Vaccine opt-outs higher in states where exemptions are easier

Three states have added educational requirements to their childhood immunization laws since 2011. That approach could bring public health benefits, researchers say.

By — Posted July 31, 2013

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

States where it is easier for parents to exempt their children from immunization requirements have vaccine-skip rates nearly three times higher than states where the opt-out procedures are more complex, said a study published in July’s Health Affairs.

But there are several efforts under way to ease vaccine exemptions, the study noted.

Since 2011, outbreaks of measles and pertussis exacerbated by pockets of suboptimal vaccination have spurred three states — California, Vermont and Washington — to enact legislation that makes skipping immunization more difficult. All three states require parents to receive some kind of government-sanctioned information on the benefits and risks of vaccines.

Meanwhile, 14 bills in 10 states have been introduced since 2011 with the intent of broadening exemption criteria. None of these bills has passed, said the study (link). Bills related to changing school-entry vaccination rules are pending in Minnesota, New Jersey, New Mexico, New York and North Carolina.

Adding educational requirements as a condition of vaccine exemption is likely to be effective, researchers concluded. They examined childhood immunization rates in the District of Columbia and 48 states where exemptions on religious or philosophical grounds are allowed in addition to medically justified opt-outs. Two states, Mississippi and West Virginia, allow only medical exemptions. The American Medical Association says only children with medical contraindications to a vaccine should be allowed to opt out.

Fourteen states were categorized as making it easy to skip vaccination based on their policies during the 2011-12 school year. In these states, parents had only to sign a standardized form. Fifteen states and the District of Columbia were ranked as having medium-difficulty exemptions because they required a form, an educational visit with a school nurse or a statement explaining a religious or philosophical objection to immunization. Another 15 states were the hardest places to opt out, requiring a standardized form and a written statement that has to be notarized. Some of the harder-to-skip states required annual completion of these requirements to opt out.

That extra requirement contributed to these states having an average exemption rate of 1.1%, nearly three times lower than the 2.9% skip rate in the states with easier opt-out rules. The medium-difficulty states had an exemption rate of 1.5%. The opt-out difficulty of four states could not be determined, and they were not included in the analysis. States with religious and philosophical exemptions had higher opt-out rates than states that allow only religiously grounded opt outs.

“Based on our findings, it seems that policymakers seeking to decrease opt-out rates should add vaccine education components to the exemption process by either mandating or encouraging yearly educational sessions in schools for parents who are reluctant to have their children vaccinated,” said Nina R. Blank, the study’s lead author. She is a research associate in the Division of Medical Ethics at New York University Langone Medical Center.

Celebrity impact on vaccination

Opt-out rules are far from the only factor driving immunization rates, Blank noted. Disease outbreaks can draw parents’ attention to the importance of vaccination in a way that physician’s advice alone may not. She added that celebrities who falsely tout a link between vaccination and autism also may deter parents from immunization and harm the public health.

On July 15, producers of the popular daytime talk show “The View” announced that actress, author and former Playboy Playmate Jenny McCarthy will join the program as a co-host in September. The move came despite objections from some physicians and others concerned about giving such a prominent platform to McCarthy, who has organized rallies against vaccines and claimed that immunization is responsible for her son’s autism.

“It pains me that she’s going to be an even more public figure in a pretty esteemed spot on television,” Blank said. “I only hope that if conversations about vaccines and autism come up that they have some really intelligent people up there to debunk whatever myths she decides to tout.”

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn