Tag: personal belief exemptions

How to Claim a Vaccine Exemption

Don’t want to get your kids vaccinated?

You might be surprised to know that no one is out there trying to force you into vaccinating them.

Want to enroll your kids in daycare, preschool, school, or college?

Then they will need to be vaccinated.

How to Claim a Vaccine Exemption

Of course, depending on where you live, you could get a vaccine exemption and leave your kids unvaccinated and unprotected.

Does your child qualify for a medical exemption? All states allow kids to claim medical exemptions to getting vaccinated. True medical exemptions are rare though, as you can see from the rates in states that actually require screening and approval of medical vaccine exemptions.

Are you a Christian Scientist? In 47 states, laws allow religious exemptions to vaccinations. Ironically, these exemptions are often abused, as you don’t actually need to belong to a religion that is against vaccines to claim a religious exemption to vaccinations.

“When you are challenged by the viewpoint of a denomination, pastor, publication, or atheist authority: You do not worship any pastor, church, religious publication, or denomination. Your pastor’s personal view on vaccines is irrelevant to your stance because pastors do not learn about the biblical implications of vaccinating during seminary and your pastor isn’t God. (Though if you have a pastor willing to go to bat for you, use him.)”

Megan on How To Get a Vaccine Religious Exemption Like a Boss

It is not even a secret that parents abuse the religious vaccine exemption, claiming them even when they don’t have a sincere religious belief against getting vaccinated.

And in 20 states, it is even easier to claim a vaccine exemption. These are the states that allow philosophical or personal belief vaccine exemptions, in which you can typically just say that you are against vaccinating and protecting your kids “for reasons of conscience.”

Vaccine exemptions are too easy to get in some states, but even with an exemption, your child will still be excluded if there is an outbreak.
Vaccine exemptions are too easy to get in some states, but even with an exemption, your child will still be excluded if there is an outbreak.

What reasons? You don’t usually have to go into much detail…

Why Parents Abuse Vaccine Exemptions

It is not hard to understand why some parents abuse vaccine exemptions.

They abuse vaccine exemptions because they can.

In many states, it is easy to abuse vaccine exemptions because medical exemptions aren’t verified and approved and it is often easier and more convenient to get an exemption than to get vaccinated. Believe it or not, some doctors will even sell you a medical exemption for your child. Also, parents are made to feel so scared by anti-vaccine propaganda that they think that they need to get an exemption.

“Permitting personal belief exemptions and easily granting exemptions are associated with higher and increasing nonmedical US exemption rates. State policies granting personal belief exemptions and states that easily grant exemptions are associated with increased pertussis incidence.”

Omer et al on Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence.

But just because you can claim an easy exemption in a state without strong vaccine exemption laws doesn’t mean that you should.

While there are no benefits to delaying or skipping vaccines, there are plenty of risks. And the risks aren’t just to your unvaccinated child. We continue to see and hear about kids who are too young to be vaccinated or who couldn’t be vaccinated getting caught up in outbreaks caused by others who simply chose to not get vaccinated.

“I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

Dr. Bob Sears in The Vaccine Book

Not surprisingly, websites and organizations that give advice on getting kids easy vaccine exemptions never mention these risks. They also overstate the risks of vaccines and don’t mention the benefits of getting vaccinated.

Vaccines are safe and necessary. Unless your child has a true medical contraindication to getting one or more vaccines, do a little more research before getting a non-medical exemption.

What to Know About Claiming a Vaccine Exemption

While it is typically not hard to claim a vaccine exemption for your child, since vaccines are safe and necessary, be sure you understand the risks of delaying or skipping any vaccines if your child doesn’t need a true medical exemption.

More on Claiming a Vaccine Exemption

 

Abuse of Vaccine Exemptions

Every state has laws mandating vaccines to attend school and daycare.

Every state also allows exemptions to those mandates, including:

The way that  these laws and exemptions are set up leaves a lot of room for abuse though.

Abuse of Religious Exemptions

How many religions are actually against kids getting vaccinated?

That’s right, almost none.

So why are there so many religious vaccine exemptions in most states, especially in states that don’t have a personal belief exemption?

Right again.

Folks who don’t want to vaccinate their kids, and can’t use a personal belief exemption, just say that vaccinating them would be against their religion.

Abuse of Medical Exemptions

There are some children who shouldn’t be vaccinated.

These children can get a true medical exemption to one or more vaccines because they have a real contraindication or precaution to getting vaccinated.

“If a child has a medical exemption to immunization, a physician licensed to practice medicine in New York State must certify that the immunization is detrimental to the child’s health. The medical exemption should specify which immunization is detrimental to the child’s health, provide information as to why the immunization is contraindicated based on current accepted medical practice, and specify the length of time the immunization is medically contraindicated, if known.”

