More Parents Declining Immunizations: One State Acts

Washington State has now made it more difficult to decline immunizations.

In the past, Washington allowed parents to simply sign a form at the school to decline immunizations. This resulted in 7.6 percent vaccination opt outs for the 2008-09 school year, according to Washington’s Health Department.

So What Changed?

The Legislature adopted a law requiring a doctor’s signature to opt their children out of vaccines. Since the new law was adopted, the opt-out rate has fallen by a quarter.

Yet despite efforts of government, more parents are choosing not to have their children vaccinated, especially in states that make it easy to opt out, according to a study recently published in The New England Journal of Medicine.

And while the rate of children whose parents claimed exemptions remains low — slightly more than 2 percent of all kindergarten students in 2011, up from just over 1 percent in 2006 — the national increase is “concerning,” said Saad Omer, an assistant professor of global health at Emory University who led the study.

For the study, they computed the annual change in the rates of non-medical exemptions from school immunization requirements. They then compared these rates between states that allow philosophical exemptions and states that allow only religious exemptions.  They also compared states with respect to how difficult it is to obtain non-medical exemptions because of certain administrative procedures.

Dr. Omer’s study categorizes state exemption policies on a scale from easy to difficult. The easiest rules require parents only to fill out a standardized form, which often involves merely checking a box.  More stringent policies require parents to write a letter, detailing precisely why they believe their children should be exempt. “These laws have an impact,” he said. “The idea is to nudge the balance of convenience away from getting exemptions.”

The opt-out rate increased fastest in states like Oregon and Arizona — and Washington, before its law changed — where it was easy to get an exemption.  In such states, the rate rose by an average of 13 percent a year from 2006 to 2011, according to the study.  In states that made it harder to get an exemption from vaccination, such as Iowa and Alabama, the opt-out rate also rose, but more slowly, by an average of 8 percent a year.  Mississippi and West Virginia allow no exemptions.

Jonathan Bell, a naturopathic doctor in Washington State who encourages his patients to vaccinate their children said, “Those who opt out tend to distrust the public health establishment because of what they see as its unsavory connections with the pharmaceutical industry. The argument is, ‘Oh no, I’m putting off vaccines,’ ” he said. “ ‘I’m part of a group that’s smart enough to understand the government is a pawn of big pharma.’ ”

Still, he said that only a small group is adamantly against vaccines, with many of the rest trying to stagger or individualize the schedules of inoculation for their children. Others had opted out simply because it was easy.


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