Use of Fees to Discourage Nonmedical Exemptions to School Immunization Laws in US States

Billington, John; Omer, Saad B.

doi:10.2105/ajph.2015.302967

Cited by 15 publications

(8 citation statements)

References 7 publications

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“…As a result, in June, 2015, California joined Mississippi and West Virginia as the third state to adopt a medical-exemption-only regulation for school attendance; the California law took effect in July 2016 [ 38 ]. Given the lack of successful educational interventions to address vaccine hesitancy and vaccine uptake to-date it is possible that, in order to address geographic clusters of PBEs, Arizona may need to consider further changes to the current PBE process [ 39 ]. If PBE rate declines continue to be negligible and VPD rates continue to increase in Arizona, especially in high-exemption areas, legislative action to impose exemption-related processing fees or to adopt a medical-exemption-only regulation in Arizona may warrant consideration.…”

Section: Discussionmentioning

confidence: 99%

Parental attitudes and perceptions associated with childhood vaccine exemptions in high-exemption schools

et al. 2018

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Previous work demonstrates that individuals who obtain exemptions from school immunization requirements are geographically clustered, making regional differences in vaccination coverage a significant concern. Even where exemption levels are high, there are still parents that vaccinate. School-level assessments have determined that exemptors are more likely to attend wealthier schools with fewer minorities. Few studies have assessed divergent opinions within the context of a higher-exemption community to examine subtle differences in opinion surrounding vaccinations. Therefore, the objective of this work was to assess attitudes and perceptions towards vaccinations and compare them for exemptors and non-exemptors. We administered surveys to parents in high-exemption (>10%) elementary schools in Arizona during the 2012–13 school year. A total of 404 surveys were completed by parents among schools in Maricopa (n = 7) and Yavapai (n = 2) counties. Of these, 35% (n = 141) were exemptors and 65% (n = 261) were non-exemptors. Exemptors were more likely than non-exemptors to be concerned about serious side-effects (p<0.001). They were more likely to report knowing someone who had been diagnosed with a vaccine-preventable disease (p<0.001) but less likely to report that this had been a serious illness in that person (p<0.001) and they believed it is better for a child to develop immunity through illness than vaccination (p<0.001). They were less likely to trust physicians (p<0.001) and information about vaccines (p<0.001) and were more likely to obtain their health care from a naturopath (p<0.001). In summary, exemptors in these Arizona schools do not appear to be exempting their children from vaccinations due to convenience, as has been hypothesized in other settings. Based on the divergent views within high-exemption schools and reported distrust of the medical establishment, target interventions for high-exemption schools are discussed. Additionally, given the lack of effective non-policy based interventions to-date, the negligible declines in personal belief exemption rates, and vaccine preventable disease rate increases in Arizona, especially in high-exemption areas, legislative action in Arizona may also warrant further investigation.

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Section: Discussionmentioning

confidence: 99%

Parental attitudes and perceptions associated with childhood vaccine exemptions in high-exemption schools

et al. 2018

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“…To the author’s knowledge, this thesis is currently the most robust academic endeavour to develop the evidence base to study the effect of national law and policy on access to medicines in LMICs. A large body of public health law implementation and evaluation research exists, albeit mostly in the US context [ 28 , 58 , 59 , 60 , 61 , 62 ]. These studies are often based on reliable online repositories of legislation and policy in English, implementation mechanisms described in scholarship and understood in practice, and robust datasets of outcome measures- all of which are commonly unavailable or underdeveloped in LMIC contexts.…”

Section: Discussionmentioning

confidence: 99%

Universal access to essential medicines as part of the right to health: a cross-national comparison of national laws, medicines policies, and health system indicators

