Dec 17 2013

Recommended Reading: State Vaccine Exemptions’ Significant Impact on Vaccine Rates


A new study published recently in the American Journal of Public Health finds that non-medical exemption laws for vaccines required for school or daycare admission have significantly impacted the vaccination rates of at least one disease. The researchers reviewed relevant laws and regulations for each year between 2001 and 2008 and rated them on their restrictiveness in granting exemptions. The study was funded by a grant from the Public Health Law Research program, a national program of the Robert Wood Johnson Foundation.

According to the study, state laws that make it difficult for children to be exempted from vaccines on religious or philosophical grounds could reduce the number of whooping cough cases, but did not have an impact on cases of measles, mumps, haemophilus influenza type B (Hib) or Hepatitis B.

“Our research shows that during the study period, if all states increased the restrictiveness of their non-medical exemption laws by one level, the number of U.S. whooping cough cases would decline by 1.14 percent, resulting in 171 fewer cases per year,” according to study author Y. Tony Yang, ScD, MPH, associate professor at the College of Health and Human Services at George Mason University.

The study found that the impact on whooping cough may be greater than for the other diseases studied simply because whooping cough affects more people. Researchers call this a “threshold effect,” which means laws may not have a significant impact unless they works to prevent a disease that affects a critical mass of people. During the study period, whooping cough was much more prevalent than the four other diseases studied—the average incidence rate for whooping cough was 18 per 100,000 individuals from 2001 to 2008. For Hib, Hepatitis B, measles, and mumps, the mean incidence rates were less than 1 per 100,000.

Laws and regulations governing exemptions for mandatory vaccination can vary considerably by state. Medical exemptions are permitted in all states for individuals with certain illnesses, allergies or immune system disorders. All but two states, West Virginia and Mississippi, permit individuals to exempt their children on religious or philosophical grounds. As of 2012, one-third of states permit citizens to claim a philosophical exemption.

A new report, Outbreaks: Protecting Americans from Infectious Diseases, released this week by Trust for American’s Health has several recommendations aimed at improving vaccination rates including:

  • Increase public education campaigns about the safety and effectiveness of vaccines
  • Increase provider education and standards of care
  • Bolster immunization registries and tracking
  • Ensure coverage of all recommended vaccines under Medicare
  • Continue support for vaccine funding programs
  • Provide adequate support for the purchase and administration of vaccines
  • Support additional research for vaccines
  • Expand school vaccination requirements to include the HPV vaccine
  • Expand the settings where vaccinations can be given and can receive adequate reimbursement including increased use of pharmacies, schools, workplaces and faith-based organizations to provide vaccines
  • Require universal immunization of health care personnel for all recommended vaccines

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Tags: Disease Prevention and Health Promotion, Infectious disease, Public health law, Recommended Reading, Vaccines