The Impact of Personal Belief Exemption Policies
Oct 09, 2012

The topic of school vaccine exemptions is heavily debated.  A person may be in favor of vaccinating their own child, yet not feel it’s necessary to impose strong school vaccination policies on others. Some parents who choose to delay or selectively vaccinate their children may be concerned that personal belief exemptions will be eliminated.  Other parents with medically fragile children – who either can’t be immunized for medical reasons, or who are at high risk of complications from preventable diseases – tend to feel it is unfair for a purposely unvaccinated child to endanger the health of others by attending public school.
All you have to do is read the (almost) 200 comments that have appeared on the Vaccinate Your Baby Facebook page last week when this topic was brought up for discussion and you’ll immediately see just how passionate people are about school exemption policies.
But how do the policymakers weigh in? 
Interestingly, this question is explored in a recent Nature article entitled “US states make opting out of vaccinations harder.  Legislative efforts aim to tackle rising incidence of disease.”  The article, written by Tara Haelle, explains how states are seeing an increase in preventable diseases, and details how some states are making a more concentrated effort to toughen the laws that govern school immunization policies as a way to help reduce the number of unimmunized students.
The article is quick to clarify that

“The issue is not a partisan one: bills have sponsors in both parties.” 

The author provides specific examples of the growing exemption rates in three specific states which have recently attempted to modify their policies.

“In Washington, 6% of children entering kindergarten in 2010–11 had an exemption; in Vermont, the figure was 6.2%, compared with the US average of 1.5%. In California, exemptions rates rose by 25% between 2008 and 2010.”

The article goes on to explain,

“These figures are alarming policy-makers, who fear that vaccination rates may fall below the threshold where even unvaccinated people are protected.”

Haelle further defines these legislative changes as an attempt by policy makers to address what she calls the “Path of Least Resistance” .    Michele Roberts, communications manager for the Washington Department of Public Health, elaborated on that idea when she was quoted as saying,

“One of the instigators for our laws was the thought that many parents were exempting for convenience.  It was easier to sign the exemption form than to track down records or to get your kid to an appointment.”

Public health departments, like those in WA and CA, are supporting policy changes based on studies that have shown that the existence of personal-belief exemptions, and the ease of getting them, is directly linked to reduced vaccination rates and a growing incidence of disease.
Coincidently, another article in Parade magazine this week, entitled “Why So Many Parents Are Delaying or Skipping Vaccines” , further explains the concerns that these new policies are hoping to address.  The author, Seth Mnookin, who also wrote The Panic Virus: The True Story Behind the Vaccine-Autism Controversy, begins by highlighting a personal story provided by Brendalee Metcalf, one of Every Child By Two’s first parent immunization advocates.
Sadly, Brendalee’s daughter Julieanna was one of five children in Minnesota who contracted Hib along with three children who had either skipped or delayed the Hib vaccine and a child who was too young to have been fully immunized.  Though Julieanna was vaccinated, it was later determined that she had a rare immune deficiency that made the Hib vaccine ineffective in her. Mnookin highlights this story as an example of what can happen when parents choose not to vaccinate and explains,

“They are not simply putting their own kids at risk; they’re also unwittingly jeopardizing newborns, pregnant women, the elderly, and people like Julieanna with preexisting conditions. Those populations are increasingly vulnerable as diseases that we thought had been contained start to return, in larger numbers each year.”

He also provides details about vaccine refusal, stating that

“…while only about 2 percent of parents refuse all immunizations, more than 1 in 10 skip some vaccines or delay the age at which they’re given. Increasingly, these parents tend to be clustered together, creating communities where vaccination rates may have dropped below the levels needed to keep infectious diseases at bay.”

He then addresses one of the biggest concerns.

“One place where herd immunity can quickly be compromised is schools. Currently, at least 19 states allow parents to opt out of childhood inoculations for “philosophical” reasons (nearly every state allows a religious exemption, and all allow medical exemptions), and more and more families are doing so. In 2010 the San Diego Union-Tribune reported that the number of area parents who exempted their kindergartener from vaccines had quadrupled since 1990. In 2010, California schools experienced the highest rate of vaccine noncompliance in more than 30 years.”

The Parade article offers a complete discussion of vaccine delay and refusal, and effectively demonstrates how these seemingly isolated parental decisions can truly impact us as a society.
Meanwhile, a small but vocal anti-immunization contingency continues to argue that their rights are being restricted.  However, it’s important that we recognize that their rights remain and only the process by which they have to file for these exemptions has been changed.  New policies, like those in WA. still allow for personal belief  exemptions, but the law now requires parents to discuss immunization benefits with a health care provider before allowing for an immunization exemption, and it appears to be impacted the “path of least resistance”.  The overall exemption rates in the state have already dropped from 6% in 2010-2011 to 4.5% of Kindergartener’s in just one year.  Now we just need to wait to see if similar statistics will be seen in states such as CA, where similar changes were made to the personal belief exemption policies just last month.
As more states consider changes in their school vaccination exemption policies, we will continue to keep our readers updated on how these policies are being received by parents and being supported by public health departments and state legislatures.

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