Time to Speak Out in Support of Strong School Vaccine Policies
Apr 14, 2015

jyTzFXoGLast week California legislators were asked to cast a very important vote on a very critical matter – school vaccine exemptions.

California Senate Bill 277 would remove the Personal Belief Exemption (PBE) option from the school and child care enrollment requirements and require schools to publicly provide information about their immunization rates.  Last week the first hearing of the bill passed the Senate Health Committee in a 6-2 vote.  The bill now faces an Education Committee hearing on April 15th at 9am before potentially moving to a Senate floor vote.

But what happens to this bill doesn’t just pertain to parents in California. What happens in California is important to every parent across the country and here’s why…

Unlike Vegas, what happens in California doesn’t stay in California.  

Consider the ongoing measles outbreak that is linked to the Disneyland Resort.  What began as a single case of measles in a popular tourist location in Anaheim, California quickly spread to 7 states and into both Canada and Mexico.  While it’s fascinating to see the dynamics of how diseases spread, this situation illustrates how an outbreak of an infectious disease in one location can quickly spread across the country in a matter of weeks.

As the number of measles cases climbed, healthcare providers and public health professionals grew increasingly concerned.  And parents with infants too young to be immunized, and parents of children who are immunocompromised – like Jennifer Hibben-White and Dr. Tim Jacks – grew increasingly angry.  The result has been a surge in state bills aimed at tightening school vaccine exemption policies.

School vaccine policies are governed by the states. 

What parents may not realize, is that each state governs their own school vaccine requirements.  In fact, Every Child By Two was founded in 1991 by Former First Lady Rosalynn Carter and Former Fist Lady of Arkansas Betty Bumpers as a response to a U.S. measles epidemic which sickened more than 55,000 individuals, hospitalized over 11,000 and killed more than 120 people, including young children.  In response to this outbreak, the two co-founders traveled the entire nation to alert people about immunization concerns.  As a result, they’ve been credited with the passage of laws mandating school-age vaccination requirements in every state and the establishment of immunization coalitions that continue to operate in most states.

While every state allows for valid medical exemptions to vaccinations, states differ as to whether they will allow personal belief or religious exemptions (though very few religions actually oppose vaccines).ExImmunMap15

Additionally, the procedures by which a parent can obtain an exemption for their child also vary by state.  In most states, it can be as easy as a parent signing a piece of paper.  In fact, filing an exemption is often much easier than fulfilling the requirement of getting vaccinated.  Therefore, it’s presumed that exemptions rates may be on the rise partly because parents are becoming increasingly aware of just how easy they are to get.

Ultimately, the states are accountable for the number of school vaccination exemptions.  However, it’s the persistent efforts of vaccine critics that continually encourage parents to refuse vaccines that may be responsible.  In fact, there are various websites and forums that are known to assist parents in navigating exemption requirements.

So now, concerned about outbreaks of diseases like measles and whooping cough, and amidst evidence that the current  measles outbreak has been driven by those who refuse vaccines, state legislators are looking to address the matter through the introduction of new immunization related bills.  There are eight states (CA, MD, OK, VT, WA, NC, ME and RI) with bills that are trying to remove personal belief or religious exemptions.  There are four states (CT, NJ, NM and TX) looking to tighten the rules that apply to religious exemptions.  There are six states (CO, TX, IL, MN, PA, and OR)  trying to add some kind of educational component to current exemption policies.  There are plenty of other immunization related bills – estimated to be as many as 110 – under consideration so far this year.  

The choice to forego vaccination is directly linked to the risk of disease.  

Various studies have shown that personal belief exemptions for vaccination put people at increased risk of disease.  In the case of the recent measles outbreak that originated in Disney, epidemiologists were able to retrace the geographic spread of the cases by using modeling based on infection rates.  They calculated that the vaccination rates in the populations of those exposed during the outbreak ranged from a high of 86% to a low of 50%.  This is significantly less than the 96-99% vaccination rates that scientists agree is necessary to achieve “herd immunity” and prevent measles from becoming endemic again.  They published their findings in JAMA Pediatrics along with a statement that read,

“the outbreak shines a glaring spotlight on our nation’s growing antivaccination movement and the prevalence of vaccination-hesitant parents”

In reporting on the study, a National Geographic article explained,

“clusters of like-minded people disinclined to vaccinate their kids are scattered throughout every state that allows vaccine exemptions—whether in the megalopolises of California or in the rural outreaches of North Dakota. These clusters cross all dividing lines: socioeconomic classes, education levels, and political and religious views. A single common thread unites them: reluctance to vaccinate.”

Tightening laws that govern school vaccine exemption policies has proven to be effective.  

California is not the first state to try to tighten school vaccine exemption policies, and this is not California’s first legislative rodeo (as we’ve seen with AB 2109).  States with historically high exemption rates, such as Washington, Oregon and Colorado, have all addressed these issues before.  From these collective experiences in various states we have begun to see small successes. For example, after enacting legislation that required Washington parents to get information from a healthcare provider about the benefits and risk of vaccines before being granted an exemption, the Kindergarten exemption rate dropped from 6% in 2010-2011, to 4.5% in 2011-2012.  And the data reports are similar in other states as well.

Many of the bills currently under consideration would similarly require parents to visit with a healthcare provider before getting a personal belief exemption.  Some bills are trying to remove all personal belief exemptions, while others are trying to require documentation to support religious exemptions. There are also bills that would give parents public access to school immunization and exemption rates.

