Review of the Vaccine-Autism Myth

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.   And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong.  

At the European Journal of Paediatric Neurology, Lidia V. Gabis and colleagues have an article titled "The myth of vaccination and autism spectrum." Abstract:

Background

Among all of the studied potential causes of autism, vaccines have received some of the most scrutiny and have been the topic of many evidence-based studies. These efforts have led the great majority of scientists, physicians, and public health researchers to refute causation between vaccines and autism.

Rationale

This presumed association and concern has been a major contributor to parents’ refusal to immunize their children and has become a major threat to public health in secluded populations over the last two decades, even prior to the COVID-19 pandemic. With the emergence of COVID-19 immunizations, sentiments towards this topic were addressed as a public health concern that may influence the ability to overcome the Corona virus worldwide.

Scientific review of data

Despite the overwhelming data demonstrating that there is no link between vaccines and autism, many parents are hesitant to immunize their children because of the alleged association.

Other contributing factors to the myths and conspiracy theories surrounding the association between vaccines and autism include the fact that the diagnosis of autism is typically made after the age of receiving the main childhood immunizations, as well as the occasional occurrence of regression after the age of first year vaccinations. In spite of vast evidence that the main contribution to the increase in incidence is from improvement of the diagnostic process, this rapid and publicized rise in autism diagnoses feeds parental concerns regarding any medical intervention that may be associated with the health of their children.

Recommandations

It is plausible that with more evidence-based studies linking autism to specific etiologies the myth will diminish and disappear eventually. In an era where conspiracy theories are prevalent on social media, it is critical that evidence-based studies relating autism to specific etiologies be made public, and that information concerning autism diagnosis and causes be made more readily available through social media and parental organizations.

From the article:

Conspiracy theories are reinforced by the very basis of Internet search engines. There are “discussion groups” on any topic and user communities. Searching for information will inevitably lead to any source of information, regardless of its validity. Opponents of vaccines build sites, discussion groups, etc., so that a “reasonable person” who writes the phrase “vaccines, autism, against” this will inevitably reach sites that deal extensively with the subject, and that may seem scientific and authoritative the general public and may create a false representation of the topic. Communication styles within the media revealed that vaccination and antivaccination comments use different kinds of language in their communication of information In addition, the vaccine-skeptical sites were highly interactive, with spaces for community discussion, and oriented towards the creation of people that believe to be affected by vaccination. In contrast authoritative pro-vaccination sites offer limited interactivity and focus on evidence-based knowledge and perceived as aloof and dictatorial.

Antivax Podcaster Gets COVID

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.   And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong.  

A growing number of them are getting COVID.

Mary Papenfuss at Yahoo:

A podcaster who opposed the COVID-19 vaccine contracted the disease and was on a ventilator Saturday after he attended the right-wing “ReAwaken America” event in Dallas early this month, according to his podcast network and conspiracy theorist attorney Lin Wood.

Podcast network Frog News said on the social media site Telegram that Doug Kuzma’s last communication with them included a photo of him posing with ivermectin, the antiparasitic medicine that many claim treats COVID despite federal health agencies’ warnings not to use it for such purposes, and other chemicals after the three-day event that featured Michael Flynn, who briefly served as Donald Trump’s national security adviser and later pleaded guilty to lying to the FBI.

As of Saturday, Kuzma was “sedated and on a ventilator.” He was “not conscious,” noted a Frog News message. “Doug needs heavy, heavy prayers.”

Readiness for Driving

In The Politics of Autism, I discuss interactions between police and autistic people.  Sometimes they occur on the road.  A number of ASD people drive cars.

A release from Children's Hospital of Philadelphia:

A collaborative study from the Center for Injury Research and Prevention (CIRP) and the Center for Autism Research (CAR) at Children’s Hospital of Philadelphia (CHOP) found that only 8% of pediatric healthcare and behavioral service providers feel prepared to assess whether their autistic patients are ready to drive. These findings, recently published in the Journal of Autism and Developmental Disorders, suggest a critical need to develop resources that prepare providers and others who work with autistic youth to effectively facilitate independence and mobility as their patients become adults.

