine. The story has been corrected.