Education Week - May 14, 2014 - 23

States Tighten
Exemptions
On Vaccines
Four-year-old Holly Ann
Haley braces for a
vaccine at her doctor's
office in Berlin, Vt. The
state recently revised
the personal exemption
process for vaccines.
CONTINUED FROM PAGE 1
only to your child and your family;
there are consequences to your community
as well."
Since 2011, Washington, Oregon,
California, and Vermont have revised
their personal exemption processes.
In Colorado-a state with one of the
highest opt-out rates in the country
and the most recent one to examine
its vaccine-exemption policies-a
bill passed this month would draw
schools into the public health fight.
House Bill 1288, which has not yet
been signed by the governor, will require
schools to collect information
about their vaccination rates and to
provide it to parents upon request.
The state's permissive school choice
laws would allow parents to transfer
their children-including immunecompromised
children who are not
able to be vaccinated-to schools with
higher vaccination rates, advocates
for the legislation said.
And making the information publicly
available could hold schools accountable
for enforcing existing laws
and encourage them to promote vaccinations
through efforts like schoolbased
health centers and pop-up clinics
at school registration events, Ms.
Wasserman said.
"We think it fits in the education
reform model that places parents in
the role of making decisions based on
quality," Ms. Wasserman said of the
reporting requirement. "It's an innovative
part of the bill, and other states
are already taking a look at it."
National Picture
All states require a schedule of
vaccines that a child must have
before he or she can be enrolled in
school. Every state allows exemptions
from vaccines for medical reasons,
and all but Mississippi and
West Virginia allow exemptions for
religious reasons, according to the
Centers for Disease Control and
Prevention in Atlanta.
Public health experts find the most
fault with personal exemptions, also
known as philosophical exemptions,
which are in place in 19 states. Those
exemptions typically allow parents to
opt out of vaccinating their children
by signing a one-time form and without
disclosing a reason.
And the number of parents claiming
such exemptions has grown over
the last decade, with high concentrations
of exemptions in states with especially
permissive policies.
Some parents, including those who
opposed tightening restrictions on
Colorado's personal exemption, argue
that it's their right to make medical
decisions for their children, regardless
of the reason.
The movement to opt out of all or
some vaccines has spiked in recent
years, in part because of scientifically
unproven claims that vaccines
are linked to autism and because of
misinformation spread online, vaccine
proponents say.
And as vaccines have been effective
LAWS AT A GLANCE
While all states have school vaccination
laws on the books, states vary on how
much leeway parents have to opt their
children out of required vaccinations.
50
at largely wiping out the diseases
they are designed to prevent, the public
has grown less concerned about
those diseases, Glen J. Nowak, the
director of the Center for Health
& Risk Communication at the
University of Georgia in Athens
said in a conference call with
public-health advocates.
For some parents, that kind of
progress tips the scale of concern
away from illnesses and toward any
possible side effects associated with
the vaccines.
"One of the things that happens
with low disease awareness is increased
focus on risks" of vaccines,
Mr. Nowak said.
In addition, immunization schedules
have grown more complicated,
and some people are resistant to any
form of government mandate, Mr.
Nowak said.
Waning 'Herd Immunity'
Data from the federal Centers for
Disease Control and Prevention show
that, in 2012, between 90 percent and
95 percent of kindergarten students
in most states had received two doses
of the measles, mumps, and rubella
(mmr) vaccine. The data showed the
same range of coverage for most
states for the diphtheria, tetanus
toxoid, and acellular pertussis (dtap)
vaccination.
By contrast, just 85.7 percent of
Colorado kindergartners had received
the mmr vaccine, and just 82.9
percent had the dtap vaccination, the
data show. Of the Colorado students
whose parents claimed an exemption,
93 percent chose the personal belief
exemption.
Vaccination rates that low fall
below the threshold of what is required
for what's known as "herd immunity"
or "community immunity,"
which requires immunization rates of
between 90 and 95 percent for most
vaccines, Ms. Wasserman said.
