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When It's Hard To Get A Vaccine Exemption, More Kids Get Shots


One factor in the number of non-vaccinated children are state laws regulating nonmedical exemptions. These laws vary from state to state - 48 states allow for religious exemptions, and 19 states allow parents to opt out of vaccinating their children based on personal or philosophical beliefs. Mississippi and West Virginia are the only states that ban all nonmedical exemptions. Dr. Saad Omer is an epidemiologist with the Emory Vaccine Center in Atlanta. He has studied and written about these exemptions, and he joins us now to talk about them. Welcome to the program.

SAAD OMER: Thank you.

SIEGEL: You found that in states where it's easier to get a nonmedical exemption, inoculations went down and disease rates went up. How many unvaccinated children are we talking about?

OMER: So we are talking about, in terms of the exemptions - they range from a little less than 1 percent to around 6-7 percent in states. So there's a lot of variability in state-level vaccine refusals. At the national level, the estimates are a little over 2 percent.

SIEGEL: And the trend over the past decade has been for more exceptions, more refusals, more cases of diseases that you could be vaccinated for.

OMER: So what we have seen is that through 2011 there had been an increase in exemptions or vaccine refusals. Since then we haven't seen more up-to-date trend analysis, so it remains to be seen whether this rate has stabilized or have gone up.

SIEGEL: Now, we have - on the one hand, we have some parents claiming I don't want my child to be vaccinated. We have far more people saying their children and people saying the other people's children should also be vaccinated. But you've written about states that allow for a parental choice, but also increase the rate of inoculation by the way that they implement the exemptions. So give us an example of that.

OMER: So for my perspective it's a soft policy option in a sense that it's a commonsense thing to have a policy where the balance of convenience is heavily in favor of vaccination because there is a lot of individual and societal interest in getting all children vaccinated because of individual inherit (ph) immunity. So one way of dealing with this is to have these rational exemption requirements - i.e., it should not be easier to get your child exempt compared to get them vaccinated.

SIEGEL: Give us some examples of states that have exemptions from vaccinations for personal or philosophical beliefs that are on different ends of the spectrum of how easy it is to gain those exemptions.

OMER: So for example, it's fairly easy to get exemption in Colorado and Arizona, or even Missouri, etcetera. On the difficult side you have, actually, the South has pretty rational immunization requirements. In California - I'll give you an example of California. Up until recently their exemption used to be very easy. They came in and they implemented a law a couple of years ago. They now have this requirement that you have to go to a physician or a practitioner or a clinician to get the documentation that they have discussed the risks of non-vaccination with you.

SIEGEL: You would have to conclude, as you do, that I guess what some would consider an authoritarian approach to this, which is go state to state, revoke all of these nonmedical exemptions, get people vaccinated. You can't send your kid to a registered day care center if he's not vaccinated - wouldn't work you'd say.

OMER: My concern is that we will have, after the current fear of this outbreak goes down - laws are for generations - then we'll have a backlash in a few years. The public perception of these issues changes drastically, so I think our laws work. They work as nudges. They don't work as shoves. And there's broader acceptance of things that are more rational rather than things that are a little bit more draconian. And so therefore I believe that this is an intervention. This is a set of interventions that is efficacious or effective. We should go with that rather than moving to a place where we could have a little bit of a backlash.

SIEGEL: Dr. Omer, thanks for talking with us.

OMER: My pleasure.

SIEGEL: Dr. Saad Omer - epidemiologist. He's with the Emory Vaccine Center in Atlanta, but spoke with us here in our studio in Washington, D.C. Transcript provided by NPR, Copyright NPR.

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