Vaccine Refusal and the Politics of School Vaccination Exemptions
Apr 30, 2013

schoolbuildingAcross the U.S., individual state policies determine which immunizations a child needs in order to be permitted to attend school.  And each state also has different ways in which parents can obtain exemptions from these requirements.  However, as vaccine exemption rates climb, so do outbreaks of vaccine preventable diseases which are threatening the health of our children.  Some states are trying to respond by making an effort to legislate their way toward better public health.   However, both vaccine supporters and critics maintain different interpretations of “informed consent“.

On the one hand, public health departments are supporting legislation in states such as West Virginia, Oregon, and Vermont that seek to add requirements to an all-too-easy exemption process.  Prior to opting out of vaccines for their children, they want parents to be adequately informed of the risks of these decisions.  From the public health standpoint, if a parent wants to opt-out of vaccinating their child, the process shouldn’t be any easier than what parents are expected to do to adhere to the vaccine requirement.  Therefore, by requiring parents to discuss vaccines with a health care provider, to learn about the risks of not vaccinating, new state legislation is seeking to provide better parental education and information.  It would only be expected that this would be welcomed by those who question the safety and efficacy of vaccines.

However, a small but vocal minority of anti-vaccine advocates would like to have legislators believe that these new laws are taking away their “rights” and actually interfering with their perception of informed consent.   So they have circled the wagons and are writing letters, calling their legislators and demanding that their choice to refuse vaccination is not only protected, but remains unquestioned.  However, if they don’t support vaccine conversations with qualified medical personnel, how can they claim that they are supportive of informed consent?  The truth of the matter is that they don’t want their misguided decisions questioned.  They would rather remain confident in their decisions by focusing on the minimal risks of vaccinations and ignoring the overwhelmingly proven benefits.

The fact is that public health departments have both science and statistics on their side.  For example, children whose parents have exempted them from the measles vaccine are more than 35 times more likely to contract measles compared to vaccinated children.  And the exemption data across the country reveals that the easier it is for parents to opt out of required vaccinations, the more likely it is that the vaccination rates will drop.  For instance, a 2006 study found that states with loose exemption policies had approximately 50% more cases of whooping cough (pertussis) compared to states with stricter policies

The only concern that non-vaccinators seem to focus on are which exemptions will remain available – medical, religious and/or philosophical.  But to be honest, even that may not matter much.  It’s a common occurrence for parents to admit to filing religious exemptions in states that don’t allow for philosophical or personal belief exemptions.  Despite the fact that there are few, if any religions (besides perhaps Christian Science) that have come out clearly in opposition to immunizations, parents are often advised to claim a religious exemption so that their choice to not vaccinate will not be questioned.

For instance, in the state of Oregon, a bill which is currently moving through the State legislature is seeking to add administrative requirements to the non-medical exemptions process.  Unfortunately, Oregon currently has the highest rate of non-medical exemptions at 5.8% and in some schools the rate was as high as 76%, all of which were classified as religious exemptions because personal belief exemptions are not permitted.  But the reality is that non-vaccinating parents are using the religious vaccine exemptions inappropriately.  Therefore, a new bill (SB 132) is being considered that will not eliminate religious exemptions, but will require parents to either (1) submit a form that has been co-signed by a medical practitioner that documents receipt of information about the risks and benefits of immunization or (2) submit a certificate that verifies completion of a vaccine educational module on the internet. Again, the law seeks to ensure that a little extra effort and education is required before being allowed to refrain from vaccinating thereby putting children and communities at risk of preventable diseases.  However, because non-vaccinating parents are successfully misusing the current religious exemptions, they are also strongly opposed to any law that would jeopardize the ease in which they can currently work the system.

And in West Virginia, a state that currently only allows for valid medical exemptions, the National Vaccine Information Center (NVIC), a well-organized and cleverly named anti-vaccine organization, has been trying to advance their own agenda by seeking amendments to HB2831.  The proposed changes to the bill would strip the state’s health department of their ability to add new vaccines to those required for school and instead place these decisions in the hands of a legislative health committee.  But here’s the real kicker. In a bold move, NVIC has somehow managed to be added into the bill, requiring that at least “three c
onsumers” be appointed to a special committee by  none other than the State Director of NVIC.  The bill reads: 

  “A minimum of three consumers should be appointed by the State Director for the National Vaccine Information Center in addition to the consumers appointed by the Secretary of the Department of Health and Human Resources. The state epidemiologist shall serve as an advisor to the committee. Members of the advisory committee shall serve two-year terms.” 

 It is astonishing to know that a known anti-vaccine organization could be granted just as much power to appoint people to a health advisory committee as the state’s very own Secretary of the Department of Health and Human Resources.  Meanwhile the state epidemiologist, a medical professional with critical immunization related expertise, will only serve in the capacity of an advisor. 

The irony in all of this is that the NVIC plan may very well backfire in other states.  For instance, in Vermont there are two bills currently being considered by the state legislature.  Those bills (numbers H.114 and H.138) deal specifically with pertussis immunization.  However, since the state is so concerned about the dangers of pertussis outbreaks and the negative health impact pertussis has had on children, the proposed bills would suspend both philosophical and religious exemptions if the immunization rate at a school for a particular vaccine falls below a 90 percent threshold.   Personally I believe this is brilliant because the issue really isn’t of allowing exemptions as much as it tends to be parents abusing the exemptions.  What will the defenders of “informed consent” do now?  If they continue to advertise the ease in which a parent can get an exemption, they may find that the exemptions are withheld.   And since many parents who choose to forgo immunization admit that they do not feel a personal concern or responsibility to others who can’t be vaccinated, it becomes every man, woman and child for themselves.  

As the battles continue across the country, it’s encouraging to see that immunization rates are already improving in the states that have enacted legislation which requires additional education requirements before claiming personal belief exemptions.  For example, a recent law which passed in Washington State requires parents to meet with health care providers to understand the risks of foregoing immunizations before getting a vaccine waiver.  Since July 2011, when the law went into effect, the number of children receiving all of their immunizations has been rising. In the 2011-12 school year, only 4.5% of kindergarteners received a vaccine exemption compared with 6% the previous school year.  While this is still a high percentage of exemptions in comparison to most other states, it’s encouraging to see that the new legislation is working to address public health concerns, particularly in a state which was the epicenter of one of the largest measles and pertussis outbreaks in recent U.S. history. 

Now is the time for vaccine advocates to speak out in favor of strong vaccination policies and reasonable requirements for vaccine exemptions.  Are we going to just sit back and allow non-vaccinating, exemption pushing individuals to represent our diverse parental views on school vaccine policies?  I certainly hope not.  Be sure to sign up to receive Every Child By Two action alerts about legislation of this nature and learn what you can do to support strong immunization policies in your state.  Don’t wait, because if you do, it may just be too late.

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