A portion of every population is
unable to be vaccinated because
they are too young or because their
immune systems are too fragile.
Through "herd immunity," a critical
mass of the population is immunized,
helping to protect those without vaccines
and to slow potential contagious
outbreaks, according to the cdc.
Low immunization rates can directly
affect schools, Ms. Wasserman
said. In many states, public health
officials have required unvaccinated
students to stay home during outstates
require specified vaccines
for students, but allow exemptions
for medical reasons.
48
states grant exemptions for
people who have religious
beliefs against immunizations.
(Mississippi and West Virginia
do not allow this exemption.)
SOURCE:
National Conference
of State Legislatures
19
breaks. In April, local health officials
in Ohio warned parents that unvaccinated
students may have to stay
home for 25 days or longer if the region's
mumps outbreak spreads into
schools.
"By not having kids in seats, you're
impacting their ability to have the instruction
time and the teaching time,"
Ms. Wasserman said.
In Colorado, many students missed
extended periods of school in 2012
and 2013 as the state faced a surge of
cases of pertussis, or whooping cough.
The state's health department reported
415 cases of pertussis in 2011,
a number that grew to 1,494 in 2012
and 1,035 in 2013.
Public health officials blamed low
vaccination rates and a change in the
vaccine in the 1990s that made it less
effective for some.
Other Approaches
States with permissive personal
exemption policies have opted to
amend them in recent years, rather
than eliminating them all together.
In 2011, Washington passed a bill
requiring parents to obtain a doctor's
signature before claiming a personal
exemption. In 2012, California passed
a similar law.
Under Oregon's law, passed last
year, parents must now obtain a doctor's
signature or complete an online
education module before claiming a
personal exemption.
Colorado's bill originally included a
similar "informed exemption" requirement,
but lawmakers amended that
portion out of the bill after hours of
emotional testimony from parents
who oppose vaccinations and appeals
from parents and medical professionals
who support them.
Opponents called the medical
states allow exemptions for those who object
to immunizations for personal or moral beliefs.
Arizona
Arkansas
California
Colorado
Idaho
Louisiana
Maine
Michigan
Minnesota
Missouri*
North Dakota
Ohio
Oklahoma
Pennsylvania
Texas
Utah
Vermont
Washington
Wisconsin
* Applies
only to
day care,
preschool,
and
nursery
schools
counseling requirement "a re-education
campaign," "brainwashing," and
"propaganda."
The National Vaccine Information
Center, a Sterling, Va.-based organization
"dedicated to the prevention
of vaccine injuries and deaths," said
that, "under the guise of public education,"
the bill "makes it legal for the
state to brand a minority of citizens
as intellectually or morally inferior
and serves to harass and coerce citizens
making health care decisions for
their minor children."
After the amendments, the bill still
would require the Colorado Department
of Public Health and Environment
to create a process for sharing
and analyzing immunization data. It
would also require the state's board of
health to create an online education
module that parents can consult for
information about vaccines and to reevaluate
how frequently parents have
to submit exemption forms.
Discussion groups assembled by
the Colorado Children's Immunization
Coalition to evaluate the state's
policies supported requiring parents
to reauthorize exemptions on a schedule
that mirrors a child's vaccination
schedule, Ms. Wasserman said.
This would give parents an opportunity
to reconsider their decision
and remind those who opted out for
reasons of convenience that they still
need to vaccinate their children, she
said.
"People are often adopting this option
without having a deeply held
personal belief," she said of the personal
exemption. "We wanted to close
that convenience loophole and also
offer opportunities to get sciencebased,
research-based, credible information
out there about the importance
of vaccines."
A spokesman for Colorado Gov.
John Hickenlooper, a Democrat, said
last week that his office has not yet
received the bill, and he will review it
before signing it.
The Rules for Engagement blog tracks
news and trends on this issue.
www.edweek.org/go/rulesforengagement
EDUCATION WEEK | May 14, 2014 | www.edweek.org | 23
Toby Talbot/AP-File
http://www.edweek.org/go/rulesforengagement http://www.edweek.org
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