Home > Get Involved, In the News > Where Does Your State Stand on School Immunization Exemptions?

Where Does Your State Stand on School Immunization Exemptions?

February 22, 2012

States all across the country are becoming battle grounds for vaccine exemption laws.  As some grow concerned about the ease in which people can obtain immunization exemptions, they are calling for the tightening of philosophical exemptions that currently allow unvaccinated children to attend public school.  In the past few weeks, we’ve seen vaccine related legislation in states such as Vermont, Kansas, South Dakota and West Virginia and people on both sides of the issue are voicing their concerns.

In order to weigh the implications of any proposed legislation, it’s important to first understand the reasoning behind state vaccination requirements and exemptions.

Contrary to what anti-vaccination groups say, vaccines are not forced upon anyone.

While the Food and Drug Administration (FDA) regulates vaccines to ensure safety and effectiveness, there are no federal vaccination laws.  However, just as the government requires immunizations for those who volunteer to join the military, and health providers may require employees to be vaccinated in a medical setting, immunization requirements for public school enrollment are determined by individual states.  Parents are not forced to vaccinate their children.  Rather, they’re given a choice as to whether they want their children to attend public school and therefore be vaccinated according to state admission policies.

All states offer vaccine exemptions.

According to the Institute for Vaccine Safety, as of August 2011, all 50 states and the District of Columbia permitted medical exemptions from immunization requirements.  In instances of cancer, immune disorders and allergy to vaccine components, vaccination is medically contraindicated and necessitates the use of a medical exemption since vaccination could be detrimental to the health of a child.   However, non-medical exemptions are also available through religious exemptions in 48 states and philosophical/personal belief exemptions in as many as 20 states.   While exemptions often differ by state, the process by which parents can obtain these exemptions has recently been cause for concern among public health professionals.

For example, in some states the current exemptions are exercised by simply signing a pre-written statement on a school immunization form or writing a personal letter explaining one’s reasons for refusing vaccination.  More recently, in states like Washington, new laws are suggesting that non-medical vaccine exemptions must be accompanied by the signature of a medical professional.  The intent, as I understand it, is to ensure that parents aren’t using the exemptions as a matter of convenience.  By requiring a discussion with a trained and qualified medical professional, health departments can make certain that parents aren’t using exemptions to avoid a trip to the doctor’s office.  The requirement also helps to ensure that parents are properly informed regarding the benefits of vaccines and the risks of vaccine refusal.

There is reason to be concerned about high exemption rates.

Recently, changes in exemption procedures are being suggested because statistics reveal that states with less rigorous procedures for obtaining these exemptions tend to have higher exemption rates. Additionally, higher exemption rates are often concentrated in specific communities, which subsequently increases the likelihood of disease transmission in that same community.    In support of recent legislation in Kansas,  Robert Moser, MD, Secretary and State Health Officer, Kansas Department of Health and Environment, referenced these points:

  • States that made it easy to get exemptions had 90 percent more cases of whooping cough than states with stricter rules; states that allowed only religious and medical exemptions did not have a significantly higher rate of whooping cough.
  • Schools with exemption rates as low as 2 percent to 4 percent are at increased risk for disease outbreaks.
  • Exempted children have been found to be 22 to 35 times more likely to get measles than vaccinated children.
  • The number of exemptions granted for nonmedical reasons grew by 6 percent per year between 1991 and 2004 in states that offered personal belief exemptions.
  • Risks to the community, particularly vulnerable individuals within the community, are exacerbated by the tendency for nonmedical exemptions to cluster in small geographic areas rather than be evenly distributed throughout the state. These risks are evident even when overall immunization coverage levels for the state as a whole remain relatively high.

While vaccine hesitant parents want to claim vaccination as a personal choice, the reality is that the decision to remain purposely unvaccinated can have dangerous, and sometimes even deadly consequences, to those that are either too young to be vaccinated or who have legitimate medical contraindications.  It has never been suggested that parents be forced to vaccinate their children.  However, it seem reasonable to discourage the casual use of non-medical exemptions so as not to endanger the health of the public school children who do their part to protect our public health by getting vaccinated.

Be aware of the battles being waged against public health.

Unfortunately, even though the majority of parents vaccinate their children, most people are unaware of the battles being waged in state legislatures these days.  Meanwhile, anti-vaccination organizations are actively calling for the expansion of personal belief exemptions under the guise of freedom of choice.  In fact, just this morning in West Virginia anti-vaccine activists gathered on the steps of the state capital in support of Senate Bill 50, introduced by Senator David Nohe in hopes of paving the way for non-medical exemptions in West Virginia.

In an article the Senator wrote for Age of Autism, he explains that his son suffered a reaction to a vaccine and has since been advised not to be vaccinated.  In this case, the Senator’s son would easily be granted a medical exemption.   Unfortunately, instead of acknowledging that his son is cocooned from dangerous diseases by his vaccinated classmates, the Senator fails to realize that his efforts to expand the use of non-medical exemptions will likely decrease immunization rates, increase the incidence of disease, and increase the risk that his own son may contract a preventable disease.

Perhaps there will come a time when all parents and politicians will appreciate that protecting public health is not only in everyone’s best interest, but it is essentially everyone’s responsibility.  If you value vaccinations for the immunity they offer our community, I urge you to ensure that your state’s laws are working to protect your family.  Every Child By Two recently suggested that people take action in the state of Vermont by signing an online petition that calls for the retraction of a philosophical vaccine exemption for school entry in that state.   Perhaps there is something that you can do in your state?

