Required childhood immunizations and vaccine exemptions: The bottom line

By Jeff Duchin, MD, Health Officer

Media coverage of our recent publication in the journal Pediatrics gave some people the mistaken impression that my colleagues and I want to provide children with a choice to “opt out” of required vaccinations, except for measles vaccine.

The fact is that families in Washington currently have the ability to opt out of any required vaccine. About 3% of Washington state children opt out of one or more vaccines using a non-medical exemption. In addition, another 13% of children are non-compliant with vaccination requirements – that is they haven’t requested an exemption and don’t have the required vaccinations at school entry.

immunizationIf you read no further, here’s the bottom line: We strongly recommend that all children receive all recommended vaccines and we do not recommend the use of non-medical exemptions or increasing the ability to opt out of any vaccine requirements.

Our publication is intended to promote dialogue about the best ways to increase the number of children receiving all recommended vaccines while safeguarding our communities against outbreaks of vaccine preventable diseases.

We favor several strategies to increase immunization rates, including:

  • Improving enforcement of our current immunization requirements
  • Making non-medical exemptions more difficult to get
  • And, if needed, eliminating the current option for non-medical exemptions for measles vaccine.

We say this about measles because it’s unique — a serious disease that can that spread readily through a community without direct contact with an ill person when levels of measles vaccine coverage are not high enough. There’s a safe and extremely effective vaccine that produces long lasting protection, and very high levels of measles vaccine coverage can prevent community spread.

Other diseases for which vaccines are routinely recommended do not currently pose the same risk for community outbreaks as measles does, with the exception of pertussis.  However, although pertussis vaccine produces good short-term protection, it does not provide sufficient long-term protection to prevent community outbreaks.

If enforcement of current vaccination requirements doesn’t sustain the necessary high levels of measles vaccine coverage, eliminating non-medical exemptions for measles vaccine may be required to protect against community outbreaks.

Although we categorically do not endorse the use of non-medical exemptions for any vaccine, we think only measles poses a sufficient threat of preventable outbreaks to consider eliminating the currently available personal choice to opt-out of vaccination in order to protect the community.

In summary:

1) All children should receive all recommended vaccines (unless they have a true medical contraindication to being immunized with a specific vaccine);

2) We should take a number of steps to improve immunization rates; 

3) Elimination of the current non-medical exemption option for measles vaccine is reasonable in order to protect against measles outbreaks;

4) We do not encourage use of non-medical exemptions for any vaccine.

2 thoughts on “Required childhood immunizations and vaccine exemptions: The bottom line

  1. I disagree- as vaccination levels decrease the other diseases will start to show the same profile- ease of transmissiblity, adaptation, then community deaths. We’ll be removing the environmental constrictions on these organisms and they WILL take advantage. I also am not convinced that Measles is “unique” because all the diseases we vaccinate for are deadly: Hib kills through meningitis, diphtheria horrifically suffocates it’s victims by sealing the airway, and tetanus? A horrifically painful disease whose muscle contractions break bones before the victim suffocates as their diaphragm is paralyzed. So I don’t agree that measles outranks the others in terms of danger. In the past a mother would probably wish for measles before any of the others I’ve mentioned.

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