How Many People Aren’t Vaccinating Their Kids in Your State?

In some places, dodging your children's immunizations is as easy as checking a box.

—By Tasneem Raja and Chris Mooney

| Mon Feb. 17, 2014

 

 

It's easy to find bad information about the safety of vaccines on the internet. That's, well, the internet. But what's scarier is that in many states, parents who buy into those myths can easily opt out of immunizing their children. In some cases, it's no harder than checking a box on a school form saying that vaccines are against their "personal beliefs."

In a 2012 study of vaccine exemption policies across the country, a team of researchers led by Saad Omer, a professor of public health at Emory University, found that of the 20 states that allowed personal belief exemptions for enrollment in a public school or child-care program, less than a third made it "difficult" to do so (for instance, by making parents re-apply for one each year, explain their beliefs in writing, or get a notarized letter of approval from a health care provider). In the nine "easy" states identified in the study, the rules required only signing a form. Indeed, Omer suspects that some parents sign vaccine exemption forms not because they actually hold anti-vaccine beliefs, but simply because it's easier than juggling the doctors' appointments, missed work, and other inconveniences of getting kids vaccinated. (More about that here.)

Personal belief exemptions aren't the only option available to vaccine-averse parents. Every state allows for medical exemptions for reasons such as an anaphylactic allergic response to a previous vaccine. Forty-eight states (all but West Virginia and Mississippi) allow exemptions on religious grounds. In many states, obtaining a religious exemption isn't any harder than getting a personal belief exemption. But according to Omer, religious exemptions aren't as popular as personal belief exemptions. He's found that opt-out rates in states that allow personal belief exemptions are 2.5 times as high as rates in states that only permit religious exemptions. In one analysis he found that whooping cough rates in states with personal belief exemptions are more than double those in states that allow only religious exemptions.

Unsurprisingly, Omer's research also shows that states that make it easy to get a non-medical exemption see a corresponding dip in numbers of schoolchildren who get their shots. Rates of non-medical exemptions in the "easy" states were 2.3 times higher than rates in states with difficult exemption policies. Not only that, but that rate is climbing faster in easy states than it is in difficult states.

Rates of Nonmedical Exemptions from School Immunization, According to Type of Exemption and Ease of Obtaining One, 2006–2011 Saad Omer et al, The New England Journal of Medicine

Non-medical vaccine exemptions are dangerous because they threaten what's known as "herd immunity:" Diseases simply can't spread in a community where a high enough percentage of the population is vaccinated against them. The required percentage of vaccinations to ensure herd immunity varies by disease; for pertussis (whooping cough), it's between 93 and 95 percent, according to Johns Hopkins' Jessica Atwell, lead author of a study on pertussis and vaccines published last year in the journal Pediatrics. So if even a seemingly small number of kids across the state aren't getting their shots, the immunity rate of the entire community can drop below safe levels. When that happens, lots of people are put at risk: infants who are too young to get shots, children who haven't had their full series of shots yet, and those who can't get vaccinated for medical reasons such as pregnancy or immune-system problems. And, of course, the exempted, unvaccinated children are also at risk.

With a personal belief exemption rate four times the national average, Marin County had the second-highest rate of whooping cough in the state of California.

In California, the percentage of kindergartners who get their full set of shots has been dropping since 2008, while the rate of personal belief exemptions jumped by nearly a percentage point in that time. Given that the national average exemption rate is 1.8 percent, that's a big increase. During a California outbreak of pertussis in 2010, more than 9,000 cases were reported, and ten infants died. It was the worst outbreak of whooping cough in 60 years.

In the Pediatrics study, Atwell and her fellow researchers identified 39 geographic "clusters" across California—ranging in size from a few blocks to entire counties—where belief-driven opt-out rates are higher than the norm. The team found higher rates of whooping cough associated with these clusters. For example: Marin County, which had a personal belief exemption rate of 7.8 percent in 2012—nearly four times the national average—has the second-highest rate of whooping cough in the whole state. These results support the findings of a 2006 study led by Emory's Omer which found higher rates of pertussis in states that allowed personal belief exemptions and had easy policies for doing so.

California is not the only state with high-exemption hotspots. On Vashon Island, Washington, 17 percent of kindergartners failed to receive their shots in 2013 due to a "personal/philosophical" exemption. That's nine times the current national average. The year before, Vashon Islanders accounted for 16 percent of all whooping cough cases in Washington state's King County, despite housing just one percent of its population. And a 2008 study of exemption rates in Michigan found 23 clusters within the state, and, you guessed it, a correlation with higher rates of whooping cough. Even individual schools and churches can serve as ground zero: After a measles outbreak broke out in north Texas in 2012, the state epidemiologist linked it t a local megachurch whose pastor had spread anti-vaccine myths in the past.

 

After Washington made it harder to obtain a personal belief exemption, the exemption rate dropped by 40 percent in just two years.

