The threat posed by vaccine-preventable diseases was vividly illustrated last month in Traverse City, where a school closed for the better part of a week after an outbreak of pertussis (whooping cough) in its student body. Pertussis was a common illness a century ago, but the number of cases dwindled throughout the twentieth century and the disease nearly disappeared in the U.S. after the introduction of a vaccine in the 1950s. But in recent years, it has made a comeback, and today clusters of large numbers of undervaccinated children in Michigan are susceptible to this easily preventable disease.
Starting next month, Michigan parents will find it harder to exempt their children from the state’s mandatory vaccines. Parents who seek a non-medical exemption will have to attend what the Michigan Department of Community Health is calling a “conversation” before their children’s waivers will be valid. Parents who want exemptions for one or more of their children’s vaccines will have to sit through a seminar or a one-on-one meeting with a county health department employee. Only then will their children be able to attend schools or licensed daycares without their full complement of state-mandated vaccines.
Advocates of the rule change hope it will allow health officials an opportunity to address noncompliant parents’ misinformation about vaccines. However, like other efforts to increase vaccine compliance, it is likely the new rule will only increase resistance to compulsory vaccination.
The most effective way to increase parents’ willingness to vaccinate their children is to cultivate a trusting relationship between them and their health-care providers. The new rule forces county public health employees into an awkward position in the middle of that relationship, and it will likely engender ill will among vaccine-anxious parents.
The high number of under-vaccinated children in Michigan is due in part to one of the most lenient vaccine exemption policies in the nation, requiring only that a parent sign a form stating they are religiously or philosophically opposed to mandatory vaccines. Michigan also has one of the highest vaccine exemption rates in the nation, more than three times the national average. The new rule was announced on the heels of a recent report from MLive detailing local exemption rates, many of which are well into double digits. Nearly half the state’s population lives in counties where vaccination rates are below the estimated percentage necessary to confer herd immunity.
Besides the pertussis outbreak in Traverse City, there are five recently reported cases of measles in the state, all in people who had not been vaccinated.
Research shows that vaccine noncompliance is more common among better educated parents and among parents of higher socioeconomic status. Over the last decade their numbers have been growing. Today, nearly 40 percent of parents of young children report they have refused or delayed a vaccine that their children’s physicians have recommended, and more than 12 percent have refused or delayed one of the state-mandated vaccines. In Michigan, some of the lowest vaccination rates are found in the state’s most expensive and elite private schools.
“Education” as a remedy for parents who refuse to fully vaccinate their children is based on the belief that noncompliance is the result of misinformation or simple ignorance on the part of the parents. The best research on the subject shows that the mythbusting approach to increasing vaccine compliance often backfires.
In this month’s journal Vaccine, researchers reported that about 43 percent of Americans incorrectly believe the flu vaccine can give you the flu. After educating them to correct their misunderstanding, researchers found a significant reduction in acceptance of the myth. However, paradoxically, they found that their education campaign also significantly reduced participants’ willingness to get the flu vaccine. These findings are in line with other studies that have similarly demonstrated that correcting myths about vaccines is often not an effective approach for promoting immunization.
I have spoken with health employees in some of the Michigan counties that already follow the new rule. They told me their efforts rarely change the minds of noncompliant parents. They often meet parents who lack access to health care providers or do not have the time to get their children into clinics for vaccines. For them, the requirement that they visit a county health nurse is an opportunity for access to vaccines. But for others – the growing number of more affluent parents whose resistance to the modern vaccine schedule so frustrates health officials – the new rule is typically seen an intrusion into what they view as a private medical decision.
Research has shown that when states make it easier for parents to exempt their children from mandatory vaccines, more do so. It is reasonable to expect this new rule will reduce the number of parents who seek waivers for their children. However, that may not translate into a higher compliance rate. Parents may instead avoid fully vaccinating their children and instead choose to homeschool, send them to unlicensed daycares, or seek “vaccine-friendly” physicians who will provide them with medical exemptions.