We’ll do our best to keep you informed of specific legislative actions, but we suggest you contact your state health department to ask how you can make a difference in preserving public health.   For more information on state vaccination requirements and exemptions we encourage you to explore some of these valuable resources.

Immunization Action Coalion

Institute for Vaccine Safety (Map of Vaccine Exemptions)

National Conference of State Legislatures

Association of State and Territorial Health Officials (ASTHO)

  1. Richids
    February 22, 2012 at 4:25 pm

    “the Senator fails to realize that his efforts to expand the use of non-medical exemptions will likely decrease immunization rates”

    That’s not true, the states with philosophical exemptions actually have some of the highest coverage rates in the nation. According to the CDC’s National Immunization Survey, there is no link between having exemptions or the type of exemption and lower vaccination coverage. Many other states with both religious and philosophical exemptions have a higher vaccination rate than West Virginia.

    Exemptions for religious and moral beliefs are claimed on the average by less than 1% of the population. If vaccination coverage falls by 1%, that is not nearly enough to lose herd immunity. Herd immunity has never been threatened by exemptions in the 48 other states that allow this freedom.

    CDC link – http://www.cdc.gov/vaccines/stats-surv/nis/figures/01-331_figure.htm

  2. Richids
    February 22, 2012 at 4:29 pm

    In fact when you look at the 2010 data and compare Mississippi (Medical only) with Vermont (Medical, Religious and Philosophical) you see that in most cases the difference 9 years after that previous data is still 1%.

    http://www.cdc.gov/vaccines/stats-surv/nis/data/tables_2010.htm

  3. Chris
    February 22, 2012 at 4:51 pm

    Seriously? Most of the states in that list have lower vaccination rates. Many are those that have had major outbreaks of disease like California, Indiana, Iowa, Oregon, Arizona, and Washington (which recently tightened up its rules a little). Plus some outbreaks in places where “religious” exemptions were made.

    Again, the rules are only for attending public schools. Be a good libertarian and never send your children to government schools. You are more than welcome to gather up your “freedom loving” friends and create your own private school that ignores any and all public health policies.

    According to the CDC’s National Immunization Survey, there is no link between having exemptions or the type of exemption and lower vaccination coverage.

    Citations that were relevant would have been nice. You should try some next time. Like these, one of which concludes “Permitting personal belief exemptions and easily granting exemptions are associated with higher and increasing nonmedical US exemption rates” :

    Pediatrics. 2009 Jun;123(6):1446-51.
    Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children.

    Am J Epidemiol. 2008 Dec 15;168(12):1389-96. Epub 2008 Oct 15.
    Geographic clustering of nonmedical exemptions to school immunization requirements and associations with geographic clustering of pertussis.

    JAMA. 2006 Oct 11;296(14):1757-63.
    Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence.

    JAMA. 2000 Dec 27;284(24):3145-50.
    Individual and community risks of measles and pertussis associated with personal exemptions to immunization.

    JAMA. 1999 Jul 7;282(1):47-53.
    Health consequences of religious and philosophical exemptions from immunization laws: individual and societal risk of measles.

  4. Nathan
    February 22, 2012 at 6:21 pm

    It’s not a good sign when you have to cherry pick all the way across the country to find data that supports your claims. Compare Mississippi to its more demographically similar bordering neighbors that have both philosophical and religious exemptions, Louisiana and Arkansas.

    Here is the 24 month 2010 data from where you linked:

    http://www2a.cdc.gov/nip/coverage/nis/nis_iap3.asp?fmt=v&rpt=tab09_24mo_iap&qtr=Q1/2010-Q4/2010

    There’s no 3:3:1 data here, but there is 4:3:1 data, that is, how many children got 4 doses of DTaP, 3 of polio, and one of MMR vaccine by age 24 months.

    Mississipi (medical exemptions only): 82.1%
    Louisiana (medical, religious, and philosophical): 72.2%
    Arkansas (medical, religious, and philosophical) 76.5%

    Or take a look at single MMR vaccine coverage between these states, as herd immunity for measles would be highly dependent on this:

    Mississipi (medical exemptions only): 92.8%
    Louisiana (medical, religious, and philosophical): 85.3%
    Arkansas (medical, religious, and philosophical) 88.5%

    Far more than 1%. And your 3-3-1 data from 2001 shows similar discrepancies between Mississippi and its neighboring states.

  5. Nathan
    February 22, 2012 at 6:25 pm

    Iowa has a religious, but not philosophical exemption. Iowa also happens to have some of the highest vaccination rates in the country, as recognized by a recent Commonwealth report.

    http://www.commonwealthfund.org/News/News-Releases/2011/Jan/Child-Health-Release.aspx

  6. Chris
    February 22, 2012 at 6:38 pm

    Oops. Sorry. I was thinking of the mumps outbreak, but that was more of older college students who had only one MMR.

    Thanks for correcting me.

  7. February 25, 2012 at 9:48 pm

    You wrote: “In an article the Senator wrote for Age of Autism, he explains that his son suffered a reaction to a vaccine and has since been advised not to be vaccinated. In this case, the Senator’s son would easily be granted a medical exemption.”

