Posts Tagged ‘school vaccine requirements’

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.

Take Action to Protect Student Health in Colorado

April 11, 2014 1 comment

Earlier this week ABC News’ Dr. Richard Besser explained that children deserve to be protected from disease while in public school.  With rising school vaccine exemption rates and pockets of unvaccinated students, our children and our communities are at risk of suffering from unnecessary disease outbreaks.  It’s what Dr. Besser explains as a “ticking time bomb“. Several states, such as WA, OR, VT and CA, have already taken measures to help increase immunization rates by modifying the way parents file for school vaccine exemptions.  By ensuring parents understand the benefits and risks of vaccines, and by requiring more than just a parental signature to secure an exemption, these states are beginning to see a rise in student immunization rates.  And Colorado is the latest state to stand up for student health with the introduction of Colorado House Bill 1288.

CCICOver the past few months the Colorado Children’s Immunization Coalition has been keeping us informed about HB 1288 and how it is progressing through the state legislature.  The bill preserves parental rights and continues to allow for parents to make choices for their children, but it also protects public health by ensuring parents are making well-informed and carefully considered decisions about immunizations.  Under Colorado law today, parent signature is the only requirement to elect a personal belief exemption.  This means it’s easier and more convenient to elect a personal belief exemption than to uphold the requirement to provide immunization records to a child care provider or school.  It’s time we create a fair process for all parents, which will reduce the likelihood of parents are opting out of vaccinating their children as a matter of convenience.

What House Bill 1288 does:

HB 1288 requires that parents electing a personal belief exemption demonstrate that they understand the benefits and risk of vaccination, both for their child and the community. This is done by submitting a personal belief exemption that includes the signature of a health care provider licensed to administer vaccines, or by taking an online education module and submitting the certificate of completion to the child care provider or school. One of the most critical components of HB 1288 is that it also allows parents the right to access vaccination rates for all Colorado child care centers and schools.  Every parent has a right to know the percentage of unvaccinated students are attending their child’s school so that they are free to make the best choice for the health of their child.

Why House Bill 1288 is important to everyone, not just for children in Colorado:

Read more…

Rights of the Unvaccinated Child: The Role of School Immunization Requirements

March 20, 2014 17 comments

This is the fifth post in a five-part series written by guest blogger Dorit Rubinstein Reiss.

Dr. Reiss is a Professor of Law at the University of California Hastings College of  the Law in San Francisco, CA, who often examines the social policies of vaccination in various articles, blogs and law journals.  In this series, she will elaborate on the legal mechanisms that are available to protect children against the risk of non-vaccination.  A detailed explanation of each of the following posts appears at the conclusion of this article.



Much has been written about school immunization requirements and exemptions, usually from the point of view of protecting public health and preventing outbreaks, or in regard to parental rights. This blog itself has carried several posts on the topic (here, here and here).  An important justification for immunization requirements is that in a school environment children are in close contact and some preventable diseases can be transmitted easily. Schools are therefore vulnerable to outbreaks, and those outbreaks put all children in danger. Because an unvaccinated child in school puts others at risk, it is appropriate to intervene and limit parental freedom.

However, that is not the focus of this discussion. 

The following entry will address the role school immunization requirements can play in protecting a child against her own parents’ decision not to vaccinate.

The starting point is that school immunization requirements are both constitutional and effective. The Supreme Court ruled that they were constitutional as early as 1922, in Zucht v. King, 260 U.S. 174 (1922).

There are several indications that these requirements are effective. Mississippi, which only offers medical exemptions from school immunization, has very high rates of immunization. In Connecticut, a new requirement that children in child care receive the influenza vaccine led to rates’ increasing from 67.8% to 84.1% (and a corresponding decrease in flu-related hospitalization for children). Allowing parents to opt out can lead to less protection: studies have shown that easy-to-obtain exemptions from school immunization requirements lead to higher rates of exemptions[1] and that rates of nonmedical exemptions are higher when a state offers a personal choice exemption in addition to a religious one.[2]

At the same time, school immunization requirements can also lead to resistance and opposition. Nobody likes to be coerced, and some people who would not otherwise oppose immunization may resent and resist a mandate.

Vaccine advocates often say that parents have a choice: they can homeschool or send their child to a private school. But the ability to do that depends on the state’s willingness; quite a few states apply school immunization requirements to private schools, and several, including North Carolina and Virginia, further apply them to homeschooled children. So, parents may not have a choice in the strict sense – and if the goal is maximum protection of the child, that may be appropriate.[3] Even in states where the option is available, not every family can afford private school or is capable of homeschooling, and for families that can homeschool, there remains an element of coercion in telling parents that they must choose between vaccinating and restricting the ability of at least one member to work full-time.

What Does the Law Say? Read more…

Governor’s Directive May Undermine State Vaccine Exemption Policies

October 18, 2013 17 comments

AP2109governor_jerry_brownLast year, an immunization bill to help protect the children, schools and communities in California from vaccine preventable diseases was introduced to the State Assembly.  This proposed bill (AB 2109) was intended to reduce the number of students claiming non-medical vaccination exemptions and minimize the impact of disease outbreaks caused in part by pockets of under-vaccinated children. After many hearings the bill, which was co-sponsored by the California Immunization Coalition, the California Medical Association, the American Academy of Pediatrics – CA and the Health Officers Association of California, was approved by the State Assembly and signed into law by California Governor Jerry Brown in September, 2012.

However, upon signing the bill the Governor added a specific directive that may impact the way in which the new exemption forms are written and seriously undermine the bill’s original intent. Bill supporters are now left to question whether the Governor’s actions were appropriate.  Were his changes an attempt to re-interpret the law?  And does he have the authority to make such changes?

As approved, AB 2109 would not interfere with parental options to secure personal belief exemptions from required school vaccinations.  Rather, the bill would simply establish new policies regarding the process by which parents would need to file for an exemption.  Read more…

Study Shows Support for Tightening School Vaccine Exemptions

ECBT-Bus Shelter Ads_Resized_68.5x47 Emma SmallPeople who believe in the benefit of immunizations often try to encourage others to vaccinate.  They do so because they are motivated by concern for their family and their community.  They understand that widespread immunization programs do more than just protect the individual.  They help protect entire communities.

Sure, there are times when a person may be vaccinated but not achieve the immunity that was expected.  Likewise, there are people who can’t be vaccinated, either because they suffer with certain medical conditions, or they are too young to receive certain vaccines.  But this is why vaccinations are beneficial to public health.  Statistics show that the more people who are vaccinated, the greater the reduction in overall incidence of disease, which in turn leads to less suffering, hospitalization and death.  Therefore, widespread vaccination protect vulnerable members of our society who can’t be vaccinated, who choose not to be vaccinated, or who didn’t achieve optimal immunity from a particular vaccine.  That is the beauty of community immunity.  And this is the issue at the heart of school vaccination policies.

Unfortunately, under-vaccinated pockets of children in various places across the country are attracting concern.  School vaccination policies that have  improved public health across our nation are now being undermined by a growing number of parents seeking exemptions out of fear, convenience or misinformation.  Parents, who are often complacent about diseases they rarely encounter due to the success of our nation’s widespread vaccination programs, are sometimes choosing to exempt their children from school required vaccines.   But in the past few years, in states like California, Washington, Vermont and most recently Oregon, there has been a growing movement to reduce the number of nonmedical exemptions being filed in order to ensure that falling vaccination rates don’t result in the return of dangerous diseases.

A new study out today provides a closer examination of state school vaccination policies and suggests that states with fewer barriers have higher exemption ratesRead more…