In Maricopa County Arizona, 2,947 kindergarteners obtained non-medical vaccine exemptions last year. That’s because Arizona, along with 17 other states, allows parents to opt out of vaccinating their children on both religious and philosophical grounds. The result is that thousands of children remain unprotected from deadly childhood diseases—and that thousands more may be exposed.
These are the findings of a new study in PLoS, which reports troubling increases in the rates of non-medical vaccine exemptions among 12 of the 18 states that allow them. The researchers found that specific counties are quickly turning into measles hotspots—prime for another Anaheim-style outbreak—and that more and more kindergarteners are now going to school without their shots. As of 2015, “only 72.2% of children aged 19 to 35 months in the United States were fully vaccinated,“ the authors write. “Our findings indicate that new foci of anti-vaccine activities are being established in major metropolitan areas, rendering select cities vulnerable for vaccine-preventable diseases.”
All 50 states require childhood vaccines, and grant exemptions for legitimate medical reasons (usually due to allergies, or immunocompromise from chemotherapy or steroid use). The issue at hand, however, is non-medical vaccine exemptions. All but three states allow religious exemptions (shout-out to California, West Virginia, and Mississippi), and 18 states also allow “philosophical” exemptions—which lowers the bar substantially. In those states, parents can simply claim they philosophically object to vaccinations, and their kids can go to school and infect others with impunity.
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The map above indicates which states have only medical exemptions, which states have religious but not philosophical exemptions, and which states have both religious and philosophical exemptions. As is readily apparent, states that allow parents to opt out of vaccines have the highest rates of unvaccinated kindergartners. And, as the researchers point out, states that have reinstated vaccine requirements have seen coverage improve. It really does come down to local legislation.
Lack of vaccine coverage in kindergarten should make you nervous. Before the MMR vaccine became available in 1963, measles killed about 500 children and hospitalized 48,000 each year. In their county-level analysis, the researchers highlighted Seattle, Washington, Portland, Oregon, Phoenix, Arizona, Salt Lake City, Utah, and Houston, Texas among several counties that have such high exemption rates that it is probable that we could soon see a deadly measles outbreak.
“Stricter legislative action to close [non-medical exemptions from vaccination] should become a higher priority”, the authors say. “Our concern is that the rising [non-medical exemptions] linked to the anti-vaccine movement in the US will stimulate other countries to follow a similar path.”
All 50 states have legislation requiring specified vaccines for students. Although exemptions vary from state to state, all school immunization laws grant exemptions to children for medical reasons. Almost all states grant religious exemptions for people who have religious beliefs against immunizations. Currently, 18 states allow philosophical exemptions for those who object to immunizations because of personal, moral or other beliefs.
California, WV and Mississippi allow neither
County NME rate is defined as the number of enrolling kindergarteners with an NME out of the total kindergarten enrollments (public and private) in the county.
Some data inconsistencies were present, including some missing county data for 3 states (AR, ND, OR), absent county data for 4 states (CO, LA, OH, and OK), and lacking data from the year 2016 to 2017 for 3 states (AR, PA, and TX).