Is Your Child's Classmate Unvaccinated?
Aug 30, 2010

By Christine Vara
Amid a serious pertussis epidemic in the state of California, an investigative think tank called the Watchdog Institute recently reported that vaccine refusals are on the rise.  Their research of CA schools showed that waivers signed by parents who choose to exempt their children from immunizations for kindergarten enrollment have nearly quadrupled since 1990.   Specifically, personal-belief exemptions granted to entering kindergartners in the state of CA reached a record high of 10,280 in public and private schools last fall, up from 2,719 in 1990.
You have probably heard the term ‘herd immunity’ before.  If not, you can probably venture to guess what it references.  Simply put, if enough people are immune to a specific disease, it significantly reduces the ability of that disease to spread.  (I’ve covered this in an earlier post entitled, “Measles & Immunity:  It’s All In the Numbers”.)  In order for immunizations to remain most effective, we rely on a large percentage of the population to be protected from the disease.  While there is a different “tipping point” for various diseases,generally speaking health officials prefer that immunization rates remain upwards of 90% in order to provide the best protection.    
While it remains law in United States that children be properly immunized before attending school, what many parents don’t realize is that each state governs access to their own public services.  What this essentially means is that individual states have the ability to grant exemptions to vaccination requirements for admittance into school.  While the CDC provides a recommended vaccination schedule, each state makes specific vaccine requirements of their students, as well as allowing for exemptions.  Each state allows for medical exemptions, while 48 states also allow religious exemptions and 21 states now allow for personal belief exemptions. Depending on the state, the exemption process can be as simple as in the state of CA, where a parent can sign a form stating that “some or all immunizations are contrary to my personal beliefs”.  In other states, notarized statements are required.  In the case of medical exemptions, parents may be asked to provide documentation from a doctor.
Obviously, there are some children that have legitimate medical reasons that require medical exemptions.  However, the public health concern lies more in the growing trend of parents who are utilizing personal exemptions and shifting the numbers of immunized students in a way that may ultimately threaten herd immunity.   While this is common knowledge amongst vaccine advocate groups, this may be surprising to many parents who believe all students must be immunized before coming to school.   Most parents don’t realize the popularity of personal exemptions in some areas.  They may also wrongfully assume that unvaccinated children are concentrated in lower income areas, resulting from limited access to vaccines due to lack of education or finances.  While there are still economic barriers to vaccination, what the Watchdog studies indicate is that personal exemptions are more likely to be utilized by the more affluent parents, and schools with the highest exemption rates tend to be private schools, public charter schools, and traditional public schools in affluent areas. 
 As the recent San Diego Union-Tribune article reports, states with easy exemption procedures were associated with a 90 percent higher incidence of pertussis compared to states with difficult procedures and for each one percent increase in exemptions at a school, the risk of having a pertussis outbreak went up by 12 percent.  These statistics, from studies conducted in 2000 and 2006, come from the Journal of the American Medical Association.  Of significant concern, is the study of measles outbreaks, which illustrated how 11 percent of the vaccinated children in the outbreak were infected through contact with somebody who was exempt. 
Now, let’s consider the significance of these studies for a moment.  High exemption rates link to higher incidence of disease and transmission to vaccinated children.  Concerning?  Yes.  However, a parent who chooses not to vaccinate their children will argue that if immunizations are effective, than we shouldn’t be worried about their unvaccinated children in the classroom.  Shouldn’t the vaccines we give our children protect them from anything their non-vaccinated children are carrying?  And if the vaccines don’t protect them, than aren’t we admitting that vaccines are not effective?
 While that may sound like a valid argument, what science proves is that nothing is 100% effective – including vaccines.  Within every scientific model there are limits to be considered.  I particulary like the way this was explained in a recent article on the Respectful Insolence blog.

“Of course, anti-vaccine parents both demonize and have unrealistic ideas about what vaccines can do, which is part of the problem. They demonize vaccines as the cause of autism, autoimmune disease, and asthma, along with all sorts of other health problems, even though there is no scientifically credible evidence linking vaccines to autism or any of the other conditions attributed to vaccines. Yet, at the same time, they justify their refusal with the implicit belief that vaccines are 100% effective. I refer to this as an “implicit” belief because a frequent argument made by anti-vaccine parents when it is pointed out to them that they are endangering other children is that those other children are vaccinated; so how could their precious baby ever be a threat to other children? The reason, of course, is that no vaccine is 100% effective. Some, like the MMR vaccine, are “only” around 90% effective. Now, in medicine, 90% effectiveness is in general excellent, about as high as one can expect from any intervention. It’s not 100%, though. Worse, pockets of unvaccinated children provide a repository for vaccine-preventable disease that can infect other unvaccinated children, as well as vaccinated children who, for whatever reason, did not develop effective immunity due to their vaccination.”

Add to the fact that protection often wanes over time, (a time window that may vary from person to person),  and you can understand why the CDC immunization recommendations include booster shots for both children and adults.  This has proven to be another step public health advocates are currently taking to reduce the spread of diseases like pertussis, especially in states like CA.  However, legislation is just taking hold and some states now require booster shots for school admittance as well.      
Personally, I do my part to ensure my children are up to date on their recommended vaccines, not only for their own protection, but because I believe that the vaccine requirements are part of the school’s responsibility to ensure the best means of public health possible.  Similarly, I expect the school to enforce other precautionary measures that will keep my children safe, such as practicing bus safety and conducting fire drills.  These days they even conduct “bad person” drills that are intended to prepare kids in the event that a dangerous person enters school property and threatens the safety of the students. 
While I believe these risks are minimal, it doesn’t mean I don’t support the school preparing for these situations.  I am not foolish enough to believe that these things couldn’t happen in my child’s school or my community.  No amount of money or security can eliminate the risk, but we can prepare ourselves for these situations with proper precautionary action. 
Likewise, I see immunizations in the same way.  Just because my children are healthy, exercise, eat well and wash their hands doesn’t mean they will never fall victim to disease; especially highly contagious and dangerous diseases like measles or pertussis.  So why is it that immunizations, which are a safe and effective precautionary step in the prevention of disease, are being dismissed by educated, affluent parents?    
Certainly, this is a growing concern, but the million dollar question remains.  What can we do to change these parental attitudes and protect these children, as well as the community at large, from vaccine preventable disease?    There is a school of thought (no pun intended) that some schools are no longer enforcing vaccinations, but enabling the questionable use of vaccine exemptions.  Would you believe that Whatchdog report lists the private Waldorf School in San Diego county with as many as 51% of their students unimmunized due to personal belief exemptions?  It isn’t surprising that the administration supports this anti-vaccine sentiment.  Shouldn’t our school systems be trying to educate parents about the risks of wide-spread disease and the public health responsibility we have to our community at large? 
Perhaps more concerned parents should demand to know how many of their children’s classmates are coming to school unvaccinated.  As Dr. Mark Sawyer, pediatric infectious disease specialist at Rady Children’s Hospital in San Diego noted, “Un-immunized people in general contribute to any disease rates. As the rates of un-immunized kids go up, we are inevitably going to see more and more outbreaks of diseases.”  It is clear that a failure to vaccinate children attending school endangers us all. 
How many of your child’s classmates do you believe to be immunized?  How would you feel if they weren’t?  We would like to hear your thoughts so please share your experiences by providing a comment below.


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