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California tightens vaccination exemptions for kids: how parents see it

California is moving to require that all children be vaccinated unless they have a medical exemption. Some parents say it's necessary, some say it's a violation of their rights. But there might be compromises that work.

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    A pediatrician holds a dose of the measles-mumps-rubell­a (MMR) vaccine at his practice in Northridge, Calif.
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A bill in California that requires children in schools and daycare to be immunized, even if parents have religious or philosophical objections, passed in the state Assembly Thursday and the question now is whether Gov. Jerry Brown will sign it.

The much-debated bill would make California only the third state to offer parents only medical exemptions for required vaccinations. It grew out of concerns among health professionals and advocates that some relatively large pockets of unvaccinated children were putting the most vulnerable children at greater risk for communicable diseases.

Forty-seven other states offer medical and religious exemptions, and about 21 states add a philosophical-objection category, says Mark Largent, a professor at Michigan State University.

Medical exemptions are generally thought to be necessary for up to 1 percent of the population. So if California’s law goes through, what kinds of choices might parents find themselves having to make if they have religious or other objections, or if they want to spread out the vaccinations in a way that differs from the recommended schedule? And are there other options for states that want to raise their rate of childhood immunization?

“There is a segment of the population who will pull their kids out from the eyes of public health officials” in states with the strictest laws, by home schools, says professor Largent, author of a book on the vaccine debates.

Homeschooling may be an option for some families. But for most single parents and even in some two-parent families, that’s either not financially feasible or not something they feel well-equipped to take on. That unfairness is a potential unintended consequence of the bill in California, Largent says.

“This can price people out of the ability to make decision for their child,” he says.

The view from Mississippi

But it’s not as simple as making parents choose whether to home school or not, say some parents in Mississippi who have lobbied for more flexibility in their state’s strict law.

Some whose pediatricians agree they should get a medical exemption have struggled to get such requests approved by state health officials.

“We have an 80-acre farm and we almost had to sell and uproot from two sets of grandparents,” says MaryJo Perry, who had pediatrician letters of support but still dealt with red tape for five years before she finally got a permanent exemption for her son, who had a seizure after an immunization when he was 5.

Active with the group Mississippi Parents for Vaccine Rights, Ms. Perry has collected dozens of comments from families who say they’ve either left the state or refuse to move back even though they’d like to, because of the restrictive law.

“We’ve heard from parents whose doctors have said they are intimidated by the health department,” worried about pressure if they request too many medical exemptions, she says.

Parents have sometimes found it difficult to have their children accepted into a doctor’s practice, Perry says. She showed the Monitor a letter from one pediatric practice to a parent that explained consequences if they don’t get their child vaccinated, including the possibility of death, and read in part, “Should you refuse to vaccinate your children according to the [American Academy of Pediatrics] schedule, we will ask you to find another health care provider who shares your views.”

And religious families, including Christian Scientists, say they prayerfully consider every step they take for their child’s health care. Some have written testimonials about having to go against their deepest convictions in order to enroll their children in school.

“With my hand shaking, I signed the consent, and helped restrain my 6 year old daughter so that they could inject her with this vaccine. Clearly, our religious liberties were violated by the State of Mississippi,” wrote Amy Martin of Brandon, Miss.

The view from California

Advocates for Mississippi-style laws counter that offering non-medical exemptions would mean lower overall immunization rates and put more children at risk.

“We’re in crisis. We have children dying from communicable disease in California,” says Leah Russin, who helped start Vaccinate California, a group of volunteers supporting the proposed law, SB277.

Ms. Russin became concerned when her now 21-month-old was an infant and there was a whooping cough outbreak in her area. A mother in her playgroup had not immunized her child, who was about eight months old, and she had whooping cough, prompting Russin to believe that she may have exposed younger children to it.

That mother’s opposition to vaccination, in Russin’s view, was not based in the scientific consensus, but rather on Internet blogs full of anecdotes and opinions that the risks of vaccines are higher than the risks of the diseases they are meant to ward off.

“I started seeing that type of pattern – educated mothers disregarding, distrusting, eschewing science,” she says. She can see why some mothers object to the proposed law because, if they believe vaccines are toxic or may cause terrible side effects, the option of vaccinate or home school “is a horrible choice.”  But ultimately, she says, the law should “protect the weakest and most vulnerable among us and protect the community at large.”

Many people point to Mississippi as an example because upon entering kindergarten, more than 99 percent of students are immunized.  At younger ages, the state also ranks in the top 10 for immunization rates. Those rates are great, Largent says, “but it’s not just the law that is getting kids vaccinated. It’s significant funding” for Mississippi’s vaccination efforts.

If California passes a similar law but doesn’t invest in other improvements to vaccine accessibility and education of parents, it won’t necessarily raise the rates as much as advocates hope, he says.

A third way

There is another way. A number of states, including Michigan, have been tightening their exemption policies. As families get ready to go back to school in Michigan this year, they will have to sit through several education sessions if they want a vaccination waiver, instead of simply printing out a form and handing it in at school.

That policy shift is expected to cut the number of parents who get waivers by 30 to 50 percent, Largent says.

“We can use softer coercion methods and have warmer and more cooperative relationships between health care providers and parents…. I think that will lead to more people being vaccinated, but it’s harder. It requires continued investment and effort.”

Nationally, the waiver rate is at record highs, ranging from about 1 percent to 6 percent, and the rate of kids being fully compliant with vaccine requirements is also at record highs, ranging from 68 to 82 percent, Largent says.

“Over the past 10 years we’ve gotten better at compelling parents to make a choice between getting a waiver or getting their children fully vaccinated. That’s a tremendous public health victory,” he says.

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