Vaccines and the Philosophical Exemption
Vermont law requires children in school to complete a schedule of immunizations outlined by the Department of Health, but allows for medical, religious and philosophical exemptions. While medical exemptions were never an issue, and religious exemptions are likely protected by the US Constitution, the right to use a philosophical exemption came under fire, sparking a lengthy, passionate and respectful non-partisan debate in the House last week. The following is by no means a thorough review of the issues.
Two major themes emerged as to whether non-immunized or partially immunized children should be admitted to school based on the philosophical exemption. Very generally, one side said the health risks were exaggerated or incomplete arguing for a parent’s right to make informed choices about their children’s health. The other side did not deny this right, but argued that this did not give them the right to put others at risk for serious preventable disease.
Each side was passionately presented, backed by philosophy, statistics, history and rights that I will not go into here. Both sides seemed baffled by the position of the other. The Health Care Committee dug deeper into the issues, taking testimony from over 100 individuals and groups. Throughout this process, many of us came to believe that simply removing the philosophical exemption was not likely to be the silver bullet so many desired and might do damage in the process. Ultimately, attention turned to the data on vaccination rates in Vermont, and the government’s role.
The House found shortcomings in the Department of Health data collection mechanism. A child exempt only for chicken pox, for example, is simply tabulated as “unvaccinated.” In addition, a school’s vaccination rates are based only on kindergarten statistics in the beginning of the school year. Low kindergarten numbers can therefore skew data in either direction. The House also found two different vaccination schedules were being reported and referenced, further muddying the waters.
A call to Shelburne Community School revealed that of the 765 children enrolled in pre-k through 8th grade, two students are admitted with medical exemptions and none with religious exemptions. Eleven have philosophical exemptions for one or two vaccines while nine have exemptions for all. This represents 2.9% of the student population who have some form of exemption for vaccines.
Forty-two additional students or 5.5% are enrolled in school under “provisional” admittance. These students are either behind schedule or missing a booster but within the 11-month grace period to bring these up to date. When these numbers are disaggregated, it is easier to determine 1) if a school has a problem and 2) where effort is needed to bring a school up to the recommended 95% of the population immunized.
The House-passed bill addresses this by making changes to the way data are collected and reported. Schools would see the following changes: 1) Philosophical exemptions are moved from a one-time event to a yearly requirement in which educational materials are reviewed. 2) Students under provisional admittance will need a signature from a physician indicating they are in process. 3) Someone who is authorized to give vaccinations must sign off on medical exemptions. 4) Schools will make immunization rates available to the public. 5) Extra resources will go to areas with low immunization rates, likely not Shelburne.
These reports should help to determine whether the increase in philosophical exemptions is a trend or a short-term balloon. As several school nurses told us, first time parents often become more comfortable with vaccines through contact with their child’s successfully vaccinated peers. It is unlikely the Senate will agree with these changes. It is expected that the final version will be sorted out in a committee of conference.