Rockland County Measles Executive Order
(UPDATE 4/5/2019) – A judge ruled late today to overturn the Executive Order enacted on 3/27/19, after hearing arguments presented by civil rights lawyer Michael Sussman and attorney Patti Finn on behalf of families holding religious exemptions for their healthy, unvaccinated children who were unlawfully quarantined by the directive. Sussman called Day’s action “arbitrary and capricious.”
County Executive Day issued a statement which confirmed the primary intent of the Executive Order as punitive and coercive, stating “…I want to commend those here in Rockland who have used this State of Emergency as an opportunity to get vaccinated and have conversations with their friends and neighbors about vaccination. We sought to find a new way to fight back against a disease that was eradicated [sic] almost 20 years ago and refused to sit idly by while those in Rockland were put at risk.” (Measles was never declared eradicated in the United States, but was prematurely declared “eliminated” in 2000, when 83 cases were reported nationwide.)
There were four active cases in Rockland County when the directive went into effect last Wednesday. Since that day, 12 new cases have been reported, with an increase of 10 cases from 3/28/19 to 4/5/19 – the highest weekly increase reported since the outbreak peaked in mid-November of last year. According to statistics reported on the Rockland County Department of Health website, new reported cases included 9 unvaccinated cases, 2 vaccinated, and a case of unknown vaccination status; including an infant aged less than 12 months, 7 toddlers 1-3 years of age, 3 children aged 6-18, and 1 adult. The incubation period of measles averages 10-12 days.
On Friday, Montefiore Nyack Hospital reported the exposure of 42 people, including 11 children and 4 pregnant women, at its vaccination clinic:
Executive Day’s office reported that 500 vaccinations had been administered since the Executive Order was issued, of 17,400 given since the outbreak began last October.
(UPDATE 3/27/2019) Thoughts on the Rockland County New York Executive Order:
Effective at midnight on Wednesday 3/27/19, Rockland County, New York has enacted a state of emergency regarding its six-month ongoing measles outbreak. County Executive Edwin Day announced that all unvaccinated residents under the age of 18 will be banned from public indoor spaces for 30 days:
This directive is strictly punitive and is not science-based or effective at containing the spread of disease, nor is it a constitutionally defensible policy.
Details to note:
• The executive order exempts residents “prevented from receiving a measles vaccination for a medical reason documented by a physician, or because the infant is under the age of 6 months.” This directive fails to protect the people health officials define as being at greatest risk from exposure; they can certainly contract and spread the disease while accessing the public facilities outlined in the directive. If this action were designed solely to contain the spread of virus rather than to penalize residents whom County Executive Day considers to be insufficiently compliant with his wishes, the residents at highest risk of contracting and spreading measles would be quarantined.
The Rockland County Health Department reports at least 8% of the 153 cases were confirmed as vaccinated, and an additional 10% have unknown vaccination status. Fully 30% of cases (46 subjects) were infants under one year old or adults over the age of 18 – those who would not have been restricted from public exposure under this directive.
The directive penalizes parents of unvaccinated infants 6-12 months old; however the MMR package insert explains clearly that the “safety and effectiveness of the mumps and rubella vaccine in infants less than 12 months of age have not been established. The younger the infant, the lower the likelihood of seroconversion.”
The majority of adults working in schools, shopping centers, and facilities serving the public in Rockland County have likely received only one dose of MMR, and can potentially contract and spread measles. Antibody protection in vaccinated adults, particularly recipients of only one dose, is likely to wane after 10 years.
Unvaccinated residents who follow the directive to receive the MMR will be exempted from the directive four days after vaccination, when they can still shed live measles virus and/or develop contagious “atypical measles,” and will not yet have developed serum antibody protection for additional days or weeks.
The “state of emergency” as defined will not protect the residents of Rockland County from contracting or spreading measles – it’s strictly a punitive measure to compel vaccine uptake among residents exercising their fundamental right to decline an invasive medical procedure which carries documented risks of permanent disability and death.
• Rockland County does not have a “community immunity” problem among school children. New York State public health data indicates MMR uptake in children enrolled in Rockland County schools has been consistently at or above 95% since 2013:
• The Rockland County measles outbreak peaked during the initial weeks following the first cases reported in early October 2018. New cases surged during the first weeks of November, accumulating to 83 reported cases by 12/1/18 – after which fewer than 10 new cases have been reported each week as the incidence of new cases gradually recedes. There are currently four active cases in Rockland County. This pattern is consistent with clusters of measles cases occurring around the country since 2000, the year in which 83 measles cases were reported in the U.S. and the virus was prematurely declared “eliminated” (but not eradicated).
• The timing of this Executive Order does not coincide with the peak period of exposures or new cases as shown above. Rather, it coincides with the rollout of a marketing strategy echoed by public and private pharmaceutical industry partners: In the same week that Senator Richard Pan of California and Scientific American have publicly demanded the banishment of all citizens who refuse any recommended vaccine from public life, County Executive Day has executed this vision by immediate emergency decree:
The timing of the order also deliberately coincides with the Jewish holiday of Passover, when thousands of Orthodox Jewish residents of Rockland County attend many gatherings in the public spaces the directive deems inaccessible.
• County Executive Day refused to clarify how and when the emergency law will be enforced. Violation of the emergency order as defined by law carries a penalty of 6 months in prison and a fine of $500; however Day used vague language to imply that the law will not be enforced, continuing that he’d be “absolutely hard pressed to picture any police officer taking any enforcement in this,” continuing that “if someone came to our attention, we would refer that to the District Attorney’s office…whereupon the District Attorney, based on the totality of circumstances, would decide what to do.” But there is no definition of the mechanism whereby parents would be found to violate the Emergency Order, if vaccination records will not be demanded by law enforcement officers in public spaces.
Day also expressed great contempt for both religious freedom and the right to privacy in his public statements, declaring that “there are no religious exemptions.” This is a bold misstatement. He cites the lawsuit Green Meadow Waldorf School brought against the county as evidence for this claim; the school carries the highest rate of religious exemptions in the county and was most impacted by extended quarantines of healthy exempted children. However, Day ignores numerous other private religious schools which carry high religious exemption rates – 8 schools had exemption rates above 10% in 2017; nonetheless, the overall MMR uptake among students enrolled in Rockland County schools was approximately 95%.
Day went on to describe coordinated efforts between compliant Orthodox Rabbis in Rockland County and the County Health Department, generalizing that “if there were true religious exemptions, they wouldn’t have gotten the shots.” By “they,” County Executive Day seems to mean every Orthodox Jew residing in Rockland County, whom he assumes to be exactly alike, as well as every student of every other religion enrolled in Green Meadow Waldorf School.
County Executive Day openly describes the Executive Order as a punitive action designed to coerce citizens of Rockland County into compliance with the CDC recommended schedule, stating that “there are anti-vaxxers out there” before implicating Green Meadow Waldorf School once again in the same sentence.
Sarah Dillingham is a freelance writer and mom to a rambunctious boy in the D.C. suburbs.
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