State Vaccination Exemption Policy Makes A Difference

Mother Jones has just run a very nice analysis of recent years' research on state laws governing non-medical exemption from childhood vaccines. It turns out that if a state makes it very easy for parents to exempt their children from recommended school vaccinations for non-medical reasons, lots of parents will exempt their children. This causes loss of herd immunity, and children die of childhood diseases that haven't been common for decades. And when one state (Washington) tightened up its rules by requiring a doctor's signature for exempting children from vaccination, exemption rates fell by 40%.

Meanwhile, cases of measles are on the rise in California--more than half of them involving children who were intentionally not vaccinated.

Bad News on Vaccinations

This letter to the New England Journal of Medicine reports an increase in the rate of non-medical exemptions from the childhood vaccinations generally required by state law. (Non-medical exemptions are permitted in 48 of the 50 United States.) States that allow "philosophical," as opposed to only "religious," exemptions to mandated childhood vaccinations, had higher rates of exemption, as did states with "easier" opt-out provisions. Easy opt-out states allow parents to opt out of the vaccination requirement by filling out a standardized form supplied by the school; harder opt-out provisions require an original and/or notarized letter from the parent, or a form obtainable only from the state health department.

For whatever reason--but certainly including unscientific vaccine/autism fear-mongering--there has been a dramatic decline in US parents' willingness to vaccinate their children. The result has been the return of deadly childhood diseases including pertussis, whooping cough and measles. Vaccination is among the most effective public health measures. Certainly, states should make it harder for parents to opt out of vaccination programs for non-medical reasons. But rates of opt-out are on the rise even in "difficult" opt-out states, and there is some evidence that when states make it hard to opt out of vaccination for non-medical reasons, parents respond by pressuring doctors to write them bogus "medical" excuses.

The root of the problem seems to be that vaccines are victims of their own success. Most people haven't seen the effects of the awful childhood diseases that vaccines have been so effective at eradicating. But they've heard about vaccine reactions, and have heard all the unsubstantiated--or downright fraudulent--claims about vaccines and autism. How many kids will have to suffer or die with whooping cough or measles or pertussis before the public can be persuaded to trust in some of the most reliable science in all of public health?

Vaccine Exemptions

This AP story gives a lot of interesting detail on the current parental flight from childhood vaccination. In eight of the US states, over 5% of kids don't get the required vaccinations before kindergarten; their parents exercise the right to exempt them from some or all vaccinations, instead. The exemption rate is up in more than half of all states, but highest in Western and Upper Midwestern states.

Part of the trouble is that some states make it quite simple to exempt a child from vaccination--a note from home alleging a personal opposition to immunization does the trick in Colorado, for example. Some kids need to be exempt for medical reasons, of course, and some accommodation must be made for religious opposition to vaccination; but the response to mere personal or philosophical opposition to immunization should be education, at least in the first instance, rather than surrender. Parents who exempt their children are endangering them and other people as well.