TABLE 5

Frustrations and Concerns

SubthemeQuote(s)
Lack of authority for local health department“I don’t get to approve or disapprove the medical exemptions. The law didn’t give the health officer any role, and I’ll tell you how ridiculous this is. In comparison with the fact that I have to review dog rabies vaccine exemption requests and I get to see medical records of dogs and I have the authority to disapprove requests for exemptions for rabies vaccines…and for people, we don’t have that authority.” Health officer, urban jurisdiction, medium PBE rate, high household income.
Burden on school staff“One of the weaknesses at the school level is the person who’s making these decisions is the clerk in the office, and given the paucity of school nurses, the school nurses really don’t have the time, or even the presence many times, to participate much in this process…. I think there needs to be an increased role of the school nurse in that process, but they just don’t have the time or the staff to go ahead and do that.” Health officer, urban jurisdiction, high PBE rate, medium household income; “I think it was an issue because all of our schools are so small, and there is an impact when kids don’t enroll or if they aren’t able to go to school because of that. Then it does impact their average daily attendance too. It’s just, I think, upsetting to them when they have to turn kids away because their population is so small.” Immunization coordinator, rural jurisdiction, low PBE rate, low household income.
Physicians writing problematic medical exemptions“My frustration is dealing with these doctors that would write what is thought to be maybe not completely valid medical exemptions for the students whose parents just don’t want them to get any. That’s my personal frustration, and that is shared by a lot of school nurses.” Immunization coordinator, urban jurisdiction, low PBE rate, medium household income; “Some of them go into great detail. In fact, almost a startling level of detail considering what they’re actually alleging as contraindications…like I say, I’ve got very little sympathy…the physicians know better. And this is where I start to get a little bit annoyed with my own profession.” Health officer, urban jurisdiction, low PBE rate, medium household income.
Increase in medical exemption post-SB277“My concern, my worry is that–I think we saw a fourfold increase in medical exemptions. My concern is that if that continues to occur, we may just be in the same position as before with parents pursuing medical exemptions when they’re really personal belief exemptions.” Immunization coordinator, urban jurisdiction, medium PBE rate, high household income; “The whole point is to eliminate PBEs and eliminate the pockets of susceptibility and potential transmission. And my fear is that the cottage industry bogus medical exemptions will erode that safety net that the bill was intended to create.” Immunization coordinator, urban jurisdiction, high PBE rate, high household income.