    I’m wondering how the WV medical exemption plays out in real life. How difficult is it to obtain a physician’s statement? Does it have to be renewed each year?

    If a baby receives several vaccines at once, and it isn’t clear which vaccine caused the reaction, can the doctor just recommend against all of the vaccines or does the baby have to go through getting one vaccine at a time until they figure out which one caused the problem?

    From the news stories about the demonstrations in WV it sounds as though there are a significant number of parents who are unhappy with the manner in which the medical exemption is applied.

    I’m also wondering if we can really assume that doctors will always get it right. Obviously, sometimes doctors will think something is a vaccine reaction when it was just a coincidence, but equally obviously they will sometimes think something was a coincidence when it was really a vaccine reaction..

    A careful weighing of the risks of each illness against the possible risks of the vaccine for a particular child may be needed…

  8. Nathan
    February 26, 2012 at 2:06 am

    In my state, the doctor can write a medical exemption from all the vaccines if it is unclear which vaccine caused the reaction. I can’t imagine that wouldn’t be the case in other states – you could certainly look into it in yours.

    I’m also wondering if we can really assume that doctors will always get it right. Obviously, sometimes doctors will think something is a vaccine reaction when it was just a coincidence, but equally obviously they will sometimes think something was a coincidence when it was really a vaccine reaction..

    It’s not too hard to look up what is and is not a contraindication for a vaccine.

    http://www.cdc.gov/vaccines/recs/vac-admin/downloads/contraindications-guide-508.pdf

    Hopefully doctors apply an objective standard such as this for most cases.

    A careful weighing of the risks of each illness against the possible risks of the vaccine for a particular child may be needed…

    Agreed. That is generally the idea when it comes to exemptions.

  9. Emery Max
    February 27, 2012 at 7:39 pm

    Using CDC NIS statistics for pre-school children to attempt to illustrate that philosophical exemptions reduce school age vaccination rates is not logical, for the simple fact that pre-school children are by definition not enrolled in school, therefore not subject to requirements, therefore school attendance exemption rules do not apply to them.

    Is your thinking really that undisciplined? Aren’t you guilty of cherry picking all the way down to 24 month old statistics to try to make your case for rules that don’t apply until 60 or 72 months of age?

    The only pre-k children in any state subject to vaccination requirements are those enrolled in state licensed day care or pre-school, and represent the minority of children in that age cohort in most all states. In any case the population not subject to requirements is too large to make any conclusions about the effect of exemptions.

    The proper analysis to determine the effect of the school admission Phil. Exemptions is to look at actual K-12 vaccination rates. Every state measures and publishes the information annually. http://www2.cdc.gov/nip/schoolsurv/schoolrpt1.asp?st1=122529 You can look at K rates and 6th or 7th grade rates for each state. When you look at compliance with the vaccines actually required for school attendance, and not the recommended schedule you see that compliance is excellent everywhere.

    This push against exemptions is being promoted by using inapplicable statistics, CDC NIS, misrepresented to be the actual school vax rates.

    If you do want to look at pre-k children the CDC NIS surveys can be deceptively low because several include criteria other than simple vaccine uptake, such as dose timing, and will weight against or even classify as unvaccinated children falling outside of timing milestones, i.e. an initial dose of Hep B after 24 hours, etc.

    A more accurate measurement of actual vaccines received versus compliance with CDC scheduling is done by the United Health Foundation, who measures and assigns rankings annually. If you pull the report by state they have statistics for immunization coverage 19-35 months of age that measure total vaccines received without confounding. But it still only includes children with all doses and tosses out children missing even a single dose. http://www.americashealthrankings.org/

    The real reason that school exemptions appear to be rising is the recent addition of Chicken Pox and Hep B requirements. Chicken Pox is simply too far for some parents. When Chicken Pox is added to an MMR visit it increases the normal MMR seizure rate from 1/3500 to 1/2500, and using the MMRV Pro Quad doubles that to 1/1250. Is a parent being unscientific if they can radically reduce the seizure risk to their child through dose timing or product selection?

    In WA State schools staff will not accept a parental affidavit of previous infection for Chicken Pox, requiring them to use a Phil Exemption. Imagine this conversation in a school office: “My child doesn’t need a CP shot, he had CP when he was four” -“Great, we just need confirmation from your Dr.” – “What are you talking about, this is my child, I was there” -“Sorry, we need the Dr. to sign” – “I didn’t take him to the Dr., it was only CP, and if it is in his file there that is only because I told the nurse” – “Sorry, those are the rules” – “Forget it, I am not going to hassle with that” – “OK, well I need something here on file, so fill out one of these instead”, and hands the parent a Phil Exemption form

    I am afraid this subject is much more nuanced than a pro vs anti argument.

    You can read an analysis of the Vermont Exemption story below. It is particularly absurd as Vermont was just designated the Healthiest State in the USA, and 7th grade vax rates exceed 98%.

  10. Chris
    February 27, 2012 at 9:36 pm

    Using CDC NIS statistics for pre-school children to attempt to illustrate that philosophical exemptions reduce school age vaccination rates is not logical, for the simple fact that pre-school children are by definition not enrolled in school, therefore not subject to requirements, therefore school attendance exemption rules do not apply to them.

    Could you be specific who you are referring that paragraph to? Of course it does not make sense, especially since many of the vaccines for younger children are not required for school admittance (like rotavirus and Hib). Our area only requires HepB (area where large immigrant population where it is endemic), diphtheria, tetanus, pertussis, measles, mumps, rubella, polio and varicella.