Now, some states are rethinking the personal belief loophole. Reeling from the 2010 outbreak, California passed a law making it harder to get a personal belief exemption. As of January 1, parents seeking a personal belief exemption have to obtain the signature of an authorized health care provider. (Finding such a doctor may not be easy; recent studies show that more pediatricians are choosing to drop patients who refuse to vaccinate their children.)

But not all states that currently allow personal belief exemptions are looking to tighten the rules for getting one. In a study released last week in the Journal of the American Medical Association, Omer and his colleagues surveyed the legislative landscape of vaccine exemptions, state by state. They found that of 36 bills introduced across the country last year, 31 sought to expand access to exemptions. While none of these passed, they far outweighed the number of restrictive bills; five were introduced, and three of these passed, in Washington, Vermont, and California.

There's evidence that tightening exemption laws makes a difference. After reaching an exemption rate of 7.6 percent in 2009, Washington state passed a law requiring parents to get a doctor's signature if they wanted to opt out of their children's vaccinations. In just two years, the exemption rate plummeted by more than 40 percent. Pertussis vaccination rates climbed to 92.4 percent in the past school year, representing "the highest pertussis vaccine completion rate for kindergartners since the state began to collect this data in the 2006-2007 school year," according to the Washington's Department of Health.

Now Colorado wants to follow suit. The state is tied for ninth in the nation (with Maine) for the number of kindergartners who show up at school with vaccine exemptions—nearly 3,000 of Colorado kindergartners in the 2012-2013 school year, according to the CDC. To get a personal belief exemption, parents need only fill out a single form. Recently, a task force led by the state health department released a set of recommendations for lowering the state's high opt-out rate.

Among them: publicizing the percentage of immunized kids at every public school or child-care center in the state.

Additional research by AJ Vicens and Eric Wuestewald.

Tasneem Raja

Interactive Editor

Tasneem Raja is MoJo's Interactive Editor. She specializes in web app production, interactive graphics, and user interface design. RSS | Twitter

Chris Mooney

Correspondent

Chris Mooney is a science and political journalist, podcaster, and the host of Climate Desk Live. He is the author of four books, including the New York Times bestselling The Republican War on Science. RSS | Twitter

 

 

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http://www.motherjones.com/environment/2014/02/vaccine-exemptions-states-pertussis-map

 

 

 

Having grown up during the Polio Epidemics, it's difficult to imagine any parent leaving their child unprotected.

Folks need to do some serious research about the risks before accepting the Snake Oil they're offered.

What’s the Matter With Vermont?

Anti-vaccine activists derailed a bill that could have blunted the whooping cough epidemic.

By Helena Rho

Vermont's State House in Montpelier

Photo by Jordan Silverman/Getty Images

Imagine coughing so hard and for so long that you turn blue and stop breathing. Pertussis, or whooping cough, can do that to an infant. The disease is caused by the bacterium Bordetella pertussis and occurs in three stages. The catarrhal stage, characterized by runny mucous, is highly contagious.

It’s followed by the paroxysmal stage—unstoppable, sustained, violent coughing accompanied by a “whoop” when you inhale. (Listen to a baby with whooping cough here, or see a video of a boy with whooping cough here.) In the final, convalescent stage, a cough can linger for several weeks. Pertussis can affect anyone, but it poses the most danger to infants.

A pertussis vaccine became available in the 1940s, and incidence of the infection dropped from around 200,000 per year to barely over 1,000 by 1976. But today the United States is in the middle of a pertussis epidemic. According to the Centers for Disease Control and Prevention, more than 41,000 cases of pertussis were reported nationwide in 2012. At least 18 people have died, mostly infants younger than 3 months of age—too young to be fully vaccinated. There hasn’t been such a major outbreak since 1959. The states with the most cases per capita are Wisconsin, Minnesota, and Vermont.
 

The epidemic is due in part to the reduced effectiveness and the shortened duration of immunity conferred by a relatively new vaccine. But the epidemic is also spreading because of a low vaccination rate.
 

Vaccination needs a critical mass to effectively confer “herd immunity” on a population. When vaccine rates fall below 90 percent, diseases spread readily enough to endanger people who can’t be vaccinated because of illness or because they are too young. In parts of Vermont, the vaccination rate is only 60 percent. It is one of 20 states that allow a philosophical as well as religious exemption to vaccines, and it has one of the highest philosophical exemption rates in the country.
 

George Till, a state House representative and a physician, tried to change that last year by proposing a bill to eliminate the philosophical exemption to vaccines. Instead, Act 157, which became law on July 1—when the current pertussis epidemic was already raging—turned into a complicated, compromise vaccine bill that preserved the philosophical exemption.

Till lives and practices near Burlington, Vt., and was elected to the House four years ago. In his re-election campaign, he spent $18.55 for dog bones. With dog treats in hand, this soft-spoken doctor went door to door and asked his neighbors to vote for him. Till, an OB-GYN and a Democrat, did not accept donations to his campaign from any group—he even sent back a check from Planned Parenthood.
 

Act 157 originated when a pediatrician neighbor of Till’s came to him with a concern. In a local kindergarten class, 75 percent of students were not fully vaccinated. Till researched the issue and thought it was reasonable to get rid of the philosophical exemption in order to increase vaccination rates. Till proposed a bill in the House, and state Sen. Kevin Mullin proposed an almost identical bill in the Senate.
 

