Current landscape of nonmedical vaccination exemptions in the United States: impact of policy changes

Abstract

Introduction: In the United States, high childhood vaccination coverage has reduced the morbidity and mortality due to vaccine-preventable diseases. The success of vaccination programs in achieving this high coverage is due, in part, to vaccination mandates for school entry. All states have such mandates, but there is heterogeneity across the states in the allowance of non-medical exemptions (e.g. religious or personal belief exemptions) to these mandates. Areas covered:We examine historical trends in non-medical exemption prevalence in the US, discuss recent state-level policy changes that may impact non-medical exemption prevalence, and review recent studies on the association between non-medical exemptions and infectious disease outbreaks. Expert commentary:State-level implementation of mandates, and related allowances for medical and non-medical exemptions, varies greatly across the United States. Non-medical exemption rates have increased over the last two decades, with an increased risk of disease outbreaks in clusters of children with non-medical exemptions due to differences in state laws. Recent efforts to address non-medical exemption rates range from incorporating additional administrative requirements for exemptions and disallowance of any non-medical exemptions. Continued monitoring is needed to evaluate the impact of these changes on exemption rates, to develop optimal childhood vaccination policy across the United States.

Religious Vaccine Exemptions in Kindergartners: 2011–2018

“…5,19 Because many states revised their exemption laws during the study period, we recoded exemption law strengths for each state every year with published exemption law summaries. 1,6 We did not include Mississippi and West Virginia because they did not allow nonmedical exemptions. We also excluded Arizona, which allowed personal belief exemptions only in kindergarten.…”

“…In 2016, California eliminated all nonmedical exemptions. 1 Delamater et al 21 studied the rate of medical exemptions in California before and after the legislative change, finding that medical exemptions decreased in the first year after the change. However, by the second year, medical exemption rates rose, and geographic analyses showed that the areas with rising medical exemption rates coincided with areas that previously had high rates of nonmedical exemptions.…”

“…School-entry mandatory vaccination laws are a cornerstone of American public health. 1 Major religions support vaccination, but religious exemptions to vaccines required for school entry are available in 45 states and Washington, District of Columbia. 2,3 Fifteen states permit personal belief exemptions, also known as philosophical exemptions; all states and Washington, District of Columbia, offer medical exemptions for children with contraindications to vaccination.…”

“…[4][5][6] Also, Vermont eliminated its personal belief exemption in 2016, providing an opportunity to compare religious exemption rates before and after. 1 Thus, we sought to update and enhance existing multiyear longitudinal studies of religious exemption data in American kindergartners by analyzing trends for the 2011-2012 through 2017-2018 school years. In addition to providing updated national estimates of religious exemption rates in kindergartners, we sought to compare states' proportions of kindergartners with religious exemptions by personal belief exemption availability and to observe whether the proportion of exempted kindergartners differed in Vermont before and after its 2016 policy change.…”

Bazı Batı ülkelerinde çocukluk çağı aşıları hakkındaki yakın dönemli yasal düzenlemeler

“…Mevcut aşı politikalarını değiştirmek üzere 2014-2018 arasında ABD'nin 26 eyaletinde toplam 70 yasa tasarısı sunulmuştur. 20 Virginia eyaleti 2015 yılında aşı reddi için kişisel inanç istisnasını kaldırmıştır. Aynı yıl Kaliforniya eyaletinde felsefi ve dinî nedenlerle aşı reddine izin verilmemeye başlanmıştır.…”