    The “Permissive State Exemption Laws Contribute to Increased Spread of Disease” paper linked to in the “There is reason to be concerned about high exemption rates.” paragraph has several references. They include JAMA 2006;296:1757-1763., which looked at children under age eighteen, not just preschoolers. The second reference, Am. J. Epidemiol. (2008) 168(12): 1389-1396., also looked at children under age eighteen, not just preschoolers. The fourth reference, N Engl J Med. 2009 May 7;360(19):1981-8., also looked at school age children.

    Please be a bit more clear about who is only referencing preschool children. Thank you.

    When Chicken Pox is added to an MMR visit it increases the normal MMR seizure rate from 1/3500 to 1/2500, and using the MMRV Pro Quad doubles that to 1/1250.

    Real citation needed. Not one with added scare boxes. Also, the actual schedule at the CDC site does not even mention the MMRV.

    And as far as the school scenario, that might be because in the past too many people have lied, like the family in this anecdote. Plus in the State of Washington the philosophical exemption now needs a medical professional signature, that solves the getting the information from the medical clinic problem.

  11. Emery Max
    February 28, 2012 at 3:12 am

    Chris-
    Paragraph one goes to Nathan.

    The key to this particular issue is that exemptions only affect those vaccines required for school attendance in the timeframes specified by any state to allow a student to come into compliance. In the run up for the legislation in VT DOH personnel have been citing NIS statistics without disclosing they are not the VT required school attendance schedule. Changing exemption rules has not effect on vaccines or populations not required.

    Go here to look at the state reports for actual vaccine compliance with the school required vaccines, which are the only ones affected by exemption rules. This links directly to VT, you can navigate from there. Go to “report menu” and then pick a state.

    http://www2.cdc.gov/nip/schoolsurv/schoolrpt1.asp?st1=122529

    Vermont permits K-12 students up to 1 year to catch up to the schedule. The report closes on December 31 each year, 9 months before the provisional admittance expires. 10.4% of K students have “provisional” or temporary admittance. 5% are listed as Philosophical Exemptions. Even with that all required vaccines are above 91%. If you add the 95.5% Hep B plus 10.4% Provisional plus 5% Philosophical you get 110.9%, which indicates that people are showing in several categories because they have some shots but not all required for enrollment. The majority of Philosophical exemptions are selective, not a wholesale abandonment of the schedule. Very few children have never had a vaccination, I recall a recent CDC survey saying that is less than 1%.

    VT 7th graders are above 98% compliant except for Chicken Pox. DTP reads low, but there is again a 12% Provisional admittance rate in 7th grade, because a DTaP booster is needed about that age and it takes time to catch everyone up again. Families who do Polio, MMR, & Hep B don’t skip DTaP. Go to the VT DOH site and look at previous year records when they show all grades, not just K and 7 and you see the upticks in the years following the requirements. This is when knowledge of the dose schedule and reporting criteria are needed to fully understand the statistics. The excel files cannot be directly linked to, go to the page and look at 2007/8 http://www.healthvermont.gov/hc/imm/ImmSurv.aspx

    As to the seizure rate info, those are not “scare boxes”, but summary boxes based on readers who want to skim and quickly see where the numbers come from. There is no editorializing, simple mathematical conversions from the 4/10,000 rate of the MMR +V and the 8/10,000 seizure rate of the MMRV. Below is the current version of the paper hosted at scribd, the current no longer lists the stand alone MMR seizure rate for some reason, but has the identical rates for the MMR+V and the MMRV. The statistics are in the bottom boxes of a table in the paragraph, “Choosing an option for you child’s first vaccination”.

    http://www.cdc.gov/vaccines/vpd-vac/combo-vaccines/mmrv/vacopt-factsheet-parent.htm

    For more detailed information about the normal rate of vaccine caused injuries see the WHO AEFI Immunization manual. This manual lists the normal and expected number of vaccine injuries in a programme so that if these numbers are exceeded then the Manager knows there is a problem with either the vaccine, or in delivery, known as a “programme error”. http://www.scribd.com/doc/76576786/AEFI-WPRO , page 11.

    Requiring a medical signature is not an optimum solution for a number of reasons. If you see this CDC powerpoint regarding “vaccine heisitant” parents, it speaks directly to the unworkability of that solution. Slides 14-18 detail that there is no insurance billing code for a vaccination consult therefore no compensation, providers often know less about vaccine safety than parents, and hesitant parents need more time when less is available. The information could be much more efficiently transmitted via internet, or a dvd, or even handouts. http://www.immunizationmanagers.org/membership/Janna.pdf

    This does not take into account that WA only accepts a limited number of WA only licensed providers. Any family who goes to Oregon or Idaho for healthcare (very common near Vancouver / Portland, Oregon and Spokane / Cour Delain, Id), or uses a type of provider not on the list must attempt to find a sympathetic signer for the form. That means calling up a practice and saying, “I am not a patient. I don’t want to be a patient. I simply want to come in and do whatever it is we have to so my child can skip Chicken Pox.”

