Battleground States for School Vaccination Exemption Policies
Sep 27, 2012

Recently the CDC released data regarding the vaccination coverage and exemption rates among U.S. children in Kindergarten for the 2011-2012 school year.  Upon first look, the top line analysis of the data doesn’t appear to be too concerning.
Total exemption rates, including medical, religious, and philosophic exemptions, among 49 reporting states and DC, ranged from less than 0.1% to 7.0%, which translates to a median total exemption level of about 1.5%.   Not too shabby, huh? 
But here’s the thing about data charts.  Sometimes you have to take your analysis a bit deeper.  
While 10 states can boast exemption rates of less than 1%, there were 9 states that reported exemption rates greater than 4%.  In fact, Alaska’s rates were as high as 7%, and in Oregon, the non-medical exemption rate alone was as high as 5.8%.
These figures highlight a growing concern.  While national levels of vaccination coverage may seem at or near target levels, certain states and localities are seeing dangerously low vaccination rates for some extremely transmissible diseases.  Unfortunately, concentrated numbers of unvaccinated children contribute to the possibility of disease outbreaks which then presents an unnecessary threat to all our children.  Yes, even those who are vaccinated, because no vaccine is 100% effective in 100% of the population, 100% of the time.    (If you’re unsure why a vaccinated child may be at risk of disease, check out another one of my blog posts here.)
Studies, like those compiled by The Immunization Action Coalition, suggest that personal belief exemptions for vaccinations are putting people at risk.

 “Several recent outbreaks of measles, pertussis, and varicella (chickenpox) have been traced to pockets of unvaccinated children in states that allow personal belief exemptions. To understand the impact of vaccine refusal, examine the evidence for yourself.”

The concern, as documented in various reports, is that the process of acquiring a school vaccine exemption seems to be related to the number of exemptions that are filed.  The studies show that easier standards for exemptions are typically associated with higher levels of exemption.  This helps to explain why many states are re-examining their school vaccine exemption policies.  They want fewer exemptions and less disease.
So here is a snapshot of what is currently going on in a two states that are pushing for new exemption policies.
California Bill AB 2109
For the past few months there has been an ongoing discussion regarding the impact of a bill that will require parents to visit a health care provider to ensure they are adequately informed about the consequences of not vaccinating prior to getting approval for a philosophical exemption.  The bill is not intended to limit a parent’s ability to get an exemption, only to make the process of getting one similar to that which parents must go through when adhering to the policies.  The hope is that this will reduce the number of exemptions that are filed as a matter of convenience.
A few weeks ago, Catherine Martin, the California Immunization Coalition Director, was interviewed on Fresno Public Radio (KVPR).  She discussed the bill requirements, commonly held myths about immunizations, how schools would work with parents, the importance of vaccinating and even highlighted the positive impact of a similar law that was passed in Washington State:

“Washington State passed a similar law to the one we are sending to the Governor’s office and they had a huge problem there. Their exception rate was 6% whereas California is 2.5%. In the first 11 months of implementation, their exception rate went down to 4.5%, so we think this is a good example of what can happen when parents have more information.”

The link to the live interview is available here and starts around 5:45 minutes in to the program.
As of today, the bill has successfully made it’s way through the state legislative process, and the Governor has until September 30^th to sign it.  However, as explained in a post on Respectful Insolence today, the opposition has planned a rally for tomorrow as a last-ditch attempt to put pressure on the Governor to veto the bill.  With both the support of the Senate and House, one would expect that the Governor will sign it and that CA will soon have a new policy in place.
New Jersey S 1759 
New Jersey has also set out to modify their exemption policies.  Not only are they looking to eliminate personal belief exemptions, but also tighten the restriction on religious belief exemptions.  Under the new bill, medical exemptions would be granted when a parent can present a written statement from a physician “indicating that the vaccine is medically contraindicated for a specific period of time” and why.  Additionally, religious exemptions would require a parent to submit a written statement that:

• outlines the religious tenet or practice and explains the conflict;
• makes clear that the objection is not solely a political or philosophical belief or related to concerns about vaccine safety;
• and shows that the student or parents understand “the risks and benefits of vaccination to the student and the public health,” vouched for by a signed statement from a physician saying that the student has been informed of the risk.

As I follow the progress of this legislation, it is encouraging to hear how strongly the legislation’s sponsors, State Senate Majority Leader Loretta Weinberg and Senator Joseph F. Vitale, speak about the importance of protecting public health.
Weinberg’s statements included the following:

 “Unfortunately, the issue of student immunizations is an emotionally-charged topic, with scientifically unfounded and discredited information standing in as fact.  While we need to be mindful of legitimate medical and religious reasons for students abstaining from vaccinations, we should not give credence to false science and put the public health in jeopardy.”

Senator Vitale, chairman of the senate’s health, human services and senior citizens committee adds,

 “While we want to respect people’s religious beliefs and legitimate medical concerns, we cannot allow widespread exemption from immunization based on fear and false science. Not only does it put the student at risk, but it creates a risk to the general public health and well-being.”

As more and more states consider modifying their existing policies, it will be interesting to see how the parents will receive these changes.  Some may consider it an imposition, while others may recognize the importance of the changes, thought not feel passionate enough to express their support to their elected officials.
Personally, I suspect that many exemptions are filed more out of convenience than out of personal or religious conviction.  That is why I feel that if we are to allow people to exempt their children from school vaccines than it is reasonable to ask that the exemptions they are seeking are no easier to obtain than the vaccinations themselves.
As a parent, I will support those policies that help to keep our children and our community free from preventable diseases.   However, I realize that people have differing opinions when it comes to school vaccination policies.  What do you suspect is the biggest opposition to the tightening of exemption policies and what are your concerns regarding these changes?  

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