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Philosophical, religious reasons fuel nonmedical vaccine exemption rates
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States that offer nonmedical exemptions to vaccines for philosophical and religious reasons saw a higher rate than states that allowed only religious exemptions, according to recent research published in Open Forum Infectious Diseases.
“High rates of nonmedical exemptions have been associated with higher rates of vaccine-preventable diseases. Local clusters of vaccine exemptions geographically overlap with outbreaks of pertussis,” Saad B. Omer, MPH, PhD, the William H. Foege Professor of Global Health at Emory University and Emory Vaccine Center, and colleagues wrote. “While there have been a few recent reports of nonmedical exemption rates in various states, we are not aware of a longitudinal analysis of recent national trends in nonmedical exemption rates accounting for administrative ease of nonmedical exemptions.”
The American Academy of Pediatrics, CDC and state and local health departments have previously developed resources to combat vaccine hesitancy and refusal; however, 48 states in the U.S. still offer nonmedical exemptions to vaccines. Using state-level vaccine exemption data from 2011-2012 through 2015-2016 school years, the researchers evaluated trends in nonmedical exemption rates and how those rates were associated with the ease of obtaining a nonmedical exemption and the types of exemptions that were permitted.
In total, 29 states permitted exemptions for religious-based beliefs and 19 allowed exemptions for both religious and philosophical reasons. Only nine states enacted legislative changes to make nonmedical exemptions harder to obtain over the course of the study period.
The researchers’ analysis showed that the nonmedical exemption rate was higher during the 2013-2014 through 2015-2016 school years (2.25%) compared with 2011-2012 through 2012-2013 (1.75%). Notably, the rates of nonmedical exemptions from vaccination stabilized through the 2015-2016 school year — demonstrating an important shift in the national trend, the researchers said. In states that permitted philosophical and religious exemptions, the exemption rate was 2.41 times higher than in states that permitted only religious exemptions (incidence rate ratio = 2.41; 95% CI; 1.71, 3.41).
“Continued monitoring of exemption rates is critically important to ensure the plateau in rates identified by our study is sustained,” Omer and colleagues wrote. “Improvements can also be made to within state collection of exemption data to improve this surveillance system moving forward. States will be well-served by enacting legislation that changes the balance of convenience in favor of vaccination and away from nonmedical exemption.” – by Savannah Demko
Disclosures: Omer reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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