The Senate bill passed quickly, but not so in the House. Delays sometimes happen in Vermont’s “citizen legislature,” where lawmaking is a part-time endeavor by ordinary people for just 18 weeks of the year. The bill languished in the health care committee. Then the Legislature was off for a week because the first Tuesday in March is reserved for town meetings in communities across the state.

By the time the Legislature reconvened in the capitol building, the anti-vaccination community had organized itself. “They were in the building every day, in people’s faces,” Till says. The activists blared the discredited claims of Andrew Wakefield that vaccines do more harm than good, that vaccines cause autism. Wakefield, a British physician, was stripped of his medical license for fabricating a connection between vaccines and autism. Till could not believe what was happening:

“He is God to these people.” Millions of lives have been saved through vaccines, numerous scientific studies have debunked the myth that vaccines cause autism, and the only studies to show a link have been exposed as frauds. Yet anti-vaxxers were successfully spreading misinformation.

The most egregious was their exploitation of the death of 7-year-old Kaylynne Matten of Barton, Vt. The anti-vaccine community claimed her death was due to adverse effects of the flu vaccine.

However, the coroner listed the cause of death as complications from parainfluenza virus, a different category of virus from influenza.

State Rep. Warren Kitzmiller initially supported the bill in the House. He suffered from polio as a child, a terrible disease that regularly killed or crippled tens of thousands of children in the United States during an outbreak. Polio has been almost eliminated thanks to vaccines, but it persists in parts of the world because of suspicion about vaccines. After the anti-vax lobbying effort, Kitzmiller said that he could hardly remember his illness. He said he made a miraculous recovery. He voted against the bill.

Till could not even convince his own health care committee in the House that Vermont’s declining vaccination rates were a public health problem.
 

Kevin Mullin, Till’s co-sponsor of the bill, then proposed a compromise: placing a “trigger” into the vaccine bill so that if vaccination rates fell below 90 percent in any one school, the philosophical exemption would be eliminated for that school. But they could not get enough support for this provision, and it failed to appear in the final bill. The philosophical exemption stayed in place. When it came down to protecting newborns, the immune-suppressed, and children with special health needs, Till says, “This caucus threw the most vulnerable under the bus.”
 

Act 157 did mandate that parents refusing to vaccinate their children be required to receive educational material about vaccines and also to sign an exemption form acknowledging that they understood the risks to their children and others posed by their personal decision not to vaccinate.

The Vermont Coalition for Vaccine Choice engaged an attorney, Mitchell Pearl, to challenge the language of the exemption form as unconstitutional. Pearl wrote in an open letter to the deputy commissioner of health, “signing the form is a violation of their rights under the First Amendment to the United States Constitution.” He threatened litigation if the Department of Health did not modify the exemption form’s language. The Health Department capitulated to the demands and neutralized the language of the form.
 

The Institute of Medicine recently issued a report about the safety of recommended childhood vaccines. The 14-member panel examined numerous studies, solicited feedback from many different groups, and found the current schedule of vaccines for children, which includes as many as 24 vaccines by a child’s second birthday, to be safe and effective: “The IOM committee uncovered no evidence of major safety concerns associated with adherence to the childhood immunization schedule.” The IOM acknowledged that some parents’ attitudes toward vaccines have “shifted,” largely driven by concerns about side effects, but said its report, which is the “most comprehensive examination of the immunization schedule to date,” should help reassure these parents. The IOM was clear: “Vaccines are among the most effective and safe public health interventions to prevent serious disease and death.” What’s more, “delaying or declining vaccination has led to outbreaks of such vaccine-preventable diseases as measles and whooping cough that may jeopardize public health.”
 

George Till is trying again to change the law in Vermont. He believes that the pertussis epidemic was preventable. “We had the chance to be proactive, but we blew it,” Till says. In January, he introduced new legislation in the House to eliminate in public schools both the philosophical and religious exemptions to the pertussis vaccine and to require adults who work with children to be current with their pertussis vaccination. The CDC is recommending that all adults, including pregnant women, receive a pertussis booster.
 

Schools and homes are where disease spreads. And in Vermont, Till says there are “pockets of unimmunized” posing a threat to their communities, especially in the “hot spots of anti-vaccination.”

One such hot spot lies outside the capital, Montpelier. “These young parents were born in the vaccine era and have not seen devastating diseases,” he says. Till says these parents are “picking and choosing which vaccines they give to their children.” One of the vaccines these parents are most often choosing not to give their children is against polio.

  CLICK ON LINK HERE TO VIEW THIS GREAT GRAPHIC.

Graphic by Natalie Matthews-Ramo

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Helena Rho, a former assistant professor of pediatrics, lives and writes in New York. You can read her work at helenarho.com.

http://www.slate.com/articles/health_and_science/medical_examiner/2013/02/pertussis_epidemic_how_vermont_s_anti_vaxxer_activists_stopped_a_vaccine.html