Vaccine Exemptions Rose For Years Ahead of Measles Outbreak (1)

The rate of children being exempted from measles vaccinations rose from 2012 through the 2017-2018 school year, a trend that has likely continued into the 2018-2019 school year according to a review of data in a handful of states, despite warnings from health officials of the potential for outbreaks of the disease.

More than 81,000 total U.S. children were granted exemptions from state vaccine requirements before the 2017-2018 school year, according to data from the Centers for Disease Control and Prevention and state health department records. Over the past five years the median exemption rate, the percentage of children excused from having their full range of vaccinations, rose to 2.2% from 1.8% , according to federal data.

Data at health departments in Arizona, California, Maine and North Carolina show the trend continuing.

While some states have had declines in exemptions, seven states and Washington, D.C., reported increases in exemption rates of 5% or more, ahead of the 2017-2018 school year, raising fears that areas of those states are highly susceptible to outbreaks of preventable diseases like measles.

“That is a ticking time bomb,” said Bob England, who serves as interim director for the Pima County Health Department in Arizona where only 60% of the schools have what’s considered a “community immunity” to vaccine-preventable diseases, meaning enough students are immunized to prevent a community outbreak of certain diseases. “All you need is one kid with measles or something to land in one of those schools and it’s off and running.”

The rise of anti-vaccine sentiment has been fanned by celebrity “anti-vaxxers” like Robert F. Kennedy Jr. and Jenny McCarthy, who claims vaccines caused her son’s autism.

Kennedy led a court challenge by a group of New York parents who argue their First Amendment rights will be violated if they are forced to vaccinate their children.

NY Parents Ask Judge to Allow Religious Exemption to Vaccine Law

“Religious rights are fundamental,” Kennedy said in a statement. “It is unconstitutional for the state to deprive people of such important rights when religious animus has played a key role.”

Kennedy’s group has argued vaccines can be harmful and raises concerns about side effects.

Such fears, countered by public health officials as being minimal compared to the protections vaccines offer, have been blamed for the outbreak of measles across the U.S. this year. As of August 15, 1,203 cases of measles have been confirmed by the CDC, the greatest number since 1992. The majority of these cases are among people who weren’t vaccine against measles, the agency said.

CDC researchers say the overall state exemption rates aren’t as important as vaccination rates in individual schools or communities, where outbreaks occur. Carla Black, an epidemiologist with the CDC, pointed to New York, which has long had a low overall rate of exemptions but saw 75% of the country’s measles cases because close-knit communities weren’t vaccinating their children.
While fears that vaccinations may cause health problems have pushed up exemption rates, public health officials say a major reason is that it’s simply too easy to get an exemption from vaccine requirements in some states. Sometimes dubbed “convenience exemptions,” some parents just fill out the form for an exemption rather than schedule a time to get their child their full schedule of vaccines.

Cutting Down Exemptions

Vaccine exemption rules vary from state-to-state. Three states, New York, Washington, and Maine, earlier this year put new restrictions on when parents are permitted to send their children to school without the full course of vaccines because they claim doing so would violate their personal or religious beliefs.

California eliminated personal and religious exemptions in 2015 and has seen the largest decline in such exemptions of any state, which dropped from more than 3% in 2013, to now, below 1%.

However, several other states including Oregon tried but failed to restrict who could get an exemption from vaccine requirements this year and Arizona’s legislature looked at loosening the rules around getting one.

The states with the highest exemption rates ahead of the 2018 school year were: Oregon (7.6%), Idaho (7.1%), Alaska (7%), Arizona (5.8%), and Wisconsin (5.4%).

State lawmakers say taking on the issue is difficult and messy.

Lawmakers in Washington state says hundreds of people came to Olympia to protest their bill to restrict who could get a vaccine exemption even as dozens of cases of measles were reported in the state.

Oregon State Senator Elizabeth Steiner Hayward (D) said groups opposing her bill to restrict personal exemptions threatened her family.

“People who don’t believe in vaccinations become very activated when you take this on,” said Paul Harris, a Republican in Washington state’s House of Representatives who represents an area that experienced an outbreak of measles.

Lawmakers in Washington had to water down a bill that would’ve mimicked California’s ban on all personal and religious exemptions to vaccine requirements for school children in order to get it passed this year, Harris said.

Now, supporters of the legislation are working with the state Health Department to make sure people in that state who previously claimed personal or philosophical issues with vaccinating their children don’t simply claim religious objections this year. The new law, as a compromise, ended personal or philosophical exemptions but permitted ones based on religious belief.

In Oregon, one chamber of the legislature passed a measure restricting philosophical exemptions to vaccine requirements, but the state Senate didn’t take it up. Protesters came with the Star of David sewn onto their clothes to compare supporters of the bill to the Nazis, said state Rep. Mitch Greenlick, who heads the health committee in Oregon’s House.

“That’s the kind of discourse we’re having on this,” he said.

Working Around Exemptions

In Arizona, lawmakers this year consider a trio of bills (H.B. 2470) (H.B. 2471) (H.B. 2472) meant to help parents sidestep the state’s current vaccination requirements.

State public health groups say it’s already quite easy to obtain an exemption and they’re testing an online system that requires parents to first click through some educational materials about vaccines before they can download the exemption form.

The pilot program was born after meetings with health officials, doctors, and lawmakers over how to improve the state’s immunization rate, said Jennifer Tinney, program director for the Arizona Partnership for Immunization, a nonprofit started more than 20 years ago in response to low immunization rates in Arizona. Some doctors’ groups wanted to follow California’s lead and ban personal or religious exemptions but it’s unlikely such a request would gain traction among Arizona lawmakers, she said.

“We felt it was good balance,” Tinney said. “This way parents are getting the information they need.”

The CDC is recent years has focused its attention on collecting data on children granted grace periods for vaccine requirements, Black said. These are children on track to be fully vaccinated but weren’t meeting state immunization requirements at the start of the school year.

For some states, including Florida and Arkansas, these students outnumber those getting exemptions and are less likely to be opposed to getting vaccinated, Black said. Researchers are asking schools to follow up with students granted these grace periods to see which got their required vaccinations and which might if reminded.

“In theory, those children are the low-hanging fruit,” Black said.

Christina Brady in Washington also contributed to this story.

To contact the reporter on this story: Alex Ruoff in Washington at aruoff@bgov.com

To contact the editors responsible for this story: John Dunbar at jdunbar@bloomberglaw.com; Paul Hendrie at phendrie@bgov.com