Counseling parents may curb nonmedical vaccine exemptions

Restoring community immunity requires diligence on the part of medical professionals, policymakers, and parents, wrote California state senator Richard J. Pan, MD, MPH, in an accompanying editorial.

Laws requiring that children be vaccinated before starting school are designed to protect the vaccinated children and the community at large, wrote Dr. Pan, but the passage of certain laws resulted in nonmedical exemptions that can reduce the effectiveness of childhood vaccinations on community health. In the past, parents rarely chose nonmedical exemptions because they recognized the dangers of diseases such as polio and measles and acknowledged the safety and effectiveness of the vaccines to protect against them, said Dr. Pan.

“However, some saw the opportunity to exploit these circumstances for personal gain by spreading vaccine misinformation over the Internet and social media to fuel parental anxiety and promote sales of their supplements and books, leading to increased use of nonmedical exemptions,” he said.

In Dr. Pan’s view, community immunity can be restored by creating stricter policies for vaccination and eliminating nonmedical exemptions. He authored a bill in California to abolish these exemptions, and the vaccination rate was 96% among kindergartners in California during the first year the policy was in place.

But antivaccine groups are well organized. One study found that “half of all Twitter posts about vaccines contain antivaccine beliefs.‍ Just this year [2017] in Minnesota, antivaccine groups targeted a community, causing a significant drop in vaccination rates.‍ The resulting measles outbreak exposed more than 8,000 people, sickened 79 (of which 73 were less than 10 years old), and hospitalized 22,” Dr. Pan said.

Pediatricians and other child health advocates must continue to work to address medical exemptions as well and to define the standards for what constitutes a medical exemption, Dr. Pan said. By educating and working with parents, legislators, and other health care professionals, “pediatricians need to build the political will to pass effective vaccine policy,” he said.

Dr. Pan is a California state senator in Sacramento. He had no financial conflicts to disclose. He commented in an editorial accompanying the study by Omer et al. (Pediatrics. 2017 Dec 18;141[1]:e20173449).