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SCIENCE NEWS California’s strict vaccination laws may only have a small effect


SCIENCE

SCIENCE NEWS California’s strict vaccination laws may only have a small effect

By Chelsea Whyte California is trying to increase the number of children who get vaccinatedPhoto by Rich Pedroncelli/AP/ShutterstockOfficials in US states and cities are trying several strategies to limit the number of people who go unvaccinated, which has become more urgent after recent outbreaks of vaccine-preventable diseases. In California, these measures have resulted in a…

SCIENCE NEWS California’s strict vaccination laws may only have a small effect

SCIENCE NEWS

By Chelsea Whyte

SCIENCE NEWS Chelsea Lydell holds her son, Joseph, 4, as she joins hundreds of others waiting to get into a legislative committee to oppose a proposal to give state public health officials instead of local doctors the power to decide which children can skip their shots before attending school, at the Capitol, in Sacramento, Calif. The bill, by state Sen. Richard Pan, D-Sacramento, a pediatrician, said his legislation would give state health officials the tools they need to prevent outbreaks of vaccine-preventable diseases like measles

California is trying to increase the number of children who get vaccinated

Photo by Rich Pedroncelli/AP/Shutterstock

Officials in US states and cities are trying several strategies to limit the number of people who go unvaccinated, which has become more urgent after recent outbreaks of vaccine-preventable diseases. In California, these measures have resulted in a slight decrease in the number of unvaccinated children in schools, but they haven’t fully counteracted the effects of hesitancy over whether to vaccinate.

California passed a law in 2015 that banned non-medical exemptions based on religious or philosophical beliefs for parents who wanted to opt out of vaccinating their children. It is not the only place to do so – Washington state enacted a similar law in 2019, and New York City went so far as to mandate that all people in an area with a large measles outbreak had to be vaccinated or face fines. But will these laws work?

To find out, Paul Delamater at the University of North Carolina at Chapel Hill and his colleagues analysed data from California. The team estimated the proportion of schoolchildren whose parents claimed an exemption to vaccination rules based on vaccination and enrolment data for kindergarteners and seventh graders – the grades at which schools in California check vaccine status, which corresponds to around 5 and 12 years old.

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As of now, the California law change seems to have resulted in 0.5 per cent fewer unvaccinated children. If the law remains, the researchers found that by 2027, the percentage of children with any vaccine exemption would decrease from 2.59 per cent to 1.87 per cent, where the rate is likely to stabilise.

The team also examined the effect of another law in California, which increased scrutiny on medical exemptions – because these are sometimes inappropriately used when non-medical exemptions are unavailable. In that scenario, the percentage of children with vaccine exemptions would be reduced to 1.41 per cent by 2027. If neither law was repealed or had never been enacted, their models show that the rate would stabilise at 2.36 per cent.

These are modest improvements, which may have to do with the way the laws were written, says Delamater. “At the last minute, there were a whole lot of exceptions that took the teeth out of this bill,” he says. Children who had previously been opted out of vaccines for philosophical reasons weren’t required to follow the new rules, because it only applied to new schoolchildren, and allowable medical criteria were relaxed, he says.

“The laws narrowing vaccine exemptions are beneficial but will not achieve their full potential if they are not watertight,” says Michelle Mello at Stanford University in California. She says lax rules for documenting medical exemptions led to a 250 per cent increase in the medical exemption rate in California in the two years after the law passed, with some healthcare providers inappropriately approving these exemptions.

“Some of these providers were not primary care providers at all, much less paediatricians,” she says, adding that there should be a requirement that a child’s doctor with knowledge of their medical history should be required to sign off. She also says medical exemptions should be reviewed by departments of health instead of school employees, who currently take this on because children in public schools are required to be vaccinated, and who may not have the time or expertise to best counsel families about vaccinations.

Journal reference: Annals of Internal Medicine, DOI: 10.7326/M19-1933

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