Posts Tagged ‘state vaccine exemptions’

Is it Common for Doctors to Dismiss Patients Who Refuse Vaccines?

November 2, 2015 30 comments

A new study published in Pediatrics examines the characteristics of doctors who dismiss families for refusing vaccines for their children.

While almost all of the 534 pediatricians and family physicians who were surveyed for the study have encountered parents who refuse vaccines, the survey also indicated that vaccine refusal is generally rare. Overall, 83% of doctors reported that 1% or fewer parents refuse one or more infant vaccines in a typical month.

When that happens, 21% of pediatricians and 4% of family physicians said they “always” or “often” dismiss these families, and 51% reported “always” or “often” requiring parents to sign a form if they refused.  However, there were some doctors who estimated that vaccine refusal in their practices were  between 1% to 4% of parents they encountered and some saying as many as 5% of parents they saw refused vaccines.

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Image by the “Refutations to Anti-Vaccine Memes” Facebook page.

Although the survey was conducted in 2012, it has been published in a year when people are increasingly frustrated by recurring outbreaks of vaccine preventable diseases.  For instance, following the well publicized measles outbreaks that occurred in Disneyland late last year, there has been a surge of public support for strong immunization policies that favor vaccination for school children, daycare workers and healthcare employees.  This swell of public support has often been discussed as the catalyst for the record number of new legislative bills that were introduced this year in an attempt to reduce school vaccine exemptions and boost childhood vaccination rates in various states across the country.  While there is a general consensus that more needs to be done to educate parents about the benefits of vaccines, the question of whether doctors should refuse patients who decline vaccines is an ongoing debate that has drawn a great deal of commendation and criticism.

Both the American Academy of Pediatrics (AAP) and the CDC discourage physicians from refusing to see patients who refuse vaccines.  Instead, they have tried to urge physicians to continue to treat these children in hopes that an ongoing relationship with these parents will help build the kind of trust that may eventually lead them to reconsider their vaccination choices for their children.

Meanwhile, doctors who refuse unvaccinated patients have various reasons for doing so.

Read more…

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.

ecbt_logowithcarterbumpers - Copy

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…

Legislators Must Hear From Public in Support of Strong Vaccine Policies

June 18, 2015 2 comments

2015 promises to be a big year for vaccine policy.  

got_public_healthBack in January and February the United States saw a rise in measles cases as a result of an outbreak that originated at the Disneyland amusement park in California.  As a result, parents, providers and public health professionals began raising concerns about the dangerous risks of disease, the misinformation that has been persuading people not to vaccinate, and the rising number of exemptions parents have been filing to allow their children to skip school mandated vaccines.  Soon state legislators were being encouraged to take the steps necessary to protect daycare and school aged children from vaccine preventable diseases with new, stronger immunization policies.

The request was pretty straightforward.

States need immunization policies that will help preserve and protect our public health, and every child deserves the right to attend school in an environment that is free from preventable diseases.   

The results have been both encouraging and exhausting.

Many states, such as Vermont, have since passed new legislation that will help boost school vaccination rates by either restricting philosophical exemptions, or requiring parents to discuss the risks of not vaccinating with a health care provider prior to getting an approved exemption.  Just last night, the New York State Assembly passed a bill 105-28 that will require seventh and twelfth graders to receive a meningococcal vaccine and now the bill will head to the governor’s desk.  And there are dozens of other states that are considering new policies.

When it comes to immunization policy, it takes an enormous coordination of effort to educate legislators on the issues and get a bill to become law.   

One state that has received a great deal of attention lately is California and Senate Bill 277.    If approved, SB277 would remove the personal belief exemption option from California’s school immunization statute.  The bill has already passed the Senate with a 25-10 vote in May, and cleared another impressive hurdle last week by winning a 12-6 vote in the Assembly Health Committee.  Despite the encouraging outcomes so far, supporters of the bill will tell you that the outcome is still uncertain.

The next challenge is a vote by the full Assembly, and then hopefully the bill will arrive on the Governor’s desk.   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…

Celebrating Our Nation’s Investment in Public Health and Vaccines

July 4, 2014 4 comments

Independence-DayHansPetersenAs people across the nation are getting ready to celebrate Independence Day, I’m reminded of how grateful I am to live in a country that values freedom.  As a citizen of the United States, I’m encouraged to participate in our democracy, I’m granted various protections, and I benefit from our nation’s investment in public health.  While our democracy is far from perfect, I do believe that great efforts are made to keep Americans safe and healthy – despite the fact that some people would rather live recklessly and dangerously.

When looking back upon the history of our nation’s immunization policies, we get a glimpse of both the good and the bad.  In a recent op-ed in Politico entitled “How Congress Brought the Measles Back“, Sarah Despres explains how Congressional actions have negatively influenced public opinion regarding immunizations in a way that has continued to interfere with good public health practices.   On the flip side we also hear stories about people like Andy Marso, a passionate meningitis survivor who has been instrumental in advocating for state legislation that will help protect college students from a devastating disease that almost cost him his life.  The point is that while our democracy and our public health programs are far from perfect, we have the ability to exercise our voice in the legislation that governs our nation’s policies.

We won’t always agree on what’s best, but when the discussion turns to vaccine choice some people feel strongly that they should not be “forced” to vaccinate either themselves or their children.  They argue that such government requirements interfere with their individual freedoms. Admittedly, I get a bit upset when I read such statements.

While I believe vaccines are the best way to protect from dangerous and deadly diseases, I also believe that people should have a say about their medical choices.  However, to say that people are “forced” to vaccinate is grossly inaccurate.  By exaggerating this claim, vaccine refusers are simply trying to garner support from a larger audience who wish to oppose any government intervention in their lives, regardless of any benefit it may provide to the masses.  Unfortunately, they fail to realize how vital this protection has been and how much death and suffering has been avoided because of the policies they so vehemently oppose.

The truth is that we all have choices.  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…