This study is part of a body of research that aims to understand the transportation needs of autistic adolescents. Prior studies have examined how individualized training, parental support, and driving patterns contribute to safe driving. Other studies have found that, whether autistic adolescents decide to drive or not, being able to get where they want to go on their own improves psychosocial, health and employment outcomes. While making decisions about transportation, families of both autistic and non-autistic youth seek guidance from their child’s pediatric healthcare and behavioral service providers. However, little is known about these conversations or how providers approach these topics with patients.

The researchers surveyed a total of 78 providers who care for both autistic and non-autistic patients in March and April of 2019. Most providers were attending pediatric physicians and psychologists located in Pennsylvania and New Jersey. Half reported they had general transportation-related discussions with their non-autistic patients, while only 1 in 5 had these conversations with their autistic patients. When discussing driving, 33% of providers believed they could assess if their non-autistic patients were ready to drive, while only 8% believed they could do so for their autistic patients.

“It was also surprising to learn that only 1 in 4 providers refer their patients, autistic or not, to other providers for driving-related issues,” says Emma Sartin, PhD, MPH, lead author and a postdoctoral fellow at CIRP. “Our next steps will be to start developing resources and tools so that families, and the professionals who support them, are not left largely on their own to make or guide important decisions about driving.”

A lack of guidance for families on how to navigate transportation decisions could be critical, as previous CHOP research found that two-thirds of 15- to 18-year-old autistic adolescents without intellectual disability are currently driving or planning to drive, and 1 in 3 autistic individuals without intellectual disability get licensed by age 21. Other recent research conducted at CHOP found that newly licensed young autistic drivers have similar to lower crash rates than their non-autistic peers, suggesting those who do become licensed are generally safe drivers. Additionally, young autistic drivers are much less likely to have their license suspended or to receive a traffic violation than their non-autistic peers.

“One important way that providers can help autistic teens and their families is to start talking about driving and transportation before they get to high school,” says Benjamin E. Yerys, PhD, study author and a clinical psychologist at CAR. “We know this seems early, but it provides more time for them to benefit from supports, including those services that come from outside of healthcare, including tailored instruction from a driving rehabilitation specialist.”

Resources for families to help their autistic teens transition to adulthood are available at the Center for Autism Research at CHOP and TeenDriverSource.org.

This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health Awards R01HD079398 and R01HD096221.

Sartin et al, “Brief Report: Healthcare Providers’ Discussions Regarding Transportation and Driving with Autistic and Non-autistic Patients.” J Autism Dev Disord. Online December 1, 2021. DOI: 10.1007/s10803-021-05372-3

RFK In Louisiana

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.   And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong.  

A leading antivaxxer is Robert F. Kennedy, Jr.

In Louisiana, Rosemary Westwood at WWNO-FM:

Anti-vaccine misinformation gained a stark new foothold in state politics at a recent hearing of the House Health and Welfare Committee, when Attorney General Jeff Landry brought Robert F. Kennedy Jr., one the country’s most famous anti-vaccine activists who has been discredited for spreading misinformation about COVID-19 vaccines and other shots.

The hearing was centered around the Louisiana Department of Health’s plan to include COVID-19 vaccines fully approved by the U.S. Food and Drug Administration in the regular schedule of childhood vaccinations required for schools, though state law allows broad exemptions on religious, medical or philosophical grounds.

...

The presentation encapsulated how anti-vaccine activists raise objections and concerns whether there’s any basis for them or not, he said.

[Louisiana State Health Officer Dr. Joseph] Kanter — who was called upon to testify nearly two hours into the meeting — said it was particularly concerning that Kennedy was given “center stage.” He said Kennedy’s presentation “cherry picked” data to give the appearance it was factual.

“If you look at this individual, and his track record, he has done the exact same thing for countless vaccines. He has been at the center of pieces of myths and misinformation on other vaccines that have really caused families harm,” Kanter said.

