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With School Vaccine Exemptions on the Rise, What Can Be Done to Protect Our Students?

June 12, 2018 1 comment

Today, PloS Medicine published a study that examined the increase we are seeing across the country in philosophical exemptions to school vaccine requirements, also known as personal belief exemptions.

According to the authors, 12 of the 18 states that allow philosophical exemptions have seen an increase in parents choosing to exempt their children from one or more vaccines. As a result, several metropolitan areas are at risk of an outbreak of disease, such as measles, similar to the one we saw originate at Disneyland in Anaheim, California three years ago.

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The Washington Post notes that the study “characterized many rural counties, as well as urban areas, as ‘hotspots’ because their high exemption rates put them at risk for epidemics of measles, whooping cough and other pediatric infectious diseases.

Amy Pisani, Executive Director of Every Child By Two/Vaccinate Your Family, expressed concern about what is known as the “community protection threshold” by stating, 

“It’s alarming to see the rise in exemption rates across this country, putting communities at greater risk. Parents need to understand that timely vaccines are critical to protecting children’s health and should be at the top of the family’s to-do list.”

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While the study reveals some interesting data points, there’s little information as to why it appears that parents are increasingly claiming exemptions for their children.

In most states, the school vaccine exemptions tend to be elevated in a handful of communities, as opposed to a general rise in exemptions throughout the state.  It appears that more research needs to be done to better inform public health policymakers regarding the underlying reasons parents are exempting their children from school required vaccines.

In the meantime, some of the states with the highest levels of exemptions have passed legislation to make nonmedical exemptions more difficult to obtain. For example:

  • In Washington state, a law was passed that required parents to have their exemption form signed by a health care provider.
  • In Oregon, parents have the option of watching an online module on the dangers of not vaccinating or getting a form signed by a health care provider.

While both states saw an immediate and encouraging reduction in the number of exemptions claimed, it appears that these policies have not been effective over time and exemptions are once again on the rise.

Tightening laws and policies clearly does not keep those parents who are intent on seeking exemptions from obtaining them. But how about eliminating nonmedical exemptions?

After the 2014-2015 measles outbreak in California, the state legislature decided to eliminate all nonmedical exemptions. Again, one year after the law was passed exemption rates fell dramatically and, most importantly, vaccination rates rose well above community immunity thresholds, thus better protecting communities against disease outbreaks.

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But what will the future hold?  Will parents who have philosophical reasons to avoid vaccines for their children find ways to obtain medical exemptions?

Initial data suggests that may be the case. According to an article in JAMA, the California medical exemption rate reflected a three-fold increase following the introduction of the law, from 0.17% to 0.51%. According to the article’s authors,

“Some vaccine-hesitant parents may have successfully located physicians willing to exercise the broader discretion provided by SB 277 for granting [medical exemptions]…If true, this practice would be inconsistent with the recommendation from the American Academy of Pediatrics to reserve [medical exemptions] for children having contraindications.”

In the coming years, public health partners may have a better sense of whether eliminating nonmedical exemptions can sustainably increase vaccination rates and protect our communities against dangerous vaccine-preventable diseases. We will also be looking to additional studies to learn how many parents are choosing exemptions because they have true personal objections to vaccinations, or because they don’t view vaccination as a priority among their long back-to-school lists.

In the meantime, it’s important to help state legislators and the public understand what has been tried to-date and what are the most promising policy paths forward. 

Here are some ways that you can be informed and help to inform others:

  • Consider sharing Vaccinate Your Family’s fact sheet on the impacts of exemption legislation with your local lawmakers to remind them of their role in strengthening our defenses against vaccine-preventable disease.
  • Check out Vaccinate Your Family’s 2018 State of the ImmUnion report to learn more about federal policies that aim to protect our families and communities from dangerous diseases.
  • Help ensure children are better informed about how diseases develop and how vaccines work with the immune system by sharing specially designed science curricula from The Vaccine Maker’s Project with school nurses and science teachers at your local elementary, middle or high schools.
  • Find out more about the vaccination rates in your state and community by contacting your local schools, public health department or reviewing the latest CDC vaccination coverage reports.
  • Stay informed about the latest immunization news and research by following Vaccinate Your Family’s Facebook, Twitter and Instagram accounts, subscribing to this Shot of Prevention blog and sharing the information we discuss on these channels with your social contacts.

