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Law requiring counseling from health care providers reduces vaccine exemptions
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The enactment of a state senate bill requiring parental counseling on vaccination and a signed form provided by a licensed health care provider before refusing immunization decreased the percentage of those obtaining vaccine exemptions by 40.2%.
“Given the association between procedures for obtaining exemptions and higher rates of nonmedical exemptions, several states have attempted to modify their administrative requirements for obtaining nonmedical exemptions,” Saad B. Omer, MBBS, MPH, PhD, from the Hubert Department of Global Health, the departments of epidemiology and pediatrics, and Emory Vaccine Center at Emory University, and colleagues wrote.
“One strategy implemented by several states in recent years is the addition of health care provider counseling and/or signature as a requirement to obtain a nonmedical exemption,” they wrote.
In Washington state, a senate bill (SB5005) was passed in 2011 that required physicians to counsel parents and sign a form to attain a vaccination exemption.
To assess the efficacy of provider-based counseling for vaccine hesitancy, the researchers implemented segmented regression, as well as interaction and aggregation indices, to examine the intervention’s effect on immunization coverage and exemption rates in Washington between 1997-1998 and 2013-2014. Vaccination rates of kindergartners and the rate of exemptions were also gathered from the Washington State Department of Health.
A significant relative decrease in exemption rates was observed once SB5005 was implemented (40.2%; 95% CI, –43.6% to –36.6%), with a significant absolute decrease in vaccine exemptions of 2.9 percentage points (95% CI, –4.2% to –1.7%). Additionally, the number of children who received all vaccines necessary for entering kindergarten, excluding hepatitis B, increased.
When placed in the school setting, kindergartners without vaccine exemptions were less likely to come across those with vaccine exemptions when SB5005 is used. Those with exemptions were also less likely to encounter other children who obtained vaccination exemptions. Moreover, the implementation of SB5005 reduced clustering of those with vaccine exemptions in a geographic area.
“Although there was an increase in conditional entrants — ie, students who were allowed to attend school on condition of parents subsequently providing evidence of vaccination — there was, reassuringly, a decrease in entrants who were out of compliance,” Omer and colleagues wrote. “However, the proportion of enrolled students that are conditional entrants and out of compliance was about 10% after the implementation of the law. This indicates that efforts should also focus on enforcing compliance of these conditional entrants.” – by Katherine Bortz
Disclosures: Omer reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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