The Learning Curve: San Diego’s Vaccine Exemption Doctor of Choice, in Her Own Words
Dr. Tara Zandvliet is part of a small minority of physicians who believe in giving medical exemptions based on a family history of autoimmune disease. In an interview, she laid out her approach to working with families looking to avoid vaccines.
Dr. Tara Zandvliet – or Dr. Z as she goes by in her practice – has written nearly one-third of all the medical exemptions from vaccinations in San Diego Unified School District, as I reported earlier this week.
Medical exemptions across the state have surged since a 2015 law stopped allowing parents to use personal belief exemptions to avoid vaccinations. Zandvliet is writing the bulk of her exemptions for children with family histories of autoimmune disease – a reason most doctors do not believe meets the bar for a medical exemption.
Zandvliet is a charismatic talker and spent an hour on the phone with me, explaining why she does what she does. The story has provoked an intense reaction, with many people emailing to thank me for the story and many, many more emailing … not to thank me. Zandvliet is part of a small minority of physicians who believe in giving medical exemptions based on a family history of autoimmune disease. I thought this might be a good opportunity to air out the perspective from a seldom-heard corner of medicine.
Our conversation has been edited for length and clarity.
TZ: I’m the only one around here doing them. People can’t go anywhere else. Kaiser won’t do it, Scripps won’t do it. If they’re not vaccinated, most doctors won’t even let them through the door. It’s ridiculous. That’s why I’m writing more than anyone else.
(Dr. Mark Sawyer of Rady Children’s Hospital challenged this. He said most doctors will continue to see patients who have not been vaccinated. He also noted that the American Academy of Pediatricians advises physicians to treat patients who have not been vaccinated and continue to educate them.)
TZ: It’s personalized medicine. It’s not a one-size-fits-all approach. Would you like to have your blood pressure treated this way? Where you have to take a drug, just because someone told you to? I mean, we’re supposed to be taking each person as an individual in all their amazing glory and giving them what’s the best thing for them medically, right? That’s gonna mean vaccines are good for most people, but maybe not everyone.
This debate has become so political in nature. It’s so extreme, and that’s not good for medicine. There is risk in vaccine and risk in disease. It’s impossible to make one perfectly safe. It won’t happen.
But vaccines are a public health issue. And to stop outbreaks of disease you have to have a large percentage of the public vaccinated. To get herd immunity you need 95 percent of people to have vaccines.
It’s a public health risk. It absolutely is. Each school needs to be above 95 percent for each individual vaccination. I worry when I see them go below 98 percent.
(In San Diego Unified, 12 schools have kindergarten classes with a below 95 percent vaccination rate for measles, and 14 have below 95 percent for whooping cough. Even more schools are below 98 percent. As I wrote, Zandvliet believes these are two of the most important vaccines a child can get in this area.)
So I talked to Dr. Mark Sawyer at Rady Children’s Hospital, and he was saying that most doctors don’t agree with this reason of “family history of autoimmune diseases” or allergies as reasons that you would give a medical exemption from a vaccination. And it’s not just him, this is the position of the CDC and the American Academy of Pediatricians.
He’s a good doctor. He’s sat right here in my office with me, and we’ve talked before. But look, we all have our different opinions. God bless us for having different ones. This is how science gets moved forward. If no one objected, we’d never advance medicine. I think we have a lot of kids coming up with allergies now. We’ve never seen these numbers of food allergies. They’re coming out with hives and anaphylaxis. So I’m gonna take the cautious route. I’m gonna go slow. Until they can show a study that shows these kids don’t have a higher rate of anaphylaxis from vaccinations, I’m gonna go slow.
What I’m finding in my practice is that these kids are having higher rates of severe reactions. I gave a shot to one kid recently and he had a severe local reaction. He was swollen up from the hip to the knee. I’m trying to give the kids the vaccine and they’re overreacting.
(Sawyer pointed out that no studies have shown a link between allergies or family history of autoimmune disease leading to more severe vaccine reactions. While it is theoretically possible, he said there’s no evidence to back it up. Zandvliet could design a study with her own patients to try to prove it, if she were so inclined, he said.)
So you said you try to convince all your patients to have vaccines. But isn’t this a question of either they’re entitled to a medical exemption or they aren’t? What happens when you can’t convince someone, but they don’t meet your standard for an exemption? Are you giving them one anyway?
Am I gonna write them an exemption? Hell no! Hell no. If they don’t wanna vaccinate, they can home school. And they should. That’s what I tell them. If they have a medical reason and present medical records from grandma, mom and dad – only close relatives, not cousins – and it shows that all through the family they have more vigorous response to vaccines or a serious history of autoimmune conditions, then I’m gonna write them an exemption.
How many people would you estimate you turn away for an exemption?
Oh dear god, at least seven out of 10 don’t get past the first email. I tell them they don’t have the proper documentation and they don’t contact again. Maybe it’s because they can’t get the records. If they can’t prove, I’m not taking their word for it.
What does it feel like to be practicing medicine in this corner you have? You’re writing these exemptions that most doctors wouldn’t and you’re kind of in this minority in medicine?
Frustrating. It’s frustrating and somewhat lonely. I wish we could have really good conversations about vaccinations. I wish we could have them on an individual person basis. God forbid we tell someone about the side effects [of vaccines]. The more I’m honest with my patients, the more they come in for their next vaccines. There’s not enough honesty. We have to trust that our parents, if we give them enough time, will come to the right decisions about vaccines, because they will trust us. If we keep the risk of vaccines secret, they won’t do it. They’re like a toddler, saying no you can’t make me. We have to do education. We have to make them want it.
Would you say you get a lot of vaccine-skeptical and anti-vaxxer parents coming into your practice? How do you try to talk to them about vaccines?
Yes, I would say so. Look at autism and vaccines. There was a study out of Denmark just a month and a half ago. It showed there was no link between vaccines and higher rates of autism. It’s not even a trigger. I used to think maybe it was, but this study showed conclusively that it isn’t. I’m really confident now it’s not an issue. It’s coincidental. We give them so many shots when they’re young. Every month or two we’re giving them another shot. After a shot, parents see their child has autism. We look for causes. We look for stories. It’s something we do as human kind. But that’s a big reason why I don’t write exemptions because of autism in the family. I’m pretty sure now we have decent evidence and I try to show that to them and educate them on what we know about vaccines.
What I’m Reading
- A faculty member at Southern Illinois University sent out an email to staff asking them to identify alumni who might be willing to work, basically, as volunteer faculty. John Warner of Inside Higher Ed marked that as the death knell of higher education.
- When your child is already privileged, is it really worth scamming elite universities to get them in? Turns out, no. Elite colleges do not have a significant impact on the future of privileged students. But for black, Hispanic and students with less educated parents, those colleges do have a major impact on the child’s future prospects, according to a 2014 study written up in the New York Times.
- Insane fact from this story: New Orleans is poised to become first city in the country with no traditional public schools, according to The Lens.
- Teachers in Indiana were asked to kneel down against a wall, execution-style, during an active shooter drill. Cops sprayed them with plastic pellets that left welts and bruises, according to the Indianapolis Star.
What We’re Writing
Board Trustee Kevin Beiser has been a rising star in the local Democratic Party since he joined the school board in 2010. Beiser had his sights set on the City Council in 2020. But a bombshell investigation from VOSD’s Andrew Keatts now has most local Democratic leaders calling for his resignation. Four young men told Keatts harrowing stories about how Beiser harassed, groped or assaulted them. The young men were all politically ambitious and looking to get more involved in the Democratic Party. They hoped Beiser, with his political clout, might help jumpstart their careers. Beiser has denied their allegations.