While it’s common to hear the opposition cry that these bills are infringing on parental rights, the truth is that these policies are about preserving public health and honoring the rights of all children to attend school in an environment that is free from preventable diseases. 

But make no mistake about it.  Just as there are parents, public health and medical professionals who support these various bills, there are others who have managed to convince their legislators to propose bills that are counterproductive to strong immunization policies.  In the state of Maine, for example, an expected bill would require providers to read a list of vaccine ingredients to patients before vaccination, and another bill is looking to establish a Maine Vaccine Consumer Protection Act that would set strict parameters governing vaccine injury inquiries, duplicating much of what is already handled by federal vaccine policies.

What we can learn from the battles that have gone before and the fight in California today. 

What makes California so important this go around is not just that it is where the recent measles outbreak initiated.  It’s not the high rate of exemptions and the clusters of non-vaccinated children in certain schools either.  Although both of those factors brought us to where we are today.  However, the big impact this time is seen in the parents who are stepping up and speaking out in a big and influential way.

While these bills are commonly supported by healthcare professionals, and organizations such as the AAP, the AMA, and many others, we must never underestimate the value of the constituent’s voice.  Emotional stories of alleged vaccine injury and supposed “forced” vaccination are compelling to legislators who are not always well-versed in the overwhelming data that supports vaccine safety and efficacy.

Unfortunately, bills introduced in Washington, Oregon and North Carolina just this year were withdrawn before a vote due to an outcry from a small minority of well-organized and vocal constituents.  But what we’re witnessed in California is that a growing number of parents who support vaccines and disease-free education are beginning to organize.  Bills like SB277 are getting a swell of public support in part because the majority of parents are tired of having herd immunity threatened by the motivated minority of parents who are obstructing bills they believe “force” vaccination and injure children.  Websites are springing up that counter the efforts of anti-vaccine advocates and instead help organize vaccine supporters.

And the timing couldn’t be better because we need parents who support vaccines to stand up and demand that their children’s classmates contribute to the public health, not risk it.

These policies are about preserving public health and the rights of all children to attend school in an environment that is free from preventable diseases. 

While legislation can help reduce the number of children attending schools and daycares who don’t have all the school required immunizations, these laws are not attempting to completely eliminate exemptions.  There are going to be valid medical reasons when a child should not be vaccinated.  However, the argument exists that if a parent refuses to contribute to the best interests of public health, than shouldn’t they  also give up their choice to participate in state and government-funded services like public school?

Mind you, no one is suggesting children be forced to vaccinate.  And no state is considering removing valid medical exemptions.  However, we live in a society that must begin to acknowledge that the decision to vaccinate extends beyond just the individual child.  Vaccinations may be considered a personal decision by some, but they clearly has public repercussions.  And while we may not be able to show how many cases of disease have been prevented, time and again we’ve seen the U.S. legal system rule that parents are not free to put the lives of their children and others in danger due to their own beliefs.

There are plenty of instances when the U.S. Supreme Court has stated that

 “parents may be free to become martyrs themselves. But it does not follow they are free, in identical circumstances, to make martyrs of their children.”

The Court also stated that the

“right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill-health or death.”

Now is the time for parents to speak up on this issue.  

In recent history, we’ve seen that in 2011-2013 there were more attempts by state legislatures to broaden exemptions than to tighten them, yet only bills tightening exemptions passed.  Today, we are at a critical point in which we’re seeing an encouraging number of bills that will work to tighten exemption policies.  But it will be up to the public to ensure they pass.

We urge you to join forces with other pro-vaccine advocates in your state, connect with the Immunization Coalition in your area and find out what you can do to support all the new legislation that is being considered this year.

For help getting connected to immunization advocates in your state, please email us at info@vaccinateyourfamily.org and sign up to receive email updates of state and federal immunization policies by signing up for Immunization Alerts on the bottom of the home page of the Vaccinate Your Family website.

You may also want to visit these sites for more state-specific information:  

 Immunization Action Coalition:

  • Direct links to state immunization websites (http://www.immunize.org/states).
  • State mandates on immunization and vaccine-preventable diseases (http://www.immunize.org/laws).

Vaccine Facts and Policy:

  • A comprehensive database of state level vaccine facts and policies (http://www.vaccinefactsandpolicy.org).

National Conference of State Legislatures:

  • Provides a listing of school vaccine requirements and exemptions by state (http://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx).

Vax Advocacy:

  • A new and growing website that parent-volunteers are building to help those who wish to speak up for sensible science-based public health policy (http://vaxadvocacy.org).

Additional reading addressing the legal mechanisms that are available to protect children against the risk of non-vaccination can be found in “The Rights of the Unvaccinated Child” blog series by Dorit Reiss, Professor of Law at the University of California Hastings College of Law in San Francisco, CA. 

Part 1: Setting the Legal Framework (click here to read)

Part 2: Tort Liability: Can an Injured Child Sue a Parent Based on Their Choice Not to Vaccinate? (click here to read)

Part 3: Can Parents Be Criminally Liable in Cases of Injury to an Unvaccinated Child? (click here to read)

Part 4: Under What Circumstances Is It Appropriate to Require Parents To Vaccinate? (click here to read)

Part 5: The Role of School Immunization Requirements in Protecting the Unvaccinated Child (click here to read)

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