I’m happy about a new pile of paperwork coming my way. To be clear, I’ve never said this before. But I’m serious. Instead of stewing controversy, I suspect a new bill around here could open up lines of communication. I’m not living under a rock; I understand that some feel this new bill requiring signatures for vaccine exemption is heavy handed. I wholeheartedly disagree.

Yesterday Governor Gregoire signed a new bill into law that will demand families talk with a health care worker about the risks when exempting from immunizations. It turns out, WA state lags in their vaccination rates compared to national averages. In the last 10 years there has been a doubling in the number of students with exemptions for vaccinations in our schools. The biggest reason may be a convenience factor. The state suggests that 95% of exemptions are not for a medical reason, but one for convenience. Seems like you’d never opt out of immunizations for convenience putting your child or another child at risk. Right? But then think about how nuts your life is, how chaotic it is to raise children, and work, and pay bills and and and….

Imagine this: you’re a busy mom/dad, your child is about to start Kindergarten or 6th grade. The records you have for their immunizations are incomplete. You didn’t keep the book and like me and everyone else, your paper work isn’t filed perfectly. You’re pretty sure your child is “up to date.” You’re standing at registration at the school. You’ve been waiting in line and your left heel hurts. Come to think of it, your head hurts, too. Your daughter just tugged on your pant leg; she’s hungry. Quickly, when you realize you’ve got an incomplete record, you call your daughter’s doctor office while still in line. No one picks up when you call and you’re put in a queue waiting to talk with someone in medical records. You have a choice, would you rather just sign your name, exempting your child from vaccines, or go on a hunt for the records to ensure your child truly is up to date? Sure, the answer for most any parent is clear.

You sign your name.

See? It doesn’t make any sense to have an exemption, with weighty consequences, be so easily misapplied. It puts our entire community at risk. And, a family may miss out on a chance to update immunization for their child. Further, during a break-out of chicken pox or measles or pertussis, the Dept of Health would have to contact your family and track down the records to know if you’re at risk or if others are at risk because of an un-immunized child. We know that un-immunized children are more likely to get and spread vaccine-preventable illness. It’s expensive to track inconsistent (exempted but immunized, exempted and not immunized) records down in an outbreak. And it’s becoming more common…

Washington State Realities About Vaccine Exemptions

Many children in our state rely on the community to be well immunized to stay healthy. Many suggest we need 90% of a community to be immunized to prevent an outbreak of illness. Studies show that children in schools with higher exemption rates (lower immunization rates, likely) have higher levels of disease. And as I said, we know un-immunized children are more likely to get and spread vaccine-preventable illnesses. We want to protect, or cocoon, our most vulnerable (young infants, patients with immune dysfunction, or those children on chemotherapy who can’t get vaccines). Maybe you’re one of the parents who didn’t want to opt-out, but out of convenience and/or pant-tugging-snack-needing-headache-relieving-necessity while in line, you did. In this case, if your child wasn’t truly up to date (immunization guidelines change yearly), there would be little incentive to go out of your way to ensure they received needed immunizations.

THIS convenience factor and need for “community immunity ” is the reason for the new bill. The bill isn’t about forcing or battling with families who are hesitant or opting-out of immunizations for religious reasons or for concerns about vaccine safety. This isn’t about selling vaccines. The bill works to counter families who opted out accidentally or out of convenience. The bill works to increase public education about vaccines. The bill works to get more children the immunizations they need. It’s to protect our community and our most vulnerable children. If families want to opt-out, they still can opt-out, but will have to have have a conversation with a health care worker prior. Think of this as an insurance plan for all children, demanding we all make choices with great intention rather than just convenience.

That’s where the pile of paperwork comes in. Physicians will now need to sign off on exemptions. I will happily sign these papers for families if they decide to opt-out or exempt from immunizations. But I’ll do so in person, in clinic, once we’ve discussed risks.

Take a peek at the above graphic showing exemption rates by percentile, by county. You can see, it certainly varies by county how many families choose to file for an exemption. Up until now, Washington state was one of 8 other states that required only a signature to opt-out.

This new bill allows parents to access information about vaccines from physicians and nurses, the people parents say they trust most on vaccine safety.

Some Statistics About Exemptions In The United States

The national average exemption rate is estimated to be less than 2% (that is 5 times lower than WA state currently). Thanks to WA State DOH for help with these numbers:

  • Washington is 1 of 20 states allowing for philosophical exemptions.
  • We are among a handful of state (8 total) that require parent signature only. All other states require some kind of effort to obtain philosophical or religious exemptions (e.g. notaries, writing out personal statements, direct involvement of public health, educational components, renewals).
  • States allowing for the option of a philosophical exemption often have conditions.
  • Of these 20 states, most have various conditions to getting a philosophical exemption above just a parent signature.
  • 4 states require you write out your reasons for exempting (Maine, Michigan, Louisiana, Oklahoma)
  • 4 states require the forms to be notarized (Minnesota, Texas, New Mexico, Arkansas)
  • 3 states require some kind of educational component on risks/benefits of imms (Texas, Arizona, Arkansas)
  • 3 states require direct involvement from the local or state health dept (Texas, Utah, Arkansas)
  • 2 states require renewals (Maine is ever year, Texas is every 2 years)

Some of the more recent states “expanding” their laws to allow philosophical exemptions are the ones with the most conditions. For example, Texas “expanded” their laws in 2003, but requires 1) you request the state health department send you the form, 2) sign on the form that you’ve read and understand the attached immunization materials (supplied by the state dept), 3) have the form notarized, and 4) the form expires after 2 years – at which point you start all over if you want to continue the exemption.

So, here in Washington it is up to the family, in consultation with a health care worker, if they immunize their child. Families will first have access to health information about vaccines/immunization and the risks they incur, when exempting prior to entering school.

Your thoughts? Do you think this will help protect our communities? Do you suspect, like the state does, that vaccine exemptions will go down?