States Move to Eliminate Non-Medical Exemptions for Vaccinations

February 21, 2019|12:44 p.m.| ASTHO Staff

According to CDC, by mid-February of 2019, 127 cases of measles were confirmed in 10 states (California, Colorado, Connecticut, Georgia, Illinois, Kentucky, New York, Oregon, Texas, and Washington) with outbreaks (i.e., three or more cases) occurring in Texas, Washington, and multiple jurisdictions in New York. Measles is no longer endemic to the United States; recent cases can be traced to travelers who brought measles from other countries. The reported cases are centered primarily within communities where rates of children who are vaccinated against measles is lower than needed to prevent outbreaks. Due to its high level of contagiousness, measles require a high rate of vaccination, between 93-95 percent, by some estimates. However, there are many communities across the country where the rates are much, much lower. For example, in Clark County, Washington, where a recent measles outbreak originated, the percentage of kindergarteners who received a vaccine for measles between 2004 and 2017 fell from 96.4 percent to 84.5 percent.

Every state and Washington, D.C. have vaccination requirements for children who are starting school and allow an exemption to the requirements when medically necessary. All but three states—California, Mississippi, and West Virginia—also allow non-medical exemptions (i.e., exemptions based on religious, philosophical, or personal beliefs) to school vaccination requirements. Over the past decade, the number of non-medical exemptions has increased, especially in states that allow both religious and philosophical exemptions. Additionally, researchers have identified several areas in the United States where large numbers of non-medical exemptions are granted, including the Portland, Oregon metropolitan area, where Clark County, Washington, is located.

To counter this worrying increase in the number of people who are not vaccinated against measles and other preventable diseases, states are beginning to do away with non-medical exemptions for school vaccination requirements.

In 2015, following an outbreak of measles linked to visitors at a Disney amusement park, California eliminated its non-medical exemptions. That same year, Vermont eliminated its philosophical belief exemption, allowing its religious exemption to remain in place. The most recent measles outbreaks are spurring similar state legislative activity. For example, a bill to remove the personal belief exemption for the measles, mumps, and rubella vaccine was reported favorably out of the Washington state house chamber (HB 1638). In addition, a bill to eliminate the state’s personal belief exemption for all school vaccinations received a hearing in the state senate (SB 5841). Four years after eliminating the philosophical exemption, a bill in Vermont would also remove the state’s religious exemption (H 238). Many other states are also considering bills to eliminate non-medical exemptions to school vaccination requirements, including Arizona (HB 2162), Iowa (HF 206), Maine (LD 798), Minnesota (SF 1520), New Jersey (A 3818), New York (S 2994 and A 2371), and Oregon (HB 3063).

As with any piece of legislation, it is hard to predict whether these proposals to strengthen school vaccination requirements will become law. Supporters, however, may be encouraged by a recent study in which researchers reviewed 175 vaccine exemption bills between 2011 and 2017. While researchers found that number of bills seeking to expand access to vaccine exemptions outnumbered the bills to limit the availability of exemptions, of the 13 bills signed into law the overwhelming majority (92%) placed limitations on the ability to receive an exemption from vaccine requirements.

With the increased use of non-medical vaccine exemptions leading to more outbreaks of measles and other easily preventable diseases, ASTHO expects more states to eliminate non-medical exemptions. ASTHO will continue to keep its members and the public health community informed about this important policy area.

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