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Together we can work to ensure that students get the protections they deserve in their schools and communities.

White House Administration Video-Response to Opponents of Mandatory Vaccine Laws

Opponents of state-legislated school immunization requirements drafted a “We The People” petition in February, reaching the required number of signatures to trigger an official response from the Administration.  The petition was worded and advertised as follows:

“PROHIBIT ANY LAWS MANDATING THE FORCE AND REQUIREMENT OF VACCINATIONS OF ANY KIND – No human being should be FORCED to be vaccinated against their will and/or personal/religious beliefs. I petition against making vaccinations of any kind mandatory. This includes forcing children to be vaccinated to attend public schools, activities, and daycare centers. This also includes adults working in the public or private sector.”

This official White House We The People petition website pledges that

“the right to petition your government is guaranteed by the First Amendment of the United States Constitution. We the People provides a new way to petition the Obama Administration to take action on a range of important issues facing our country. We created We the People because we want to hear from you. If a petition gets enough support, White House staff will review it, ensure it’s sent to the appropriate policy experts, and issue an official response.”

A petition must reach 100,000 signatures within thirty days of posting in order to meet the response qualification.   Vaccine opponents advertised the petition as an effort to “call for federal protection from forced vaccination” and received 132,304 signatures.
Every Child By Two could not be more pleased with the official response to this petition which includes a poignant video message from the U.S. Surgeon General Vivek Murthy.  From the official We The People website:

The evidence about vaccines’ safety and benefits is both strong and consistent — but don’t just take our word for it. We reached out to the U.S. Surgeon General, Dr. Vivek Murthy — the Nation’s Doctor — who wanted to respond to you personally on this issue.
Here’s what he had to say:

Read more…

Vaccine Exemptions Often Result of Laziness and Lies

On the subject of school vaccination exemptions, I want to get one thing straight.  I’m not against them.

My efforts to inform people about the impact exemptions have on the health of children in school is to ensure that we don’t allow parents to abuse the exemption process.  The way I look at it, exemptions must – first and foremost – remain available for those children who are medically unable to be vaccinated.    These students are at the heart of my concern as school vaccine exemption rates climb in certain areas.

The Risk to Those With Medical Exemptions

While medical exemptions are limited to those who have documented medical conditions which prohibit them from receiving certain immunizations, these children remain vulnerable to disease, and may also be more susceptible to serious complications or death as a consequence of a compromised immune system.  Therefore, maintaining a high percentage of immunized children in school not only protects the children who can be immunized, but also those who can not.  The concern begins when the number of unvaccinated children rises to the point at which it negatively impacts the protection we all receive through community immunity.

The Impact of Non-Medical Exemptions

Currently, every state (with the exemption of Mississippi and West Virginia) offers parents the opportunity to claim non-medical exemptions from required school vaccinations based on either religious or philosophical reasons.  However, as the exemption rates climb in specific schools, outbreaks of vaccine preventable disease seem to be occurring more frequently.  This has sparked concern among health care providers, infectious disease specialists and public health professionals who believe these outbreaks may be avoidable through immunization.  One research study suggested that children who are exempt from vaccination requirements were more than 22 times more likely to contract measles and nearly six times more likely to contract pertussis compared to vaccinated children.  And states with loose exemption policies has approximately 50% more cases of whooping cough compared to stricter states.

Exemptions Often More Convenient than Vaccinations Read more…

California Immunization Coalition Co-Sponsors Important Bill to Prevent Disease

April 9, 2012 59 comments

The California Immunization Coalition (CIC) is proud to be a co-sponsor of AB 2109 (Pan) Vaccine Preventable Diseases along with the American Academy of Pediatrics – CA District, the California Medical Association, and the Health Officers Association of California which has the goal of improving vaccination rates and reducing the use of the personal belief exemption out of convenience in the state of California.

