Study: Vaccine Exemptions Drop After Parental Counseling Required

Decline may stem from trust in physicians or effort needed to obtain exemptions

Rates of vaccine exemptions among students in Washington fell significantly after the state required parental counseling, according to a study published online in the journal Pediatrics. “This highlights the importance of more stringent policies for obtaining immunization exemptions,” the authors wrote.

All states allow parents to exempt their children from mandatory kindergarten vaccines for medical reasons. Twenty-nine also allow religious exemptions, and 18 allow both religious and personal belief exemptions, according to the study.

In 2011, Washington passed a law requiring families to discuss vaccine risks and benefits with a health care provider to obtain a nonmedical exemption. Researchers set out to determine the impact of the law by studying Washington State Department of Health data from the 1997–1998 through 2013–2014 school years.

They found a relative decrease in exemption rates of 40.2% and an absolute reduction of 2.9 percentage points. There also were declines in the probability that kindergartners would encounter a classmate with an exemption. The authors said the decrease in exemptions may be due to parents’ trust in physicians or the extra effort needed to obtain an exemption.

After the law went into effect, about 10% of students were granted conditional school entrance and did not meet the vaccine requirements. Researchers recommended focusing on enforcement and suggested that other states follow suit in enacting stricter policies.

“Our findings highlight the importance of evidence-informed legislation to reduce the risk of vaccine preventable diseases,” they wrote. “States in the U.S. and jurisdictions in other countries should consider adding parental counseling as a requirement for obtaining exemptions to vaccination requirements.”

The American Academy of Pediatrics (AAP) recommends eliminating nonmedical exemptions. California did so in a 2015 effort led by Democratic State Senator Richard J. Pan, MD, MPH, FAAP. In the law’s first year, 96% of California kindergartners were vaccinated, according to a commentary Dr. Pan wrote in response to the Washington study.

While initial results are positive, Dr. Pan noted “there are also reports of some physicians monetizing their license selling medical exemptions.” He called for clearly defined standards and sanctions for physicians who are profiting. He also urged pediatricians to stand up to antivaccine groups and advocate for more effective vaccine policies.

“Educating the public that vaccines are safe and effective is not enough,” Dr. Pan wrote. “To protect our children and communities, child-health advocates must organize pro-science parents who care about public safety in their community to campaign for laws to restore community immunity. Vaccines work. Every child needs community immunity. For our children’s safety, we must fight back.”

Source: AAP; December 18, 2017; Pediatrics; December 2017.