What do you think about school health requirements
The Politics of School Immunization
Some 20 states now allow parents to request exemption from compulsory school vaccination on the grounds that the parents have "philosophical or personal beliefs" about immunization. The states are part of a growing trend to give parents more say about whether their children must be vaccinated before they can attend school, and the new permissiveness is raising serious public health concerns, according to researchers who study childhood immunization.
No one doubts that huge public health benefits that have come from compulsory school vaccination in the past several decades, say Daniel Salmon and colleagues, who write about immunization in the current issue of the American Journal of Public Health. "The utility of U.S. school vaccination requirements in preventing disease and introducing new vaccines has been well documented."
But the very effectiveness of compulsory school immunization may be creating opposition to vaccination on the part of parents. "With the success of immunization programs … public attention has shifted from the risks of disease to the risks of vaccination," the researchers note. Parents who have never seen a case of measles, mumps, or whooping cough may find it hard to take those diseases seriously. On the other hand, parents can read well-documented reports of occasional ill effects such as fevers and seizures from vaccination, and they have access to widespread allegations on the Internet that vaccination may be linked to disabilities such as autism.
Concerns about the new "personal/philosophical" exemptions include speculation about "herd immunity." States have always granted some exemptions from school vaccination--on medical grounds, or if parents have religious objections to vaccination--but that has generally involved a relatively small number of children in any given school or classroom. In that case, the unvaccinated children benefit from herd immunity—when most of a population is immunized, disease is not likely to take hold, and all of the population, including the non-immunized, will remain well. The non-immunized are in effect "free riders," relying on the efforts of more compliant peers to keep them safe.
There are no reliable data at present on how many "personal/philosophical" exemptions to compulsory school vaccination states are granting. But in most states there is no public health oversight of the exemptions, leaving researchers and public health authorities to speculate about what will happen if large numbers of children come to school unvaccinated. In any resulting epidemic, they point out, not only children who are unvaccinated because of parental objections may fall ill, but also children who could not be immunized for medical reasons and the small number of vaccinated children in any population whose immunizations don’t give them full protection.
Weighing the possibilities, researchers point out that "The risks associated with granting nonmedical exemptions may be very low if the number of exemptions is small and exempted individuals are randomly distributed throughout the population; conversely, the risk increases as the prevalence of exempted individuals increases and/or exempted individuals cluster into geographical or social spheres."
One State’s Experience and a Possible Model
Salmon and his colleagues studied what happened in one state—Arkansas—when bills were introduced in the state legislature allowing parents to "opt out" of their children’s immunization requirements.
Arkansas had historically not allowed any exemptions except medical, though a religious exemption was enacted in 1967. Under the religious exemption, Arkansas Department of Health officials required parents to submit proof of membership in "a recognized church or religious denomination," a provision that federal courts struck down as an unconstitutional interference with free exercise of religion by the parents. That legal finding served as a rallying point for groups opposed to mandatory immunization, and bills were introduced to allow a new and broader exemption.
In response, a coalition of health advocacy groups, clinical providers, and insurance companies came together to oppose what they perceived to be a threat to immunization programs and public health. The Arkansas Department of Health, unable as a state agency to lead the discussion of what was seen as a political question, asked stakeholders including the American Academy of Pediatrics, the Johns Hopkins Institute for Vaccine Safety, and the Arkansas Medical Society to draft an alternative exemption proposal.
The Arkansas General Assembly ultimately passed a philosophical/personal beliefs exemption that contained many of the coalition’s recommendations, including signed and notarized statements by parents requesting an exemption and a provision for annual renewal of the request. In addition, the Arkansas law requires the Department of Health to conduct surveillance and assess disease risks associated with the exemption, and the law requires annual reporting of the rates of exemption and incidence of disease to the State Vaccine Medical Advisory Board.
At this point it’s hard to know how the recently enacted Arkansas law will play out in practice, the researchers say, but what the Arkansas experience highlights is how complex issues can become "at the juncture of politics and public health." At the very least, they say, "States should proactively review nonmedical exemptions to increase the likelihood of proper time and consideration being given to this important issue."
The article, "Public Health and the Politics of School Immunization Requirements," by Salmon and colleagues from the Johns Hopkins Institute for Vaccine Safety and the Center for Law and the People’s Health, and from the University of Arkansas for Medical Sciences and other Arkansas agencies and organizations appeared in the May issue of the American Journal of Public Health. Reprints are available at firstname.lastname@example.org .
The View from Pediatricians
In a Clinical Report published the same month as the American Journal of Public Health article, the American Academy of Pediatrics offered advice to its members on how to respond to parental refusals of immunization of children.
Noting that "the immunization of children against a multitude of infectious agents has been hailed as one of the most important health interventions of the 20th century," the report notes that even so, seven of ten pediatricians say they have had a parent refuse an immunization on behalf of a child, with measles-mumps-rubella vaccine the most frequently refused, followed by varicella vaccine, pneumococcal conjugate vaccine, hepatitis B vaccine, and diphtheria and tetanus toxoids vaccines.
For childhood vaccination programs to be successful, parents must comply with recommendations for immunization, but what is a pediatrician to do when parents refuse? The best advice, the authors conclude, is to keep in mind the best interests of children and to provide parents the risk and benefits information necessary to make informed decisions. That may involve correcting misinformation or misperceptions that may exist, such as the belief on the part of many parents that repeated immunizations weaken a child’s immune system. It may also help to point out that when parents choose not to immunize, their children may pose a risk to other persons. It may come as a new thought to parents that by not immunizing they take advantage of the benefit created by assumption of vaccine risks by others—a "moral responsibility" that the authors concede many parents might not consider compelling.
But if parents continue to refuse immunization, after a physician has attempted to explain risks and benefits, perhaps the parents should be referred to numerous websites that provide information about specific diseases. Physicians should also recognize that the cost of immunization may be a barrier for many parents, in which case the physician should "work with the family to help them obtain appropriate immunizations." And if all else fails, the report concludes, it may be necessary for a physician who believes strongly in immunization to help parents who refuse vaccinations to find alternative sources of health care.
The American Academy of Pediatrics Clinical Report, "Responding to Parental Refusals of Immunization of Children," by Dr. Douglas Diekema, appeared in the May 2005 issue of the journal Pediatrics.
What are your views about states mandating vaccines as school requirements?
Hippy Chic~Yoga posing, vintage loving, baking, cooking, crafting, gardening, upcycling, reading, mommy of 3 and devoted wifey. Follow me at http://www.accidentalcountry.blogspot.com/