Posts Tagged ‘school vaccination policies’

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.


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.”


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.


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.


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

Top Immunization Topics of 2013: Shot of Prevention’s Year in Review

December 31, 2013 3 comments

As we prepare for the challenges of 2014, we want to thank everyone who has contributed to our success in 2013.  Once again, the past year has been one of tremendous growth.  We’ve seen a record number of views and shares on a variety of Shot of Prevention blog posts and we’re especially grateful to our new blog contributors and many new subscribers.

In looking back over our efforts from this past year,  we would like to share a list of some of our most popular blog posts from 2013.  We hope that you will revisit these posts and share them with others so that we can engage more people in these important immunization discussions.

Top 5 Shot of Prevention Blog Posts of 2013

  1. Why Some Parents Are Refusing the HPV Vaccine For Their Children:  This post not only identifies some of the most common reasons parents are choosing to refuse the HPV vaccine for their children, but it includes links to scientific data that can help parents gain a better perspective regarding the HPV vaccine, including information on safety and efficacy.  Click here to read this year’s most popular post.

  2. Legal Responsibilities in Choosing Not to Vaccinate:  This guest post, written by vaccine advocate and law professor Dorit Rubinstein Reiss, explores the legal ramifications associated with those that choose not to immunize themselves or their children.  What if a unvaccinated individual is responsible for spreading a disease that causes permanent injury or even death to another individual?  Would it be reasonable to hold them liable?  Read more about the considerations here.

  3. Think Chickenpox is Party Worthy?  Think AgainJesseLee Some people mistakenly believe it is safer to sicken their children by exposing them to “wild” diseases than to obtain immunity through vaccinations.  However, the misconception that wild viruses and “natural” immunity is better for a child is a dangerous one, especially when parents are purposely infecting their children with chickenpox rather than get them vaccinated. If parents are going to take their chances with the wild varicella virus, it’s important that they first acknowledge the risks and understand that chickenpox can be dangerous and deadly.  This post, which explains the concerns of intentional exposure and highlights the unfortunate death of Jesse Lee Newman, can be read here.

  4. Why We’re Still Talking About Vaccines and Autism:  Each day, as new babies are born and more children are diagnosed with autism, questions of vaccine safety rush front and center for a new set of parents. In March of 2013, the CDC released new information about the prevalence of Autism Spectrum Disorder which then reignited conversations about the safety of immunizations.  This blog post includes links to various resources that address the subject of autism and vaccines.  But while concerns may linger, the science is in.  Read more in the post here.

  5. Vaccine Refusal and the Politics of School Vaccination Exemptions:  As vaccine exemption rates climb across various parts of the U.S., so do outbreaks of vaccine preventable diseases which are threatening the health of our children.  In 2013, many states responded to these concerns by establishing new policies for school immunization exemptions and attempting to legislate their way toward better public health.  Find out which states are taking action and how you can be alerted to legislative initiatives in your state by reading the post here.

If you have suggestions for topics you would like us to address in 2014, please feel free to add them to the comments below.  If you enjoy our posts please remember to subscribe to Shot of Prevention by clicking the link in the top right corner of this page.  You can also join us for more immunization news and discussion on our Vaccinate Your Baby Facebook page.

Thanks again for your continued support and best wishes for a happy and healthy new year!

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…

Vaccine Refusal and the Politics of School Vaccination Exemptions

April 30, 2013 446 comments

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 policiesRead more…

Battleground States for School Vaccination Exemption Policies

September 27, 2012 193 comments

The figure above shows the estimated percentage of children enrolled in kindergarten who were exempt from receiving one or more vaccines in the United States, during the 2011-12 school year.

Recently the CDC released data regarding the vaccination coverage and exemption rates among U.S. children in Kindergarten for the 2011-2012 school year.  Upon first look, the top line analysis of the data doesn’t appear to be too concerning.

Total exemption rates, including medical, religious, and philosophic exemptions, among 49 reporting states and DC, ranged from less than 0.1% to 7.0%, which translates to a median total exemption level of about 1.5%.   Not too shabby, huh? 

But here’s the thing about data charts.  Sometimes you have to take your analysis a bit deeper.  

While 10 states can boast exemption rates of less than 1%, there were 9 states that reported exemption rates greater than 4%.  In fact, Alaska’s rates were as high as 7%, and in Oregon, the non-medical exemption rate alone was as high as 5.8%.

These figures highlight a growing concern.  While national levels of vaccination coverage may seem at or near target levels, certain states and localities are seeing dangerously low vaccination rates for some extremely transmissible diseases.  Unfortunately, concentrated numbers of unvaccinated children contribute to the possibility of disease outbreaks which then presents an unnecessary threat to all our children.  Read more…