Kennedy is the founder of Children’s Health Defense, a group that promotes disinformation about vaccines and their ties to autism, among other things — claims vigorously rejected by the Centers for Disease Control and Prevention and the Autism Society of America, which states bluntly that “there has never been any credible scientific or medical evidence linking vaccinations with autism.”

During the committee hearing, the slides from Kennedy’s presentation were tweeted out by Health Freedom Louisiana. The private organization is the leading state-level organization fighting COVID-19 vaccine mandates and public health measures, including masks requirements.

Tapper Declines Debate with RFK Jr.

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.   And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong.  

A leading antivaxxer is Robert F. Kennedy, Jr.

 

Truly embarrassing.

No, I’m not going to lend credence to a conspiracy theorist whose views are so false, unhinged, and dangerous to public health his own siblings feel the need publish op-eds against him.https://t.co/sLCLs3OQ7n https://t.co/zKNZifvI1s

— Jake Tapper (@jaketapper) December 22, 2021

Here is more on the reference to the Kennedy family.

TRICARE Coverage Changes

In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families.  As many posts have discussed, the challenges are especially great for military families.

A release from Senator Jeanne Shaheen:

U.S. Senators Jeanne Shaheen (D-NH) and Kirsten Gillibrand (D-NY) wrote a letter to Secretary of Defense for Personnel and Readiness Gilbert Cisneros, to inquire about changes made to TRICARE coverage that limit treatment options for individuals with autism. Specifically, the letter asks the Pentagon to investigate how these changes restrict access to proven services like Applied Behavior Analysis (ABA) and add burdens to care for autistic dependents, like children, and members of the military.

“We write with concern regarding the Defense Health Agency’s (DHA) May 1, 2021, policy changes pertaining to services for TRICARE beneficiaries through the Autism Care Demonstration (ACD). We are concerned that those changes have created burdens for military families and may be detrimental to the best course of treatment for some beneficiaries diagnosed with Autism Spectrum Disorder (ASD),” the Senators wrote. “Therefore, we are seeking additional information regarding these changes, the steps being taken to support military families with beneficiaries diagnosed with ASD and the intentions of the Department of Defense with respect to the overall ACD.”

“Changes to TRICARE coverage of the ACD should be based on independent assessments of efficacy that prioritize the welfare of military families and dependents with autism. It is imperative that military families have consistent access to the highest standards of care,” the Senators concluded.

“We are deeply troubled by the barriers to care that TRICARE has erected for many military families with autistic children through the policy changes described by Senators Shaheen and Gillibrand in this letter,” said Dr. Andy Shih, Interim Chief Science Officer for Autism Speaks. “Military families who rely on TRICARE deserve to have access to the services they need. We are grateful to Senators Shaheen and Gillibrand for listening to the voices of these families and for raising this important and pressing issue with Undersecretary Cisneros.”

“EFM supports the independent review in the NDAA of the Autism Care Demonstration,” said Holly Duncan, Co-Director of the Autism Family Advocacy Committee of Exceptional Families of the Military (EFM). “However, it provides no immediate help for military families. The changes should be halted and services in the community and school settings should be resumed pending the outcome of the review. We support the request for a briefing and are grateful for Senator Shaheen and Senator Gillibrand for representing military families impacted by these changes.”

"The recent DHA policy to remove Behavior Technicians from the school and community setting is not consistent with generally accepted standards of care for Applied Behavioral Analysis (ABA). The unjustified changes to this medically-necessary service impacts military families’ mental health and readiness as uniformed members must decide between seeking costly secondary insurance, foregoing ABA therapy in these settings, or leaving the armed forces. We are grateful to Congressional leaders for advocating to ensure military children diagnosed with autism receive quality ABA services,” said Dr. Kristi Cabiao, President and CEO of Mission Alpha Advocacy.

Full text of the letter is available here.