  12. Emery Max
    February 28, 2012 at 6:23 am

    This is an example of the misrepresentation and conflation of NIS Statistics with the VT Required schedule published first in the Burlington Free Press:

    “Last year, Vermont Health Commissioner Dr. Harry Chen lamented the fact that only 60 percent of Vermont’s young people have had full doses of all 14 recommended immunizations, compared with 70 percent nationally and 67 percent to 76 percent in neighboring states such as New York and Massachusetts. Some lawmakers hope to increase Vermont’s immunization rate with stricter laws.”

    http://www.burlingtonfreepress.com/article/20120116/NEWS03/201160307/Vermont-lawmakers-try-boost-vaccination-rates

    That link is no longer active but you can see the article cross posted here http://neach.communitycatalyst.org/states/vt/news/vermont-lawmakers-try-to-boost-vaccination-rates

    Now here you have the top health official in the state conflating, either intentionally or through incompetence, NIS statistics with the VT Required schedule. Changing the exemption rules will have no effect on the statistic Commissioner Chen is referencing as it includes vaccines not required in Vermont and measures pre-k children largely not subject to requirements in any state. The K vaccination rates for vaccines actually required already exceed 91% with 10% of kids still catching up, how much higher than that is reasonable? Aren’t all public objectives achieved at 90% plus rates? If not, where is the tipping point, 92%?

    The unvaccinated are little threat to a vaccinated population, Consider this, when an American travels to a country with low or even non-existent vaccination rates, and endemic disease, does the CDC or State Department give you a pamphlet that says, “Warning- you are entering a population without herd immunity and your vaccines will be of virtually no help”. Of course not, and look how infreqently a vaccinated person contracts an infection in that environment.

    Imagine a Vermont Legislator, Reporter, or Citizen not conversant with the facts hearing Commissioner Chen’s quote and thinking, “My God, 40% of Vermont children are skipping shots? That’s crazy, we have to do something!”, which certainly seems to be the intention when facilitating this type of misrepresentation.

    Public Health loses credibility when thinking people learn of this type of behavior, which certainly seems to reflect an “ends justifying the means” attitude. Especially in Vermont where the 5% K exemption percentages represent maybe 400 families? Change a law for that?

  13. Nathan
    March 3, 2012 at 12:27 am

    My “undisciplined” choice of statistics was guided by those supplied by Richids, who first linked to estimated 3:3:1 data from 2001 and claimed that since Vermont and Mississippi were similar, that this is evidence that religious and philosophical exemptions do not significantly affect vaccine rates. Then he made the same claim with 2010 data.

    I simply pointed out that comparing such states with this data is not as valid as comparing nearby, more demographically similar states, and used his supplied data to make my point. Your point about coverage during school is a perfectly valid as to how Richids comparison is even less valid.

    The only pre-k children in any state subject to vaccination requirements are those enrolled in state licensed day care or pre-school, and represent the minority of children in that age cohort in most all states. In any case the population not subject to requirements is too large to make any conclusions about the effect of exemptions.

    Yet the very real possibility remains that the lack of exemptions may dissuade parents from refusing vaccination in infancy, since they may know their child will be required to get them for school. By no means am I claiming that the rates I cited prove this. However, they are more supportive of this hypothesis than Richids claim that exemptions do not affect vaccination rates. That was my entire point.

    The proper analysis to determine the effect of the school admission Phil. Exemptions is to look at actual K-12 vaccination rates. Every state measures and publishes the information annually.

    It’s not the easiest to use, but thank you for linking me to this. You kindly linked me to Vermont’s page that shows a philosophical exemption rate of 5.1% and a religious exemption rate of 0.1%. Neighboring New Hampshire, which has no philosophical exemptions, has a religious exemption rate of 1.4%. Clearly there are far more vaccine exemptions occuring in Vermont. Unfortunately, NH does not appear to have rates for specific vaccines in this year (or perhaps I am not using it right), or we could compare those.

    If you do want to look at pre-k children the CDC NIS surveys can be deceptively low because several include criteria other than simple vaccine uptake, such as dose timing, and will weight against or even classify as unvaccinated children falling outside of timing milestones, i.e. an initial dose of Hep B after 24 hours, etc.

    Perhaps in some situations, but in this case I was using the exact same standard for multiple states – percentage of children who had received a certain number of certain types of vaccines by 24 months. Timing would not seem to affect this number, and even if it did, it would affect all the states. Yet the states with exemptions neighboring Mississippi had far lower vaccination rates. Certainly there are likely to be other factors at play that affect this. Again, I was simply refuting Richids point.

    A more accurate measurement of actual vaccines received versus compliance with CDC scheduling is done by the United Health Foundation, who measures and assigns rankings annually. If you pull the report by state they have statistics for immunization coverage 19-35 months of age that measure total vaccines received without confounding.

    I did so.

    http://www.americashealthrankings.org/ALL/Immunize/2011

    New Hampshire is still 3% higher than Vermont for these particular parameters, as was Mississippi compared to Arkansas and Louisiana.

    In WA State schools staff will not accept a parental affidavit of previous infection for Chicken Pox, requiring them to use a Phil Exemption.

    Or medical exemption, as you illustrated. I highly doubt the conversation you invented would be so common that it would affect phil exemption rates. More likely, when the mother called the nurse, they would have documented it in the vaccine record. Certainly the doctor should have documented it at the time of pre-k shots, when he would be offering the vaccine, and it would already be on the record given to the school.

    You can read an analysis of the Vermont Exemption story below. It is particularly absurd as Vermont was just designated the Healthiest State in the USA, and 7th grade vax rates exceed 98%.

