When Johnny and Judy Aren’t Vaccinated

My View

There’s a troubling trend on the school health front: More parents are refusing to vaccinate school-age children.

According to a survey published in the journal Pediatrics, 87 percent of pediatricians reported parental vaccine refusals in their practice in 2013, the most recent data available, up from 75 percent in 2006.

Vaccination against deadly diseases such as polio, diphtheria and tetanus has sharply reduced death and illness over the years. Nevertheless, some parents refuse vaccination because of fear of health risks, particularly autism, though the link between autism and vaccination has been widely repudiated. Others more generally oppose governmental encroachment on parental autonomy or object on religious grounds. A limited number of children cannot be vaccinated because of an underlying health condition.

Because the effectiveness of vaccination relies on “herd immunity,” increasing the percentage of unvaccinated individuals in a population can increase the incidence of disease.

Schools’ Duty

Schools can play a significant role in preventing outbreaks of vaccine-preventable diseases through greater familiarity with state and local vaccination laws and more rigorous review of parental claims for vaccination exemption.

All 50 states and the District of Columbia mandate vaccination of children against measles, mumps, rubella, diphtheria, tetanus toxoid, acellular pertussis and varicella, and 47 of those jurisdictions also have parallel mandates for private schools. Some states mandate additional vaccines that are recommended by an expert body convened by the Centers for Disease Control and Prevention: Haemophilus influenzae type b (Hib), pneumococcal disease, meningococcal disease and/or hepatitis B. Only a few states require vaccination against human papilloma virus (HPV) and influenza.

All jurisdictions allow health-related exemption (e.g., if a child has a weakened immune system or is allergic) and most permit religiously based exemption. Seventeen states now allow parents to opt out because of “philosophical” objections based on personal, moral or other beliefs.

Exemption Eligibility

States vary in regards to the rigor with which parents must demonstrate exemption eligibility and the degree of discretion afforded to school administrators to grant or deny exemption requests. In New York, school officials may request additional documentation from parents to support their claim of “genuine and sincere” religious beliefs against vaccination. Schools may exclude exempted children from school during an outbreak.

Not surprisingly, the rate of immunization in New York is about 97 percent, and the rate of religious exemptions is less than 1 percent.

In 2015, 10 states considered or enacted legislation requiring parents to provide supporting documentation for their claimed exemption, permitting the sharing of a child’s immunization records with schools and state agencies and/or increasing public disclosure of school vaccination rates.

Monitoring Exemptions

High-exemption states consistently are associated with higher rates of outbreaks, which put at risk not only non-vaccinated children but even vaccinated children and adults, in particular the elderly and those with compromised immune systems.

Given the controversy that sometimes surrounds vaccination and the strong views expressed by non-vaccinating parents, schools may be reluctant to take a pro-vaccination position. But school administrators can and should ensure that all medically eligible students receive timely vaccination for state-mandated vaccines to the extent permitted by the laws in their jurisdiction.

To do so, administrators must understand applicable state and local laws. In particular, they should be prepared to require parents to prove the sincerity of their religious or philosophical objections with documentation to support their claimed exemption. School administrators also can document the impact of vaccine-preventable illnesses, including influenza, on student attendance and performance, and share these data with lawmakers and the public.

Finally, working with parent-teacher associations, school leaders can educate parents on the dangers of non-vaccination to not only their own children but also their children’s other family members (including younger siblings and elderly grandparents), friends and the broader community. Such education may dispel misconceptions and fears about vaccination risks. Ultimately, school administrators can help create a “culture of vaccination” in their school communities to improve the health of their entire student body.