Insurrectionist Fails with Autism Argument

In The Politics of Autism, I write:

There is no evidence linking autism to planned violence, but in recent years, mass shootings by young men have led commentators in the mainstream media and on the Internet to suggest such a connection. After the 2007 Virginia Tech massacre, for instance, news reports said that the shooter was on the spectrum. The speculation made little sense to anyone who understood autism. Whereas autistic people have language delays and deficits, the killer had learned English as a second language — and learned it well enough to major in the subject in college. Later on, it turned out that he had an entirely different problem, a social anxiety disorder. Adam Lanza, who committed the Sandy Hook massacre in 2012, may have had an Asperger’s diagnosis, but his father emphasized that his behavior stemmed from the psychiatric illnesses that he also had. Nevertheless, the media speculated about Lanza’s place on the spectrum, which worried autism parents. One mother of an autistic child wrote: “This is the first time I'm truly afraid for him. Afraid of what may happen to my son with autism at the hands of a stranger; a stranger who has chosen to buy into the media-fueled misinformation that individuals diagnosed with an Autism Spectrum Disorder are dangerous and capable of horrendous acts of terror and violence.”

Capitol insurrectionist Jacob Chansley -- the "QAnon Shaman" -- unsuccessfully used autism as a defense earlier this year. 

Another insurrectionist has tried and failed with a similar argument.

Samantha Hawkins at Courthouse News Service:

Attorneys who insisted their client has the “coping skills of a 4-year-old” proved unable Monday to secure a lenient sentence for the Washington man after he assaulted a police officer with a metal baton during the riot at the U.S. Capitol.

Defense attorney Elizabeth Kelley argued that because Devlyn Thompson, 28, has Asperger’s syndrome, he functions as a young child in many ways, and his lack of full social understanding merits consideration in deciding his punishment.

“ASD individuals can get embroiled in situations where they don’t know the consequences,” Kelley wrote in her sentencing memorandum, using an abbreviation for autism spectrum disorder. “Mr. Thompson had the socialization and communication skills of a young child, but at the same time had the intellectual capacity to maintain politics as his main special interest.”

Kelley said those factors, along with the fact that Thompson has very few friends, created the perfect storm for Thompson on Jan. 6.

In court Monday, U.S. District Judge Royce C. Lamberth told Thompson that he couldn’t justify a downward departure from the sentencing guidelines, given that Thompson violently fought in the Capitol’s West Terrace tunnel for nearly 15 minutes — yelling obscenities at officers, throwing objects — including a large audio speaker which hit a fellow rioter and drew blood — and helping members of the mob take riot shields away from police.

TV Report on Autistic Adults

In The Politics of Autism, I write:

When disabled people reach their 22d birthday, they no longer qualify for services under IDEA. ... People in the disability community refer to this point in life as “the cliff.” Once autistic people go over the cliff, they have a hard time getting services such as job placement, vocational training, and assistive technology. IDEA entitles students to transition planning services during high school, but afterwards, they have to apply as adults and establish eligibility for state and federal help. One study found that 39 percent of young autistic adults received no service at all, and most of the rest got severely limited services.

JuYeon Kim at KSHB-TV in Kansas City:

Autism spectrum disorder (ASD) affects about one in 54 children today. According to the Centers for Disease Control and Prevention (CDC), it is a developmental disability that can cause social, communication and behavioral challenges.

Autism is often called an “invisible disability” as those on the spectrum may not always show any outward characteristics. Instead, the disorder affects how the brain processes and perceives information. Patrina Dixon, a high-functioning woman with autism in her 40s, explained what it is like to be on the spectrum. 

Red State COVID

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.   And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong.  

Unfortunately, Republican politicians and conservative media figures are increasingly joining up with the anti-vaxxers.  There is a great deal of overlap between MAGA World and the antivax movement.

David Leonhardt at NYT:

In the U.S., partisanship is the biggest factor determining vaccination rates. If Democratic voters made up their own country, it would be one of the world’s most vaccinated, with more than 91 percent of adults having received at least one shot. Only about 60 percent of Republican adults have done so.

This vaccination gap has created a huge gap in death rates, one that has grown sharply during the second half of the year.

