Does a State Mandate Requiring Parental Counseling for Vaccine Exemptions Really Work?
LewisFirst, MD, MA, Editor-in-Chief, Pediatrics
The vaccine hesitancy movement in this country has gained far more momentum over the
past few years than we would have expected. Parents have been using philosophical
or religious exemptions to enable their unvaccinated children to attend school, much
to our chagrin. In some states, like Washington, the legislature was able to pass
a bill in their senate requiring counseling and a signed form from their child’s primary
care medical home before an exemption can be approved. Has the addition of this bill
made a difference in vaccination rates? Omer et al. (10.1542/peds.2017-2364) say “yes” in a study that looks at the impact of a state bill passed in 2011 in
terms of immunization coverage before and after the bill was implemented. The results
show a relative decrease of 40.2% in exemption rates and a significant absolute reduction
We asked California State Senator and pediatrician Dr. Richard Pan (10.1542/peds.2017-3449) to comment on this study, given the exemption legislation in his own state that
he helped pass. Dr. Pan notes that the initial great results from the Washington bill
has begun to lose ground in yearly data now available that were not included in the
Omer et al. study and that in Washington, despite their legislation, vaccine hesitancy
rates have begun to increase again back to where they were before the legislation
was passed. In California, however, Dr. Pan helped pass legislation that simply did
away with all philosophical and religious exemptions, allowing none to be used by
patients, with even better results than achieved in Washington. Dr. Pan offers suggestions
of what each of us can do with or without state legislation to reduce the spread of
vaccine hesitancy. He makes some sharp points about why vaccination is not an option
but a requirement if we are going to keep children healthy and eradicate serious illness.
Inject some time into reading this study and commentary and then sharing the findings
with your patients and just as importantly your local legislators.