Nonmedical Exemptions to School Immunization Requirements

Abstract

Permitting personal belief exemptions and easily granting exemptions are associated with higher and increasing nonmedical US exemption rates. State policies granting personal belief exemptions and states that easily grant exemptions are associated with increased pertussis incidence. States should examine their exemption policies to ensure control of pertussis and other vaccine-preventable diseases.

Immunization Mandates, Vaccination Coverage, and Exemption Rates in the United States

“…Allowance of religious and philosophical exemptions was associated with lower MMR and DTaP vaccination coverage and higher exemption rates, consistent with previous reports [ 5 , 9 , 26 ]. However, attempts to entirely remove the option of nonmedical exemptions should be weighed carefully and in the context of the relative rigor of all state-level immunization statutes to minimize the risk of public backlash [ 27 , 28 ].…”

Parental Refusal of Pertussis Vaccination Is Associated With an Increased Risk of Pertussis Infection in Children

“…Although this may limit the generalizability of our findings, the health plan is a large integrated health care delivery system, with broad representation of the state's population, and the rate of pertussis vaccine refusal in our study population was similar to previous estimates of vaccine refusal in states that offer personal belief exemptions. 4,8 Moreover, the demographic characteristics of parental vaccine refusers in our study were similar to what has been published previously. 9 Second, we found that physicians were more than 3 times as likely to obtain pertussis laboratory tests on unvaccinated children than vaccinated children presenting with URI symptoms but without classic pertussis symptoms.…”

State policies increase vaccination by shaping social norms

“…Furthermore, the direct effect of social norms on intentions to receive an additional COVID-19 booster shot remained significant, b = 0.17, SE = 0.05, z = 3.7, 95% CI = 0.08–0.259, implying that the effect was only partially mediated by these mechanisms. Still, the indirect effect observed represented 63.97% of the total effect, implying a medium effect on the basis of Cohen’s guidelines 19 . Thus, the results suggested that vaccination policies shape behavioral intentions through both informational and normative influences.…”