The chart below is based on data from Charles Gaba, a health care analyst who has split the country into 10 equally sized groups. The Trump line refers to the one-tenth of Americans who live in counties that voted most heavily for Trump last year, while the Biden line is the equivalent for the president’s best counties. The line labeled “swing” describes counties where each candidate won at least 45 percent of the votes:

One telling detail is that Covid deaths in both swing counties and heavily Biden counties have not risen over the past two months, even as nationwide case numbers have surged. In heavily vaccinated communities, rising caseloads don’t automatically lead to rising death tolls.

In hundreds of U.S. counties, though, most adults still have not received a Covid vaccine shot. “Just since this summer, 150,000 unvaccinated Americans have needlessly lost their lives despite the widespread availability of vaccines,” Dr. Peter Hotez of the Baylor College of Medicine, in Houston, said yesterday.

Vaccine skepticism stems in part from messages on social media and conservative outlets like Fox News, the Sinclair Broadcast Group and talk radio. Pundits on these platforms often stop short of telling people not to get vaccinated, even as they send a general negative message about the shots.

RFK Hypocrisy

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.   And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong.  

A leading antivaxxer is Robert F. Kennedy, Jr.

Rachael Bade at Politico:

TALES OF AN ANTI-VAXXER — Robert F. Kennedy Jr. is one of the most prominent anti-vaxxers in the country. So it came as a surprise when an invitation to a holiday party at his home in California last week urged attendees to be tested or vaccinated beforehand, two people familiar with the matter told Daniel Lippman.

When we called up Kennedy for comment, he pinned it on his better half, actress Cheryl Hines of “Curb Your Enthusiasm” fame. Kennedy said the party was for her entertainment industry friends and cast members, and he was unaware of what the e-vite invitation said before the day of the party.

“I guess I’m not always the boss at my own house,” Kennedy told Lippman. There was also no effort to verify vaccination or testing status of the attendees before entering, he said. (Hines didn't respond to a request for comment.)

Just this week, Kennedy was the subject of a major AP profile titled “How a Kennedy built an anti-vaccine juggernaut amid COVID-19.” The article reported that the revenue of his charity, Children’s Health Defense, more than doubled in 2020 to $6.4 million. Last month, he released his new book, “The Real Anthony Fauci: Bill Gates, Big Pharma, and the Global War on Democracy and Public Health,” which continues to be a best-seller on Amazon.

Last month, Tucker Carlson hosted him on a program where he linked vaccines to autism. 

Samira Sadeque at The Guardian reported in September:

The vast majority of employees at Fox Corporation, the umbrella company for the conservative Fox News channel, are vaccinated against coronavirus and those who are not will be required to do daily testing, according to a memo sent out from bosses – despite some of its biggest screen stars questioning the vaccine.

A daily test is stricter than the Biden administration’s firm mandate that businesses with more than 100 employees must require either vaccination or weekly testing.

 

Implementation Research

In The Politics of Autism, I discuss implementation of public policy toward autism at the federal, state, and local levels, involving  education and social services.  Implementation needs far more study.

Brian A. Boyd and colleagues have an article at Autism titled 'It’s time to close the research to practice gap in autism: The need for implementation science."

Over 15 years ago, Lord and colleagues (2005) identified the challenges of evaluating interventions for autism, and Smith and colleagues (2007) subsequently proposed guidelines to generate empirical evidence for behavioral and psychosocial interventions. Since then, intervention research has proliferated (Steinbrenner et al., 2020), but the gap between research and practice remains wide (Dingfelder & Mandell, 2011; Odom et al., 2020). Implementation science has emerged as a field to promote the use and sustainment of evidence-based practices (EBPs) in routine care and practice. In this commentary, we challenge autism researchers to take the next steps on this journey that Lord, Smith, and colleagues began. In this commentary, we briefly describe (a) the history of intervention research for autistic children and youth, (b) key features of implementation science, and (c) a framework to support the use of implementation science in autism intervention research.

