A Booster Shot for Vaccines; Amid Debate and Outbreaks, States Weigh Tougher Rules for Allowing Exemptions

A Booster Shot for Vaccines

Amid Debate and Outbreaks, States Weigh Tougher Rules for Allowing Exemptions

DONNA BRYSON and BETSY MCKAY

Jan. 5, 2014 7:02 p.m. ET

DENVER—Amid national outbreaks of measles, whooping cough and other preventable diseases, Colorado officials might make it harder for parents to exempt children from vaccinations for school and day care.Colorado is one of 48 states that allow such exemptions for reasons of personal belief or religion—often requiring little more than a parental signature on a form. In the 2012-2013 school year, about 4.3%, or 2,900 children, were excused from required vaccinations, one of the highest percentages of kindergartners in the nation.

But a surge in cases of whooping cough in the state and a spike in measles across the country has the Colorado Department of Public Health and Environment weighing new rules. One possible change would require parents to receive counseling or education on the benefits and risks of vaccination before they can opt out for nonmedical reasons.

Such a move would make Colorado the latest of a handful of states, including Washington and Oregon, to adopt tougher rules. All U.S. states allow children to be exempted from vaccination requirements for medical reasons.

Colorado officials are concerned that current procedures often make it easier for busy parents to skip vaccinations simply by filling out a form than taking their kids to the doctor for shots. They’re also eager to counter what they call confusion among parents over vaccine safety after a study a decade and a half ago linked vaccines to autism—a finding since debunked.

Vaccines are “an incredibly important public-health intervention,” said Rachel Herlihy, chief of the state health department’s immunization section.

Stricter standards could boost Colorado’s vaccination rates, which are among the lowest in the nation, with 85.7% of kindergartners immunized against measles, mumps and rubella, Dr. Herlihy and other proponents say. They would like to see Colorado’s rates closer to those of Mississippi, which allows medical exemptions only and has at least 99.9% of kindergartners vaccinated—the nation’s highest rate.

But stricter standards would limit parental choice, said Theresa Wrangham, executive director of the National Vaccine Information Center, a Sterling, Va.-based consumer group that lobbies on vaccine safety issues. It has fought tougher exemption rules in several states and says it will fight proposed changes in Colorado, too.

“It’s an important human-rights issue,” said Ms. Wrangham, who lives near Boulder, Colo. She spoke against tougher rules during public consultations the state health department held on the matter. “It’s an important ethical issue,”

It isn’t clear how much stricter rules on exemptions help reduce outbreaks. A study published online in the American Journal of Public Health in December found that tougher standards could reduce the number of whooping cough cases, but wouldn’t affect measles or several other diseases—possibly because the number of cases of those diseases is so small.

Still, federal health officials attribute a spike in measles cases last year to pockets of low vaccination rates. Measles, which is highly contagious, no longer circulates freely in the U.S. but is imported by travelers and can then spread rapidly among unvaccinated people.

Health officials also say parents, after getting exemptions for their children, sometimes simply delay rather than forgo the vaccinations, so a high exemption rate doesn’t necessarily mean a low vaccination rate.

Oregon, where 6.4% of kindergartners were exempt for nonmedical reasons from vaccinations in 2012-2013, will require as of March 1 that parents seeking exemptions listen first to a scientific presentation on the benefits and risks from a health-care provider or via an online module that the Oregon Health Authority is developing, said Lydia Emer, immunization program manager. The educational materials use science-based information from the Centers for Disease Control and Prevention on vaccines and stress the role of vaccination as a “community prevention tool,” she said.

Denver homemaker Lexi Fickenscher compares vaccinations to buckling up her 6-year-old son and 3-year-old daughter when she puts them in the car. As a former medical researcher with a master’s in public health, she worries that anti-vaccine parents are basing their decisions on anecdotes and rumors spread on the Internet.

“People who don’t vaccinate their children are potentially affecting many more people,” said Ms. Fickenscher, who recently joined Voices for Vaccines, a group promoting vaccination.

Deronn Turner, a Denver caterer and cookbook writer, said she wouldn’t be willing to be counseled before signing an exemption form. Ms. Turner hasn’t immunized any of her four children, who range in age from 3 to 14. She opposes vaccines, though she said she is open to new research.

“I want parents to be able to make the decisions about what happens to their children,” she said.

Stephanie Wasserman, executive director of the Colorado Children’s Immunization Coalition, a private group founded by doctors that is in favor of tougher exemption rules, said Colorado is unlikely to scrap all but medical exemptions like Mississippi.

“We have a unique political landscape here,” she said. “People value their individual rights and their rights as parents.”