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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.

Take Action: Ask Governor Brown to Sign Bill To Protect School Children from Vaccine Preventable Diseases

californialegislatureToday California lawmakers passed SB 277, a bill that will eliminate exemptions (other than for medical reasons) from mandated vaccinations for school children.  California will be the largest state to join ranks with West Virginia and Mississippi, who have declined non-medical exemptions from school vaccine mandates for many years.

The New York Times posted a map depicting the seriousness of the issue in California, where in some areas up to 20 percent of kindergartners are opted out of vaccines.  Details on the efforts of Californian’s in support of this bill are detailed in a recent SOP blog post.

Every Child By Two encourages readers to fax Governor Jerry Brown to urge his signature on the bill.  If you are not from California, please let the Governor know that you support his efforts and hope that your home state will follow California’s lead. Past bills of this nature have been watered down by the Governor, therefore it is important that he understand that the public is behind California in their efforts to protect school children.

The following letter was sent by ECBT last week in anticipation of the vote.

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June 26, 2015

Governor Jerry Brown
c/o State Capitol, Suite 1173
Sacramento, CA 95814

Fax: (916) 558-3160

Dear Governor Brown,

I write to you today on behalf of our organization which was founded nearly twenty-five years ago by Former First Lady Rosalynn Carter and Former First Lady of Arkansas Betty Bumpers to ensure the timely immunization of all children.  In the 1980’s these two ladies were instrumental in helping to pass the laws that exist in every state requiring school children to be fully vaccinated.  In 1991, after an outbreak of measles that took the lives of too many children, they founded Every Child By Two.

As you can imagine, we were very distressed to witness the most recent measles outbreak that began in California and rapidly spread to 131 people here in the U.S. and more in neighboring countries as exposed park goers returned to their homes, carrying the virus with them.  Read more…

Time to Speak Out in Support of Strong School Vaccine Policies

April 14, 2015 328 comments

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.   Read more…