After speaking with the CIC, they explained that their main focus in on “reducing the number of exemptions by convenience with a goal of keeping our schools and our community safe for children”.

Their primary message on this bill is NOT that they want to stop families from obtaining a personal belief exemption.  This bill does not prevent a family from refusing one or more school entry vaccines. Rather, it introduces an “information step” into the process, which is accomplished by the family and a physician, nurse practitioner or physician assistant signing a simple form that indicates the parent received information on the benefits and risks of vaccines from that health care provider.  This information step was introduced based on the following considerations:

  • Parents deserve to have reliable information to support the healthcare decisions they make for their family.
  • Children who are exempted from vaccines are at significant risk for diseases.
  • It’s important that the state ensure that requests for exemptions from immunization are based on conviction, not convenience.

You will find the AB 2109 Fact Sheet here and the current text of bill here where you can also subscribe to bill updates. Read more…

Whose “Rights” Shall Prevail in Vermont?

Last week I made the nine-hour round trip trek up to beautiful Montpelier, Vermont to testify in front of the House Committee on Healthcare.  As I made my way over the lovely mountain towns and stunning valleys en route to the hearing, I was certain that my testimony could help sway the committee to vote in favor of the Senate’s bill to eliminate “philosophical beliefs” as a reason to override Vermont laws mandating vaccination of children enrolled in licensed daycares and public schools.  With the strength of Every Child By Two’s board and cofounders behind me, and the personal stories of families whose children have suffered the consequences of vaccine preventable diseases, I made my way across the state confident that we could make a difference.

As I sat in front of the committee, the chairman made it clear that the committee had already spent the week reviewing mounds of data on exemption rates and vaccination levels, listening intently to opinions from both sides of the issue and were hoping to hear something new.

ImageWith the gauntlet laid before me, I began by explaining why our organization, a national organization based in Washington, DC, would be concerned with the public health mandates of the state of Vermont, or any other state for that matter.  Why would a former first lady and the wife of a retired Senator continue to be concerned about the vaccination policies that exist in every state to ensure the health of school-age children? I explained that our founders, Rosalynn Carter and Betty Bumpers, began their efforts to vaccinate the children of their own home states during their tenures as First Ladies of Georgia and Arkansas in the early 70s.

ImageDuring the Carter Administration Mrs. Bumpers, whose husband had since been elected to the U.S. Senate, worked side-by-side with First Lady Rosalynn Carter to establish the National Childhood Immunization Initiative with two goals: the attainment of childhood immunization levels of 90% by 1979 and establishment of a permanent system to provide comprehensive immunization services to the 3 million children born each year in the U.S.  During that time, Mrs. Carter and Bumpers were instrumental in the passage of laws mandating school-age vaccination prior to enrollment in public schools in every state. They traveled all over the country to speak to legislatures about this important issue because they knew it would save the lives of children. Read more…

Vaccine Supporters, Get Out Your Megaphones

March 29, 2012 44 comments

Last week, Dr. David Katz, the founding director of Yale University’s Prevention Research Center, wrote an article for the Huffington Post.  He explained his concern about the future of public health, stating that if we continue a trend towards rising rates of preventable diseases, coupled with declining rates of vaccination, that we may be taking a step backwards in the future.

One of my favorite quotes from this article pertained to Dr. Katz’s comments on the prevalence of vaccine misinformation in which he states,

“But in the internet age, crazy, paranoid nonsense and hard-earned, thoughtful, evidence-based expertise have the same megaphone.”

I particularly love his use of the word megaphone.  But I disagree with his statement.

Yes, crazy, paranoid nonsense is often amplified online, much like being broadcast with a megaphone.  However, in my opinion, the hard-earned, thoughtful, evidence-based expertise is barely audible in comparison.  Sure, Dr. Katz is doing his part by contributing to the Huffington Post, but I believe that many more megaphones are needed  if we are to adequately address certain public health challenges such as a possible decline in vaccination rates.