    Why should we care about the 7th grade vaccination rate? By 7th grade an unvaccinated child has had a whole lot of years to spread disease in a school.

  14. March 11, 2012 at 12:00 am

    I’m concerned about a point of misinformation. In most states vaccine laws apply to private schools as well as public schools, leaving parents with ONLY the option of homeschooling. Since not all parents are able or willing to homeschool, mandating vaccines as a condition of school attendance, with truancy laws threatening parents if children do not attend school looks quite a bit like “force”. Please explain how parents who cannot homeschool still have freedom to turn down vaccines.

    The AMA states that ALL medical procedures should include a process of informed consent.. They don’t include the words “except for vaccinations”. http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/patient-physician-relationship-topics/informed-consent.page.

    If you cannot say no to the vaccine because of your employment situation or because of mandatory school vaccination laws then there is no informed consent.

  15. Chris
    March 11, 2012 at 2:29 am

    Sorry, absolutely no sympathy for those who dislike public health polices. Since my son was denied protection from pertussis due to a history of seizures when our county had a pertussis epidemic we had to protect him by making sure everyone around him was vaccinated. That meant he did not go to certain places. We were restricted by the lack of herd immunity.

    And there are enough private schools that do not care about vaccine status. We know they exist because they are the ones that get shut down during a disease outbreak. Like this Waldorf school in Virginia.

    One thing the parents who turn down vaccines can do is start their own schools, perhaps a homeschool cooperative. Then they can ignore any public health policy they choose, and stay away from everyone else.

  16. Kelly
    March 11, 2012 at 2:13 pm

    They still have the freedom to turn down vaccines. Just because they don’t like the consequences of their decision doesn’t mean they don’t have that freedom. Others should not have to bear the burden of someone else’s decision, especially when that decision is selfish to begin with. If someone doesn’t want to contribute to society, then society doesn’t owe them a job and their children an education.

    You have not demonstrated that informed consent is not being given. The doctor’s responsibility is to inform on the procedure, not the social complications of the procedure.

  17. Nathan
    March 11, 2012 at 2:32 pm

    It also occurs to me that informed consent is independent of whether the patient truly has other options. For example, if your child requires a surgical procedure, you still need to give informed consent, even if there is no other option available for the child (and indeed, if a parent refuses certain medically necessary procedures a court order may be obtained). I am not trying to say that vaccines fall under this category – simply pointing out another situation where something is mandatory but there is still a process of informed consent

  18. kathy
    March 11, 2012 at 3:59 pm

    Informed consent just means you have the right to know what you are getting into and approve or disapprove of the procedure. You have the right of informed consent of immunization in all states. Informed consent does not mean you have the right to say no to a vaccine and still enroll in public schools or the military. Wrong use of the phrase, Minority View.

  19. March 11, 2012 at 8:33 pm

    The only fair way to deal with this issue is to require titer testing of all children, vaccinated or not. Those who are immune to all diseases can go to school. Those who lack immunity can be excluded from school. After all, this is public health we’re talking about, right? A non-immune child is a public health risk, right? Who cares if that child got a shot or not? What I care about is whether or not that child can contract and spread disease.

    P.S. My vaccine-injured child had her titers tested, and she was not immune to anything she was vaccinated for. Go figure.

  20. March 11, 2012 at 9:30 pm

    Nathan, informed consent isn’t consent if you can’t say no. It may be informed. It isn’t consent.

    In the case of a child who is ill and parents are refusing medically necessary procedures there may or may not be a court case to force the parents to comply. Each such case is individually considered, has to be ruled on by some sort of legal body, probably a judge and involves a life or death situation.

    Right now we are talking about using school attendance laws to force medical procedures on children against their parent’s will and judgement. This isn’t an emergency situation. and some of the vaccines are for illnesses which are not easily communicable in a school setting or not communicable at all, such as tetanus.

    Informed consent has to include the option of saying no without being brutally penalized. Depriving a child of a public education is quite brutal.

  21. March 11, 2012 at 9:40 pm

    Here is the actual wording from the AMA (American Medical Association). Note the reference to case law.

    nformed Consent

    Informed consent is more than simply getting a patient to sign a written consent form. It is a process of communication between a patient and physician that results in the patient’s authorization or agreement to undergo a specific medical intervention.

    In the communications process, you, as the physician providing or performing the treatment and/or procedure (not a delegated representative), should disclose and discuss with your patient:

    The patient’s diagnosis, if known;
    The nature and purpose of a proposed treatment or procedure;
    The risks and benefits of a proposed treatment or procedure;
    Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance);
    The risks and benefits of the alternative treatment or procedure; and
    The risks and benefits of not receiving or undergoing a treatment or procedure.

    In turn, your patient should have an opportunity to ask questions to elicit a better understanding of the treatment or procedure, so that he or she can make an informed decision to proceed or to refuse a particular course of medical intervention.

  22. March 11, 2012 at 9:43 pm

    The last bit of the informed consent info from the AMA got left off. Here it is:
    This communications process, or a variation thereof, is both an ethical obligation and a legal requirement spelled out in statutes and case law in all 50 states. (For more information about ethical obligations, see the AMA’s Code of Medical Ethics, contained in the AMA PolicyFinder. Providing the patient relevant information has long been a physician’s ethical obligation, but the legal concept of informed consent itself is recent.

