Where Does Your State Stand on School Immunization Exemptions?
Feb 22, 2012

States all across the country are becoming battle grounds for vaccine exemption laws.  As some grow concerned about the ease in which people can obtain immunization exemptions, they are calling for the tightening of philosophical exemptions that currently allow unvaccinated children to attend public school.  In the past few weeks, we’ve seen vaccine related legislation in states such as Vermont, Kansas, South Dakota and West Virginia and people on both sides of the issue are voicing their concerns.
In order to weigh the implications of any proposed legislation, it’s important to first understand the reasoning behind state vaccination requirements and exemptions.
Contrary to what anti-vaccination groups say, vaccines are not forced upon anyone.
While the Food and Drug Administration (FDA) regulates vaccines to ensure safety and effectiveness, there are no federal vaccination laws.  However, just as the government requires immunizations for those who volunteer to join the military, and health providers may require employees to be vaccinated in a medical setting, immunization requirements for public school enrollment are determined by individual states.  Parents are not forced to vaccinate their children.  Rather, they’re given a choice as to whether they want their children to attend public school and therefore be vaccinated according to state admission policies.
All states offer vaccine exemptions.
According to the Institute for Vaccine Safety, as of August 2011, all 50 states and the District of Columbia permitted medical exemptions from immunization requirements.  In instances of cancer, immune disorders and allergy to vaccine components, vaccination is medically contraindicated and necessitates the use of a medical exemption since vaccination could be detrimental to the health of a child.   However, non-medical exemptions are also available through religious exemptions in 48 states and philosophical/personal belief exemptions in as many as 20 states.   While exemptions often differ by state, the process by which parents can obtain these exemptions has recently been cause for concern among public health professionals.
For example, in some states the current exemptions are exercised by simply signing a pre-written statement on a school immunization form or writing a personal letter explaining one’s reasons for refusing vaccination.  More recently, in states like Washington, new laws are suggesting that non-medical vaccine exemptions must be accompanied by the signature of a medical professional.  The intent, as I understand it, is to ensure that parents aren’t using the exemptions as a matter of convenience.  By requiring a discussion with a trained and qualified medical professional, health departments can make certain that parents aren’t using exemptions to avoid a trip to the doctor’s office.  The requirement also helps to ensure that parents are properly informed regarding the benefits of vaccines and the risks of vaccine refusal.
There is reason to be concerned about high exemption rates.
Recently, changes in exemption procedures are being suggested because statistics reveal that states with less rigorous procedures for obtaining these exemptions tend to have higher exemption rates. Additionally, higher exemption rates are often concentrated in specific communities, which subsequently increases the likelihood of disease transmission in that same community.    In support of recent legislation in Kansas,  Robert Moser, MD, Secretary and State Health Officer, Kansas Department of Health and Environment, referenced these points:

• States that made it easy to get exemptions had 90 percent more cases of whooping cough than states with stricter rules; states that allowed only religious and medical exemptions did not have a significantly higher rate of whooping cough.
• Schools with exemption rates as low as 2 percent to 4 percent are at increased risk for disease outbreaks.
• Exempted children have been found to be 22 to 35 times more likely to get measles than vaccinated children.
• The number of exemptions granted for nonmedical reasons grew by 6 percent per year between 1991 and 2004 in states that offered personal belief exemptions.
• Risks to the community, particularly vulnerable individuals within the community, are exacerbated by the tendency for nonmedical exemptions to cluster in small geographic areas rather than be evenly distributed throughout the state. These risks are evident even when overall immunization coverage levels for the state as a whole remain relatively high.

While vaccine hesitant parents want to claim vaccination as a personal choice, the reality is that the decision to remain purposely unvaccinated can have dangerous, and sometimes even deadly consequences, to those that are either too young to be vaccinated or who have legitimate medical contraindications.  It has never been suggested that parents be forced to vaccinate their children.  However, it seem reasonable to discourage the casual use of non-medical exemptions so as not to endanger the health of the public school children who do their part to protect our public health by getting vaccinated.
Be aware of the battles being waged against public health.
Unfortunately, even though the majority of parents vaccinate their children, most people are unaware of the battles being waged in state legislatures these days.  Meanwhile, anti-vaccination organizations are actively calling for the expansion of personal belief exemptions under the guise of freedom of choice.  In fact, just this morning in West Virginia anti-vaccine activists gathered on the steps of the state capital in support of Senate Bill 50, introduced by Senator David Nohe in hopes of paving the way for non-medical exemptions in West Virginia.
In an article the Senator wrote for Age of Autism, he explains that his son suffered a reaction to a vaccine and has since been advised not to be vaccinated.  In this case, the Senator’s son would easily be granted a medical exemption.   Unfortunately, instead of acknowledging that his son is cocooned from dangerous diseases by his vaccinated classmates, the Senator fails to realize that his efforts to expand the use of non-medical exemptions will likely decrease immunization rates, increase the incidence of disease, and increase the risk that his own son may contract a preventable disease.
Perhaps there will come a time when all parents and politicians will appreciate that protecting public health is not only in everyone’s best interest, but it is essentially everyone’s responsibility.  If you value vaccinations for the immunity they offer our community, I urge you to ensure that your state’s laws are working to protect your family.  Every Child By Two recently suggested that people take action in the state of Vermont by signing an online petition that calls for the retraction of a philosophical vaccine exemption for school entry in that state.   Perhaps there is something that you can do in your state?
We’ll do our best to keep you informed of specific legislative actions, but we suggest you contact your state health department to ask how you can make a difference in preserving public health.   For more information on state vaccination requirements and exemptions we encourage you to explore some of these valuable resources.
Immunization Action Coalion
Institute for Vaccine Safety (Map of Vaccine Exemptions)
National Conference of State Legislatures
Association of State and Territorial Health Officials (ASTHO)

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