The way I see it, the majority of people who support vaccination (illustrated by the fact that they are themselves vaccinated) aren’t engaged in the conversation.  Sure they recognize the dangers of disease.  They even understand the benefits of vaccines.  That is why they comply with the recommendations of their doctors and other experts.  But that is often where there their engagement ends.  It’s not a selfish thing; it’s just that they don’t feel the need to be involved in the discussion.  I believe there are many people who don’t even realize that vaccine hesitancy exists.  Which helps explains why people don’t really understand the threat that vaccine hesitancy has on our public health.  It’s not that they don’t want to help.  It’s just that they don’t see the need.

Yet, if you visit a parenting chat group these days you’ll find that there are plenty of parents who come to these forums seeking information about vaccines.  Just as they have questions about breastfeeding, developmental milestones and discipline techniques, these parents often rely on the “expertise” of other parents who’ve “been there”. Read more…

Bill Addressing VT Philosophical Exemptions is Halfway There

March 16, 2012 182 comments

We covered this before and will no doubt cover it again.

The use of philosophical vaccine exemptions available in many states allow children to attend public schools without the state mandated vaccinations.  In some states, such as Vermont, there is concern about the growing use of these exemptions and how an increased number of unvaccinated children may threaten the health of other students.  There are a number of new laws in various states to address these concerns, some even calling for a more comprehensive discussion of vaccinations benefits before allowing parents to opt out of the required vaccines.

In Vermont a recent bill to remove philosophical exemptions has passed the Vermont State Senate with a 25-4 vote in favor of the new legislation.  However, even with overwhelming support in the State Senate, there may still be a struggle to get it through the House.  Currently, the bill has been assigned to the House Health Care Committee for further review, who are already hearing from opponents of the bill.

A recent op-ed from Dr. Lou DiNicola, a pediatrician at Gifford Medical Center in Randolph and the president of the American Academy of Pediatrics Vermont Chapter ran in the Valley News and the Rutland Herald.  It highlighted the concerns that parents and pediatricians have in regards to the use of philosophical exemptions in Vermont, stating,

“Last year 5.4 percent of all kindergarteners, or more than 1 in 20, were enrolled in public schools by parents who used the philosophical exemption to avoid immunizations. The recent surge in the potentially deadly but preventable disease whooping cough is an indicator of how Vermont’s reduced immunization rate is leading to real-world consequences. Last year the Department of Health reported 91 cases. In 2010 it was only 18.”

If you would like to help protect the health of children in Vermont by supporting the removal of the philosophical exemptions, it’s important that you take action by contacting the Speaker of the House Shap Smith,  the House Health Care Committee and your representative or all representatives.  You can also call and leave a message at the State House for a committee member to call you back at 802-828-2228.

The committee may also be planning a public hearing one evening next week and we will be sure to keep you updated on any further information we receive.  If this bill is to proceed it can not be accomplished without your involvement at this critical time.

Of course, we welcome your comments about this bill and hope you will let us know if you plan to take action to support it.

Representative Shap Smith, Speaker of the House
(802) 828-2245 or speaker@leg.state.vt.us

House Health Care Committee
Mike Fisher of Lincoln, Chair  – (802) 453-5517 or mfisher@leg.state.vt.us
Sarah Copeland-Hanzas of Bradford, Vice Chair – (802) 222-3536 or scopelandhanzas@leg.state.vt.us
Paul Poirier of Barre City, Ranking Member – (802) 476-7870 or ppoirier@leg.state.vt.us, paulpoirier33@gmail.com
Leigh Dakin of Chester, Clerk  – (802) 875-3456 or ldakin@leg.state.vt.us
Jim Eckhardt of Chittenden – (802) 342-0140 or jeckhardt@leg.state.vt.us
Patti Komline of Dorset – (802) 867-4232 or pkomline@leg.state.vt.us
Mary Morrissey of Bennington – (802) 442-2092 or mmorrissey@leg.state.vt.us
Chris Pearson of Burlington – (802) 860-3933 or cpearson@leg.state.vt.us
Kristy Spengler of Colchester – (802) 864-6567 or seashre@msn.com
George Till, M.D. of Jericho – (802) 899-2984 or gtill@leg.state.vt.us
Mark Woodward of Johnson – (802) 635-7166 or mwoodward@leg.state.vt.us