    Ethical obligation and a LEGAL requirement spelled out in statutes and case law in all 50 states.

    Vaccination is a medical procedure. Tying school attendance to forced medical intervention is definitely a violation of bodily integrity and a few other things.

    I think you are on very shaky legal ground.

  23. Chris
    March 11, 2012 at 9:51 pm

    Who will pay for children having several blood draws? Where is the science to support this protocol?

    And, yes, the vaccines are not 100% effective, which is why herd immunity is so important.

  24. Kelly
    March 11, 2012 at 10:43 pm

    Informed consent has to include the option of saying no without being brutally penalized. Depriving a child of a public education is quite brutal.

    The penalty isn’t being forced because of informed consent. Informed consent can be given and still come with consequences.

    You keep missing the point that there are consequences to saying no to vaccines. One of those consequences is that your child may not be able to attend public school. To my understanding, and I’m not a lawyer, but legal precedent upholds the policy of schools asking for mandatory vaccination before a child can attend. There are two states that have nothing but medical exemptions, for example.

    Nobody is forcing anyone to vaccinate. You can vaccinate and attend school, or you can choose not to vaccinate and not attend school. Parents that don’t vaccinate will have to see to their child’s education outside the public school system. I don’t understand why you have such a hard time understanding this. Seems very simple to me.

    I guess parents have to decide what is more important to them: maintaining their false perception that vaccines are more dangerous than the disease or sending the child to public school. A parent can understand the risk/benefits of vaccination and give informed consent to vaccinate or not even though they don’t like the consequences of such a choice. The consequences are not tied to informed consent.

    With the freedom to choose comes the freedom to experience the consequences of those choices.

  25. Nathan
    March 12, 2012 at 3:19 am

    In the case of a child who is ill and parents are refusing medically necessary procedures there may or may not be a court case to force the parents to comply. Each such case is individually considered, has to be ruled on by some sort of legal body, probably a judge and involves a life or death situation.

    I understand that. Nonetheless, there is a process of informed consent, even in those cases where the parent has no other feasible option. That is my point. Informed consent is a process that is independent of what factors may require the procedure.

    Right now we are talking about using school attendance laws to force medical procedures on children against their parent’s will and judgement. This isn’t an emergency situation.

    I understand that as well, although in this case the parent certainly has better options than the parent whose child requires a life saving procedure.

    Here is the actual wording from the AMA (American Medical Association). Note the reference to case law.

    Informed consent is more than simply getting a patient to sign a written consent form. It is a process of communication between a patient and physician that results in the patient’s authorization or agreement to undergo a specific medical intervention

    This communications process, or a variation thereof, is both an ethical obligation and a legal requirement spelled out in statutes and case law in all 50 states.

    It is a legal requirement, but your very definition shows that informed consent is a legal requirement for the physician and the patient. It deals with medical alternatives, risks, and benefits. It has nothing to do with what extrinsic factors, be it financial, personal, or legal, that necessitate the procedure. To not consent to vaccination carries consequences – no question about that. It is up to the parent if those consequences are worth not vaccinating (which they shouldn’t be since vaccination is the far safer choice for the child). But if the parent feels that they are, it is up to them to accomodate their individual choice – not the rest of us. The rest of us, including parents of children who cannot be vaccinated due to medical reasons, deserve to send our kids to the safest school environment possible, and that includes a minimized risk of disease. It is far more “brutal” to cause an epidemic than to be required to get your kindergarten shots.

    I think you are on very shaky legal ground.

    I’m no lawyer, but since two states have only medical exemptions, and most states have no philosophical exemption, I think your assertion is what’s shaky.

  26. March 13, 2012 at 12:00 am

    MinorityView :
    Informed consent has to include the option of saying no without being brutally penalized. Depriving a child of a public education is quite brutal.

    This seems quite ridiculous to me. Your argument in favor of vaccine refusal requires a belief in the sovereignty of the individual. That the state should not be allowed to use force against people. And yet you maintain the facade of a belief in public education.

    How does this not reduce to the position that the State should not be allowed to force individuals unless it forces others to pay for benefits for you? Homeschooling, and private schooling are both options which do not qualify as “brutal”.

  27. March 13, 2012 at 12:04 am

    Over simplification is not your friend, Kellie. Indeed, “non immune child[ren]” (Whatever that really is) are indeed public health risks. The question is one of degrees. If 99% of 4 million children are vaccinated, some of them will still be susceptible to disease. But that number will still be small enough that VPDs will have a very poor chance to cause an outbreak. Certainly a very small chance to cause a large outbreak.

  28. June 10, 2012 at 12:34 pm

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  29. October 10, 2012 at 7:51 am

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  30. lilady
    October 10, 2012 at 10:22 am

    Spammer alert above

  31. GetAware
    October 11, 2012 at 11:26 pm

    My son developed a tic disorder after a vaccination. NEVER again will I allow the formaldehyde, aborted fetus tissue, animal dna, not to mention the neurotoxic additives like Thimerosal to ever be injected into my children again. EVER. PERIOD.

  32. Nathan
    October 12, 2012 at 12:42 am

    Tic disorders are extremely common in children. What objective evidence indicates that vaccinations can cause them?

  33. October 12, 2012 at 5:17 am

    @GetAware – so how about the large about of formaldehyde that your body generates on a daily basis are part of normal metabolic processes (much more, in a single day, than the entire vaccine schedule – which is spread across a decade).