Dear Colleague letter regarding guidelines for use of immunization exemptions

Fortunately, these medical reasons to skip or delay vaccines are not very common and are often temporary. They can include the contraindications and precautions listed in the package insert for each vaccine and by the Advisory Committee on Immunization Practices, with the most common medical exemptions being:

  • a severe allergic reaction to a previous dose
  • a severe allergic reaction to a vaccine component
  • a known severe immunodeficiency and live vaccines
  • a moderate or severe acute illness with or without fever (precaution)
  • a progressive neurologic disorder (precaution)
A family history of these conditions would not be a reason to skip or delay any vaccines.
Although it will get you a medical exemption for just $120 in California, a family history of these conditions would not be a reason to skip or delay any vaccines.

Most other things are “incorrectly perceived as contraindications to vaccination” and should not be a medical exemptions, including having :

  • a mild acute illness with or without fever
  • a mild to moderate local reaction
  • relatives with allergies
  • a family history of seizures
  • a stable neurologic condition
  • an autoimmune disease
  • a family history of an adverse event after DTP or DTaP administration

A medical exemption can also exist if your child already had the disease and so has natural immunity. In most cases, except for chicken pox disease, titers will likely need to be done to prove that your child already has immunity.

Stopping the Abuse of Vaccine Exemptions

We know that vaccine exemptions are being abused.

How do you stop it?

“Permitting personal belief exemptions and easily granting exemptions are associated with higher and increasing nonmedical US exemption rates. State policies granting personal belief exemptions and states that easily grant exemptions are associated with increased pertussis incidence.”

Omer et al on Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence.

You likely have to make it harder to get a vaccine exemption.

Strong exemption laws, which are needed in many states, make it clear that:

  • many exemptions are temporary
  • medical exemptions are based on ACIP guidelines, current accepted medical practice, and evidence based medicine – not anecdotes
  • religious exemptions specifically exclude philosophical exemptions and must reflect a sincere religious belief
  • exempted students will be excluded from school during outbreaks
  • exemptions should include a signed affidavit that is notarized
  • exemptions should be recertified each year
  • a separate exemption application will be needed for each vaccine

Getting an exemption shouldn’t be easier than getting vaccinated! And it should include some degree of education against the myths and misinformation that scares parents away from vaccinating their kids.

“Because rare medically recognized contraindications for specific individuals to receive specific vaccines exist, legitimate medical exemptions to immunization requirements are important to observe. However, nonmedical exemptions to immunization requirements are problematic because of medical, public health, and ethical reasons and create unnecessary risk to both individual people and communities.”

AAP on Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance

You could also get rid of nonmedical vaccine exemptions.

Of course, for that to work, you can’t allow just anything to count as a medical exemption.

“Review of all medical exemption requests will be conducted at the Mississippi State Department of Health by the State Epidemiologist or Deputy State Epidemiologist.”

Mississippi Medical Exemption Policy

In Mississippi, for example, where medical exemptions are reviewed and approved by the State Epidemiologist or Deputy State Epidemiologist, there were just 208 medical exemptions in the whole state during the 2016-17 school year.

In some states, rates of medical exemptions might be six or seven times higher. This is mostly seen in states that don’t allow personal belief exemptions and make it difficult to get a religious exemption.

That seems to be the case in Nebraska, where there are no personal belief exemptions and you have to submit a notarized statement to get a religious exemptions. Their high rates of medical exemptions likely reflect some abuse and the fact that medical exemptions aren’t reviewed or approved by anyone, they just reflect “that, in the health care provider’s opinion, the specified immunization(s) required would be injurious to the health and well – being of the student or any member of the student’s family or household.”

As we are seeing, that simply invites vaccine exemption abuse.

Very few states currently require that exemption applications go to the health department for review. Those that do include Alabama, Arkansas, Michigan, Minnesota, Mississippi, and West Virginia.

California is notably absent. I guess they didn’t see the potential for abuse when they passed their latest vaccine law. I mean, who could have guessed that doctors would actually be selling medical exemptions to parents based on unrelated conditions, like a family history of diabetes, celiac disease, or autism?

The non-medical vaccine exemption form in Colorado includes information on the risks of each vaccine-preventable disease.
The non-medical vaccine exemption form in Colorado includes information on the risks of each vaccine-preventable disease.

At the very least, until we have stronger exemption laws, parents who want to get a nonmedical exemption should acknowledge that they understand the risks they are taking when they skip or delay their child’s vaccines.

What to Know About Abuse of Vaccine Exemptions

While medical exemptions are necessary for kids who have true contraindications to getting vaccinated, stronger laws can help decrease the abuse we see in medical, religious, and personal belief vaccine exemptions.