A basic requirement for implementation science is that there should be a clearly operationalized, conceptually sound, EBP to implement. In the last two decades, autism intervention science has accelerated rapidly, providing evidence-based comprehensive program models (e.g. the Early Start Denver Model, Pivotal Response Treatment, and the Lovaas Model), and focused intervention practices (e.g. reinforcement, prompting, and naturalistic strategies). Continued attention to discovering and validating practices that support autistic individuals will always be important. However, the variety of evidence-based intervention approaches and outcomes produced, as documented by systematic reviews and meta-analyses (Hume et al., 2021; Sandbank et al., 2020), suggests that the field is ready to move from solely a science of intervention efficacy, so well articulated by Smith et al., to a science of intervention implementation and sustainment.

Implementation science is “the scientific study of methods to promote the systematic uptake of clinical research findings and other EBPs into routine practice.” (Ogden & Fixsen, 2014, p. 4). Efforts to close the research-to-practice gap lie along a continuum from passive knowledge transfer to more active supports. At the passive end is diffusion, or the expectation that community practitioners will find EBPs on their own. Dissemination comprises more active communication about the innovation (e.g. public health smoking cessation campaigns; Learn the Signs, Act Early). Implementation is an active process that involves activities designed to motivate users and increase their ability to use an innovation (Dearing et al., 2018). Although they are important steps, diffusion and dissemination alone often do not lead to successful use of EBP. Implementation science identifies the change mechanisms (e.g. infrastructure of support, Odom et al., 2013; collaborative research culture, Stahmer et al., 2017) needed to ensure high-quality use of an innovation in practice.

Children's Health Defense Prospers During the Pandemic

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.   And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong.  

A leading antivaxxer is Robert F. Kennedy, Jr.

Michelle R. Smith at AP:

While many nonprofits and businesses have struggled during the pandemic, Kennedy’s anti-vaccine group has thrived. An investigation by The Associated Press finds that Children’s Health Defense has raked in funding and followers as Kennedy used his star power as a member of one of America’s most famous families to open doors, raise money and lend his group credibility. Filings with charity regulators show revenue more than doubled in 2020, to $6.8 million.

Since the pandemic started, Children’s Health Defense has expanded the reach of its newsletter, which uses slanted information, cherry-picked facts and conspiracy theories to spread distrust of the COVID-19 vaccines. The group has also launched an internet TV channel and started a movie studio. CHD has global ambitions. In addition to opening new U.S. branches, it now boasts outposts in Canada, Europe and, most recently, Australia. It’s translating articles into French, German, Italian and Spanish, and it’s on a hiring spree.

...

Kennedy often says he started looking at vaccines after a mother told him she believed her son developed autism from exposure to mercury in a vaccine. The theory has been thoroughly debunked. The form of mercury, thimerosal, was removed from childhood vaccines years ago with no effect on the levels of autism. Still, Kennedy and others continue to argue, against the scientific consensus, that vaccines are linked to autism, food allergies and a host of other medical problems. Among the ingredients he tells people to watch out for are common substances such as aluminum, acetaminophen, fluoride and food additives.

BBB and the Subminimum

In The Politics of Autism, I discuss the employment of people on the autism spectrum.

Shirin Ali at The Hill:

The National Down Syndrome Society points out that people employed under the 14(c) certificates are often trained to perform tasks that don’t actually build capacity or transfer into skills that will help them land other jobs. “This practice reinforces the stigmatic misconception that people with disabilities are less productive and creates an artificial competitive barrier to future employment opportunities.”

Congress is trying to fix this, with Sen. Bob Casey (D-Pa.) announcing in November the Transformation to Competitive Integrated Employment Act (TCIEA) that aims to provide grants to states or employers to go toward transitioning to a business model that pays workers with disabilities at least minimum wage.

Biden’s Build Back Better bill incorporates much of TCIEA by providing $300 million toward a multi-year grant program that would assist states and employers to transform their business models to provide at least the minimum wage applicable in that state. It doesn’t completely outlaw FSLA provisions that allow subminimum wage, but through issuing grants the federal government will require states to provide assurances that it won’t permit employers to use subminimum wage certificates.

Build Back Better also proposes giving $24 million in grants to states that have already eliminated the certificates allowing subminimum wages and another $6 million toward establishing a national technical assistance center to assist states and employers in their transition to end subminimum wages.