Eliminating Nonmedical Immunization Exemptions in California: Is It Working?
LewisFirst, MD, MS, Editor in Chief, Pediatrics
In 2016, California implemented a bill to eliminate nonmedical exemptions for immunizations
for children entering the public schools in that state. Now that this law has been
in effect for a few years, has it resulted in more children being up-to-date on their
vaccines? Delamater et al. (10.1542/peds.2018-3301) opted to take a sharp look at vaccinations and the rate of nonmedical exemptions
before and after the bill was implemented. The results are optimistically disappointing.
What do we mean by that statement? The good news, and reason to be optimistic, is
that the rate of children entering kindergarten who were not up-to-date on vaccinations
decreased over the first year from 7.15% to 4.42 % However, in the second year after
the bill was passed, the percent of kindergarten students not up-to-date in their
vaccinations increased from 0.45% to 4.87% and not because of a resurgence of non-medical
exemptions—but work around exemptions—meaning more parents were claiming medical exemptions
for their children, or home-schooling, or simply said they were “overdue” but would
be caught up eventually. While one could blame parents as the reason why not-up-to-date
rates went up two years after the bill in that they were seeking alternative ways
to exempt their children from immunizations, health care professionals could be considered
accomplices in granting more of these medical exemptions than perhaps they should.
Perhaps schools are also playing a role in being overly lenient in admitting students
who are “overdue” for their vaccines but have yet to get them. Clearly there are more
strategies to consider if a non-medical exemption bill is going to succeed in increasing
vaccine rates in our schools. Failure to do so might be a key contributor to why
we are seeing the outbreak of measles and other vaccine preventable illnesses in this
country. Inject some time into reading this study and then consider working with
your fellow child health care professionals, schools, and of course your patients
to advocate in your state for even more limited exemptions for school entry. The
alternative, as measles spreads around this country, is not worth considering.