More Information on Abuse of Vaccine Exemptions

 

Hiding in the Herd

The term herd immunity has been used for almost 100 years, since about 1923.

Other terms relating to herd immunity, like ‘hiding in the herd’ and ‘free-riding’ have come into use more recently.

Hiding in the Herd

Some people can get away with hiding in the herd.

Actually, they depend on it.

“Herd immunity is present in a community when such a high percentage of its members have been immunized from a particular disease that the disease cannot gain a foothold in the community. Thus, achieving and maintaining herd immunity protects not only those who have been vaccinated, but also those with compromised or weak immune systems, such as the elderly, babies, and those afflicted with HIV.”

Anthony Ciolli on Mandatory School Vaccinations: The Role of Tort Law

That’s because we don’t need 100% of people to be vaccinated and protected for herd immunity to work.

Many children with cancer and other medical conditions benefit from herd immunity.
Many children with cancer and other medical conditions benefit from herd immunity. (CC BY 2.0)

So people who are too young to be vaccinated or fully vaccinated, people who can’t be vaccinated because they were born with an immunodeficiency or get cancer and are on chemotherapy and other true medical exemptions, and even people who are vaccinated but their vaccine didn’t work, can still hope to be protected from vaccine preventable diseases because everyone around them is vaccinated.

These people still get the benefits of herd immunity. Even though they are unvaccinated and susceptible to getting a disease, they probably won’t, because most others in the herd are vaccinated and protected.

But it is not just those people with medical exemptions who try and hide in the herd.

“These numbers have led the National Vaccine Advisory Committee to conclude that religious and philosophical exemptions do not pose a threat to public health.”

T May on Free-riding, fairness and the rights of minority groups in exemption from mandatory childhood vaccination

And that was okay too for a while. It wasn’t that long ago that “free-riding” by those using philosophical or religious exemptions wasn’t a problem, because their numbers were small and herd immunity rates could still be maintained.

Can You Hide in the Herd?

Hiding in the herd can’t work for everyone though.

Surprisingly, Dr. Bob explains that well in his vaccine book that scares parents about toxins in vaccines, while reassuring them that it is okay to space out their child’s vaccines.

“I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

Dr. Bob Sears in The Vaccine Book

Basically, if too many people are trying to hide in the herd and have skipped their vaccines, then we have a breakdown in herd immunity and we start to see the return of many vaccine-preventable diseases.

These aren’t people who can’t be vaccinated though.

They are people who refuse to be vaccinated and intentionally don’t vaccinate their kids.

“In other words, hide in the herd, but do not tell the herd you’re hiding; otherwise, outbreaks will ensue. Sears’ advice was prescient. Recent outbreaks of measles in 15 states, caused by an erosion of herd immunity in communities where parents had chosen not to vaccinate their children, were the largest in the United States since 1996.”

Dr. Paul Offit on The Problem With Dr Bob’s Alternative Vaccine Schedule

And that seems to be exactly what happened as more and more parents have walked into their pediatrician’s offices with a copy of Dr. Bob’s Alternative Vaccine Schedule.

While he predicted that it would “increase vaccination rates in our country,” as most others knew,  they went down instead, and we continue to see more and more clusters of unvaccinated children.

Of course, Dr. Bob didn’t create the modern antivaccine-movement, but the bandwagoning effect he and other “thought influencers in the anti-vaccine movement” have on parents isn’t hard to see. Parents get scared by their anti-vaccine talking points and they go on to scare other parents into not vaccinating and protecting their own kids.

Tragically, the consequences of all of this was predictable too.

“If more parents insist on Sears’ vaccine schedules, then fewer children will be protected, with the inevitable consequence of continued or worsening outbreaks of vaccine-preventable diseases.”

Dr. Paul Offit on The Problem With Dr Bob’s Alternative Vaccine Schedule

More outbreaks of vaccine-preventable diseases.

What to Know About Hiding in the Herd

When too many people try and hide in the herd, it makes it hard to maintain necessary levels of herd immunity, which puts everyone, including medically fragile children and adults, at higher risk for getting a vaccine-preventable disease.

More About Hiding in the Herd

Personal Belief Exemptions to Vaccines

Twenty states allow personal belief exemptions, also called a philosophical exemption, to getting vaccinated to attend daycare and school.

In most other states, a religious exemption can be used, or abused, as a personal belief exemption.

Only three states, California, Mississippi, and West Virginia, do not allow non-medical exemptions to vaccines.

These exemptions are for state vaccine mandates to attend school and daycare.

What is a personal belief or philosophical exemption? Does it have to do with the strength of your convictions? Usually not. In Texas, for example, parents can “choose an exemption from immunization requirements for reasons of conscience,” but they don’t have to list any of those reasons.

For more information: