Rule change for vaccine exemptions unlikely to help compliance rates

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.

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Mon, 12/29/2014 - 12:07pm
I wouldn't expect much change, people don't like to be told in essence "you are wrong", their ego can't take it. People read too much garbage medical junk on the internet and other sources.
Mon, 12/29/2014 - 8:34pm
***, It may not be the 'junk' on the internet, have you considered the conflicting 'medical studies' that are headline articles in the media and how they maybe undermining the confidence of the public?
Karen Davey
Mon, 12/29/2014 - 12:16pm
I hope your conclusion is wrong, Mark. This is getting scary! Also, you didn't mention in your statement regarding the flu that many people misunderstand what influenza is and think that gastro-enteritis is the flu.
Mon, 12/29/2014 - 1:27pm
In the interest of "education" let's visit the fact that this years flu vaccine was not the correct strain. And even if it was, there is a 49% chance it will work.
Mon, 12/29/2014 - 1:45pm
I have pulled my kids out of public schools and will not be strong armed by the state when it comes to living my life or raising my children
Henry S. Bareiss
Wed, 02/04/2015 - 1:28pm
That's fine if you live in isolation. If you don't, your children represent a health hazard to those who FOR MEDICAL reasons can't be immunized. Measles are highly infectious. Its impact on a child can be disastrous. Under the present laws you can't be required to get the immunization but don't for a minute think this is only about you. There is such a thing as group immunity protecting those who haven't been immunized but that only works if enough people get on board. Otherwise those without immunity are at risk, including your children. The tracj record in the US and other modern country is extremely good for immunizations. The disease is always worse than the shot.
Mon, 12/29/2014 - 9:05pm
There is no indication that anyone is asking the parents why they are delaying or refusing vaccination. Could a reason be that the vaccination are bundled for efficiency, could that raise parental concern about how a children with a sensitive immune system will react? Could it be that most vaccines involve egg cultures and the parents of children with allergies (especially egg) are concern how their children will react? Could it be that parents who have had one child with a possible reaction are hesitant about their other children? Has anyone considered the conflicting medical concerns that we may over protect our children and disrupt their immune systems? I wonder how many of the exemptions are a delays rather than actual denial of vaccination, and if so are the metrics an accurate measure of the system? Has anyone considered a review of the metrics? What is the purpose of the program, is it 100% vaccination or to prevent student deaths or to protect the teachers or (?)?
Henry S. Bareiss
Wed, 02/04/2015 - 1:45pm
Your concerns are usually best discussed with your health provider. He/she is best qualified to answer your child's situation. Most exemptions, however, have nothing to do with actual medical risks (see Joe Jurecki). 100% is not needed for group immunity but it has to be in the high 90's, the exact level I don't know.
Mon, 12/29/2014 - 9:34pm
Duane brings up a great point: Why aren't these so-called experts doing more to assuage parent's concerns as to why they are accelerating vaccination schedules and combining far more vaccines into one shot compared to how vaccines were originally given? You'll see a higher compliance rate when you stick to what has proven to work instead of crossing your fingers and hoping that there isn't an adverse reaction when you start using kids as guinea pigs.
Mon, 12/29/2014 - 9:50pm
They shouldn't be allowed to send their kids to public school unvaccinated without a legitimate medical reason. If you want to be stupid with your children's health, so be it. Homeschool or find a private school where all the parents are just as dumb.
Tue, 12/30/2014 - 9:55am
Question: How can you prove the safety & efficacy of a vaccine? Answer: you can't. Think about it for a moment and you will see... You don't know who is susceptible to what? My wife and I raised 5 kids. Go ahead, call us ignorant, that's OK, but to this day as parents one of the wisest decisions we've made was to NOT vaccinate. Our kids are healthy no ADD etc. Plus, by now too many people have read/heard about the books Dr Mary's Monkey and Me & Lee. The SV40 cancer causing virus seems alive and...
Henry S. Bareiss
Wed, 02/04/2015 - 1:59pm
Count yourself lucky. You apparently benefited from others getting their children immunized (group immunity). As far as the efficacy of the immunizations, there are many years of research with many people. The results are conclusive: the disease is worse than the immunization. Aside from specific children with allergies or exceedingly weak immune systtems, there is little risk. Here there is no medical debate. For individuals who for medical reasons have to go without usually benefit from everyone else being on board. If one child gets measles (for example), he/she represents a real threat to the health and life of the child who for any reason is not immunized. Once again, count yourself lucky for that is truly what your are. I know how terrible childhood diseases can be. Apparently you don't. I also know it is terrible when someone needlessly gets very sick.
Henry S. Bareiss
Wed, 02/04/2015 - 2:10pm
Given the resistance of drivers to buckle up, many didn't. When it became a primary offense with a fine, compliance went way up. Surveys and studies have shown many lives were saved. The politics, it seems, is against taking such an approach to immunizations, but many lives and health can be saved this way. I know there are some who say "Don't confuse me with the facts, I've already made up my mind." This isn't just about individual rights but about community welfare too. We have to decide, do individual desires trump public good? It is important to remember just how awful these childhood diseases are. I can. There is no controversy among medical researchers that the immunizations are way less harmful than the disease. The "studies" that argue otherwise have been shown to be faulty or even downright fraudulent.