Perehudoff

2020

Global Health Action

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Background: Access to essential medicines for the world's poor and vulnerable has made little progress since 2000, except for a few specific medicines such as antiretrovirals for HIV/ AIDS. Human rights principles written into national law can create a supportive environment for universal access to medicines; however, systematic research and policy guidance on this topic is lacking. Objective: To examine how international human rights law and WHO's essential medicines policies are embedded in national law for medicines affordability and financing, and interpreted and implemented in practice to promote universal access to essential medicines. Methods: This thesis consists of (1) a cross-national content analysis of 192 national constitutions, 71 national medicines policies, and legislation for universal health coverage (UHC) from 16 mostly low-and middle-income countries; (2) a case study of medicines litigation in Uruguay, and (3) a follow-up report of eight right to health indicators for access to medicines from 195 countries. Results: Some, but not all, of the 12 principles from human rights law and WHO's policy are embedded in national UHC law and medicines policies (part 1). Even the most rights-compliant legislation for access to medicines is subject to the unique and inconsistent interpretation of domestic courts, which may be inconsistent with the right to health in international law (part 2). Many national health systems for which data were available still fail to meet the official targets for eight indicators of access to medicines (part 3). Conclusions: International human rights law and WHO policy are embedded in national law for essential medicines and practically implemented in national health systems. Law makers can use these findings and the example texts in this thesis as a starting point for writing and monitoring governments' rights-based legal commitments for access to medicines. Future research should study the effect of national law on access to medicines and population health.

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“…Among participants that did report seeing problematic medical exemptions, a primary concern was physicians charging fees for medical exemptions. While financial disincentives such as processing fees can be used to discourage nonmedical exemptions 23 , it is not clear whether the processing fees discourage parent from seeking medical exemptions for children without scientifically-valid contradictions to immunization. Based on a family’s income, processing fees may contribute to social disparities in access to exemptions, particularly under more strict exemption regimes such as SB277 in California.…”

Section: Discussionmentioning

confidence: 99%

Experiences With Medical Exemptions After a Change in Vaccine Exemption Policy in California

et al. 2018

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Objective: In 2015 California passed Senate Bill 227 (SB277), eliminating nonmedical vaccine exemptions for school entry. The objective of this study was to describe the experiences of health officers and immunization staff addressing medical exemption requests under SB277. Methods: We conducted semi-structured telephone interviews between August and September 2017 with health officers and immunization staff from local health jurisdictions in California. Interviews were recorded, transcribed, and analyzed for key themes. Result: We conducted 34 interviews with 40 health officers and immunization staff representing 35 of the 61 local health jurisdictions in California. Four main themes emerged related to experiences with medical exemptions: 1) role of stakeholders, 2) reviewing medical exemptions received by schools, 3) medical exemptions that were perceived as problematic, and 4) frustration and concern over medical exemptions. Generally, local health jurisdictions described a narrow role in providing support and technical assistance to schools. Only five jurisdictions actively tracked medical exemptions received by schools, with one jurisdiction facing a lawsuit as a result. Many examples were provided of medical exemptions that listed conditions that are not consistent with scientifically-justified medical contraindications for immunization (family history of allergies and autoimmune diseases) and of physicians charging steep fees ($150-$300) for medical exemptions. Participants also reported concerns about the burden on schools to review medical exemptions, and about the sharp increase in medical exemptions post-SB277. Conclusion: Participants reported many challenges and concerns with medical exemptions under SB277. Without additional legal changes to SB277, including a standardized review of medical exemptions, some physicians may continue to write medical exemptions for vaccine-hesitant parents, potentially limiting the long-term impact of SB277.

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Use of Fees to Discourage Nonmedical Exemptions to School Immunization Laws in US States

Cited by 15 publications

References 7 publications

Parental attitudes and perceptions associated with childhood vaccine exemptions in high-exemption schools

Parental attitudes and perceptions associated with childhood vaccine exemptions in high-exemption schools

Universal access to essential medicines as part of the right to health: a cross-national comparison of national laws, medicines policies, and health system indicators

Experiences With Medical Exemptions After a Change in Vaccine Exemption Policy in California

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