Note: On Thursday, Mary Romaniec moderated a panel for Vaccine Choice Massachusetts featuring Dr. Andrew Wakefield and the movie The Pathological Optimist. One of the topics covered during the Q&A was standing orders. We're running Mary's article again to revisit this important topic.
By Mary Romaniec
State and local health departments, along with large medical practices, are poised to increase adult immunization rates by implementing policies and procedures that support a program known as “Standing Orders.”
At a recent event held in Boston, a small group of demonstrators stood outside the Westin Copley hotel where the Take A Stand™: Use Standing Orders to Improve Adult Immunization Rates workshop was taking place. The workshop is described as “a unique national program being conducted for a limited time by the Immunization Action Coalition (IAC), supported by a sponsorship from Pfizer”.
If IAC sounds familiar it is because they are the group that boasted how they used their listserv to get “Vaxxed” banned from Tribeca Film Festival.
Demonstrators explained the problem is that Standing Orders is a form of collusion and corruption to push pharmaceutical interests, spreading it out across the country via the kind of workshops held in Boston. In other words, they are going straight to health departments and doctor practices to show them how to increase adult immunizations rates via on file Standing Orders to vaccinate according to the CDC adult schedule (flu, shingles, boosters). The move essentially shuts down public knowledge and discourse on the subject by going around state legislators or open forums for discussion.
According to Dr. L.J. Tan from IAC, “Our challenge is adult immunization rates are very poor. Standing Orders allow a practice to routinize administration of vaccines,” Tan said.
By routinize, Tan clarified that it meant the practitioner, or someone on staff, can have a conversation about the need for boosters or other adult vaccines. However, the caveat in the details is that it means your personal physician can write in your medical charts a “standing order”, which can then be done against your knowledge or will in any hospital setting.
What happens in hospitals?
When you enter any hospital for an emergency or surgery, you sign a bunch of forms prior to them treating you or a loved one. One of the things you consent to is to be treated with “biologics”, which is a code word for a wide range of products including vaccines. So if your regular physician has in the chart a standing order (even if you don’t know they wrote it) you could be given a vaccine against your will or knowledge. Informed patients may write “No vaccines” on any admittance form, but what happens if there are contradictory standing orders from your physician? Who would be accountable if they vaccinate an unconscious patient who had objected in writing? Truthfully, probably no one.
What medical professionals know that legislators don’t
I first heard about this program when Boston area nurses notified me their offices received a flyer via fax for the four-hour workshop. They were the demonstrators at the hotel, one of whom recognized her office colleagues as they headed into the event. According to them, there is very real potential harm from Standing Orders as they have witnessed or knew about patients who were vaccinated while unconscious.
I text messaged a state representative to ask if he knew the event was going on just across town, and he messaged back he knew nothing about it nor was there anything on the docket that covered adult immunization rates. Now perhaps the reason why state legislators are not involved in any discussion on the Standing Orders program is because it falls under the umbrella and in the jurisdiction of Public Health solely. Clearly they are not currently involved with the CDC vaccine schedule for infants except to regulate how personal beliefs, medical and religious waivers are determined as a school requirement.
But look what happened in West Virginia when state lawmakers had no say when the State Health Department moved to mandate vaccines for school admittance. Legislators were not involved, and therefore neither was public discourse. On the extreme end for discourse was California’s foray into vaccine mandates via SB277 and the huge public outcry which exposed pharmaceutical nepotism at the highest levels.
Is it just the adults that are the target?
There is not a shred of doubt other states are looking at the debacle that happened in California as an example of what they want to avoid, taking cue from the seamless nature of the process by going through the State health departments. To be clear, even though “Standing Orders” is geared to increasing adult immunization rates, nothing within it defines how children will be excluded from a similar program. HPV and flu shots could easily become a standing order from a pediatrician for a minor. With health records now electronic, the ramifications of a standing order program have yet to be fully understood or realized.
In a private conversation with a Public Health Pediatrician, he lamented what former Texas Governor Rick Perry did when he mandated HPV for school aged children. As the pediatrician explained, the move spotlighted HPV nationally for greater scrutiny, which then led to public outcry and pushback. Perry reneged on the mandate after the outcry, but the damage to “Public Health” was done, according to the pediatrician. Instead he would have preferred a more nuanced approach, to keep it as a conversation between health professionals and their patients, so that the public would not be squeamish about HPV: enter “Standing Orders” to routinize the conversation.
Avoiding public discussion
The concept of health departments mandating health policy is nothing new. What is new is how the vaccine schedule is increasing along with public awareness of potential harm from any and all of them.
At another Massachusetts health event sponsored by area hospitals, a crowd of 300 or so medical professionals and community leaders gathered to hear how a comprehensive health initiative was improving the quality of health in the county. Conspicuously missing from the 73 page handout and hour long presentation was any mention of increasing immunization rates. In its place were the words “access to fresh produce”.
It was confusing to witness the push for increasing vaccine rates potentially coming from State Health Departments (albeit not publicly), in contrast to how the local communities have identified nutrition as a better answer. Then again, it could be that a public forum with the word “immunizations” would stigmatize the whole program, which brings it back to what the pediatrician pointed out. The more the public knows about and discusses how vaccine politics encroach in our lives, the greater the pushback.
So then from their perspective it may be better to avoid publicly talking about immunization rates, and instead just implement the backdoor approach: Standing Orders.
Mary Romaniec is a reporter who lives in Massachusetts. She is the author of Victory over Autism: Practical Steps and Wisdom toward Recovery for the Whole Family. She writes, speaks and advocates for families of special needs children.