State Legislation Surrounding Vaccine Exemptions

March 01, 2018|4:38 p.m.| ASTHO Staff

Last week, the New York State Department of Health warned of potential exposure to measles in New York City and surrounding counties. According to the announcement, an Australian tourist with a confirmed case of measles visited several hotels, the Metropolitan Museum of Art, and other venues in the area. While the risk of developing measles is very low, especially for those who have been immunized, it is highly contagious. According to CDC, “if one person has it, 90 percent of the people close to that person who are not immune will also become infected.” The Measles, Mumps, and Rubella (MMR) Vaccine can prevent measles and, with few exceptions, is required by state law for children entering school.

The episode in New York is a reminder of the 2015 measles outbreak in California that likely started with an infected tourist at Disneyland. That outbreak, which resulted in nearly 150 measles cases across seven states, Canada, and Mexico, caused the California legislature to remove the state’s personal belief exemption for required school vaccinations (SB 277). In doing so, California joined Mississippi and West Virginia as the few states that allow only medical exemptions for vaccinations. A recent report in the New York Times examined the results from California’s law change and revealed a 20-30 percent increase in the number of kindergartner vaccinations at many schools with low vaccination rates. From a public health policy standpoint, the authors noted how “one law changed the behavior of impassioned resisters more effectively than a thousand public service announcements might have.”

While the vast majority of states continue to allow non-medical exemptions for school vaccinations, policymakers continue to seek ways to ensure that exemptions are valid and informed. Common approaches to ensuring the validity and information surrounding non-medical exemptions include the establishment of administrative processes to claim exemptions, requirements for the completion or receipt of education about vaccinations, and requirements for the publication or notification of exemption rates in schools. For example, Utah enacted a law in 2017 (HB 308) tasking the health department with developing an online course detailing the benefits and risks of vaccination. Parents or guardians must complete this online course in order to obtain an immunization exemption form. Under the previous law, parents or guardians had to visit a local health department for consultation.

Efforts to improve vaccine protections against measles are also occurring outside of school, as some states now have laws focusing on MMR vaccination requirements in healthcare facilities. For a review of these laws and their implications for patients and healthcare workers, please see the CDC Public Health Law Program’s Menu of State Healthcare Facility Measles, Mumps, and Rubella (MMR) Vaccination Laws.

It is expected that non-medical exemptions will continue as a debate in state legislatures. For 2018, ASTHO is tracking legislation related to vaccine exemptions which can be found on the ASTHO State and Territorial Legislative Tracking webpage.