    Also, the my name links to a website which debunks the other claims that you’ve made as well. You really should do a bit more research before you post.

  34. sarah
    January 16, 2013 at 10:18 pm

    I am wondering about exemptions for colleges. My child has been exempted so far and is a junior in high school. Now we need to think about colleges that will allow exemptions.

  35. January 16, 2013 at 11:21 pm

    @sarah, did you even read the article you are commenting on?

  36. Mariah
    January 28, 2013 at 3:40 pm

    Wow there are some intense replies. I have no data. All I know is my daughter almost died from a reaction to the first vaccine given to her in hospital after birth. She has severe food allergies (easier to list the things she can eat not can’t) She is allergic to all the same food I and her grandmother are. I have a rare condition where my skin test shows no allergy then I can eat the item infront of the allergist and they can watch me swell. I also grew into allergies instead of out of them. Our allergist says we are “freaks of nature” lol. With that in mind (plus my background for vaccine reaction) my daughter has been advised to forgo them all together. This idea truly scared me at first but it seems my daughter has a way better immune system than all of her vaccinated friends. Why this is I have no idea. Maybe mother nature knew she wouldn’t be able to handle vaccines so she made her never really get sick and if she does she gets over it in 2 or 3 days (when it takes other children a week or more). I have no scientific explanation and I will say that being non vaccinated is a hard path. People look down on you and dont even bother to understand your situation. It seems most people would rather my daughter be vaccinated when it would probably kill her than have her around them. The fact is she is healthy and happy. I did what was best for my family.

  37. Lawrence
    January 28, 2013 at 3:46 pm

    @mariah – your daughter is one of the reasons why people who can be vaccinated , should do so, to help keep the overall immunity levels high so she nevers gets exposed to a VPD.

  38. Jules
    January 28, 2013 at 4:26 pm

    Mariah….it is not surprising that un-vaccinated kids are healthier than vaccinated ones; better, healthy immune systems.
    BTW…the GAPS diet will help get rid of allergies to food.

  39. January 28, 2013 at 5:14 pm

    @Jules – I’m sure you’d be happy to provide some citations for your opinions, because in studies, the only difference between vaccinated and unvaccinated kids was that the unvaccinated kids had a much higher rate of contracting VPDs.

    So, care to share?

    Otherwise, creating a larger pool of unvaccinated kids just means Mariah’s daughter is in more danger of contracting a disease for the very reason that she is medically unable to get the vaccine – what is your excuse?

  40. Chris
    January 28, 2013 at 5:31 pm

    Mariah:

    Our allergist says we are “freaks of nature” lol. With that in mind (plus my background for vaccine reaction) my daughter has been advised to forgo them all together.

    If all is true, then your daughter is dependent on herd immunity. You should be doing your best to make sure everyone who can is vaccinated, all the more reason to make sure only those with real medical reasons should be exempt from vaccines required for school attendance.

    Jules:

    it is not surprising that un-vaccinated kids are healthier than vaccinated ones; better, healthy immune systems.

    Citation needed.

  41. June 12, 2013 at 9:32 am

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  42. June 20, 2013 at 9:57 am

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  43. Wilson
    July 23, 2013 at 6:57 pm

    Public health policies are for a reason! Don’t sound so ignorant. Everyone should be vaccinated. It’s for your own good! I have 3 children and they all get their vaccinations and its not for the purpose of school. It’s for their lives! It’s prevents more then we know and that’s because we don’t have to worry about as much with the vaccinations being given! It’s brilliant! How would everyone feel if there were a cure for cancer and nobody wanted to use it?!! Or HIV? Same thing almost.

  44. Wilson
    July 23, 2013 at 7:04 pm

    And exemptions should only be medical in my opinion. If its life or death then obviously it should be life. It’s not only about who is and isn’t vaccinated either. It’s also about genes and parents. I have a 7 year old son who almost never gets sick. Has all of his vaccinations. I have a 4 year old son is sick more frequently and also has his vaccinations but they have different fathers.

  45. September 15, 2013 at 6:12 am

    This is incorrect. I live in Montana. Even if you homeschool, you are REQUIRED BY LAW to provide proof of immunization, or fill out a medical or religious exemption. If you are not part of a religion that opposes vaccines, or have no medical exemption, then you ARE forced to vaccinate. It’s not true only children who go to public school are required to vaccinate. That is wrong. Some states only have a medical exemption, and to get one you need proof there could be a life threatening reaction.

  46. Mysty
    October 12, 2013 at 11:26 pm

    In WV, a child’s doctor can write and recommend a medical exemption for a
    Child who’s suffered sever adverse reactions to a vaccine. And then that exemption has to be approved by the county health officer, & then the state health officer. This very rarely ever happens. And the health officers have been notorious for harassing doctors who provide medical exemptions.

  47. Lawrence
    October 13, 2013 at 8:53 am

    I would love to see proof of that Mysty…..

  48. November 2, 2013 at 12:52 pm

    I hardly drop comments, but i did some searching and wound up here Where
    Does Your State Stand on School Immunization Exemptions?
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  49. November 15, 2013 at 8:54 pm

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  50. Matt
    February 25, 2014 at 2:01 pm

    What a load of crap….

  51. Lawrence
    February 25, 2014 at 2:55 pm

    @Matt – and what load would that be?

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