California Gives Child Vaccination Debate a Shot in the Arm

June 25th, 2012 by CHHS RAs

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By Megan Ix, CHHS Research Assistant

The reemergence of some vaccine-preventable diseases is a growing cause for concern in the United States. A key reason behind this reemergence is the decline in child vaccination rates. Often parents may have unfounded fears as a result of misinformation or false assumptions and “opt-out,” or choose not to have their children vaccinated. While public health education campaigns in favor of child vaccinations can be effective, vaccine-preventable outbreaks continue and trends show that vaccination rates are declining. High vaccination rates are crucial to protecting the public from certain diseases, and a decline in vaccination rates puts the entire population at risk. Given the importance of vaccinations for both individual and public health, some states are considering strategies that go beyond education campaigns, such as legislation, to increase vaccination rates in children.

In many states, the process to opt out of vaccinations for children is often as simple as signing an exemption form. All states offer vaccine exemptions for medical reasons, and most states offer a belief exemption.  The belief exemption, whether it’s based on personal or religious convictions, varies by state. Some states are concerned that it has become easier for parents to opt-out of vaccinations than to take their child to see a doctor, so legislators are looking for ways to create more stringent exemption requirements. California, a state that permits personal belief exemptions, and also suffered from an epidemic of whooping cough in 2010, is taking measures to make opting out more difficult. Bill AB 2109, which would require parents to get counseling from a doctor before opting out of childhood immunizations, has passed the General Assembly and will move to the Senate. Vermont is considering a similar bill after an attempt to eliminate the personal belief exemption failed. These states are following in the footsteps of Washington State, which now requires that parents seeking non-medical exemptions have a vaccine provider’s signature on the exemption form stating that the parent has been given vaccine benefit and risk information. 

A 2010 CHHS blog post on California’s whooping cough outbreak suggests several reasons behind declining immunization rates, including misconceptions about vaccine safety. Thus, mandatory education prior to obtaining an exemption may be an important step in correcting misconceptions about vaccines. The education may be directed at a surprising demographic: a CDC report on the 2009-2010 school year noted that falling vaccination rates are not following poverty levels or other typical indicators for health outcomes. In fact, Mississippi, ranked as one of the poorest states based on median income, led the rankings for childhood immunizations. Rather a “vaccine hesitancy” trend is developing among more affluent, educated parents. Instead of accepting the full slate of recommended vaccinations, these parents are increasingly picking and choosing vaccines. Mandatory education will encourage doctors and parents to address vaccine concerns one-on-one. .   

Critics of more stringent exemption measures voice concerns that such measures are a step toward mandatory vaccinations, which infringe upon parents’ individual rights to choose whether or not to vaccinate their children.  Opponents of California’s opt out bill are also concerned that doctors may refuse to sign exemption forms if parents still choose not to vaccinate their children after receiving the vaccine information, thereby giving doctors  coercive power. The purpose of signing the exemption form is to confirm that a parent received information about vaccinations; it is not an endorsement of the parents’ final decision. Thus, nothing suggests that this law would cause doctors to impose their own beliefs on patients.

While critics argue that regulations similar to those proposed in California go too far in forcing parents to vaccinate their children, this is neither the purpose nor the likely effect of such legislation. The proposed law in California is a move towards promoting informed and educated decisions regarding the selected use of vaccines. In a time where once-eradicated diseases are reemerging, it is important to balance a parent’s individual choice with the importance of protecting the public’s health. The goal of requiring counseling prior to receiving a vaccine exemption is not intended to force vaccinations, but instead aims to make the exemption process a considered decision by ensuring that opting-out isn’t easier than opting in, and that parents have accurate information about the risks and benefits of vaccines.  

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