Some State Vaccination Laws Contribute To Greater Exemption Rates And Disease Outbreaks In The United States

W. David Bradford · Anne M. Mandich

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Vaccine Coverage and Hesitancy Healthcare Policy and Management Public Health Policies and Education

Abstract

Health officials attest that immunizations are among the most successful interventions in public health. However, there remains a substantial unvaccinated population in the United States. We analyzed how state-level vaccination exemption laws affect immunization rates and the incidence of preventable disease. We measured the association between each component of state kindergarten vaccination exemption laws and state vaccination exemption rates from 2002 to 2012, using the Centers for Disease Control and Prevention's annual school assessment reports. We found that policies such as requiring health department approval of nonmedical exemptions, requiring a physician to sign an exemption application, and having criminal or civil punishments for noncompliance with immunization requirements had a significant effect in reducing vaccine exemptions. Our exemption law effectiveness index identified eighteen states with the most effective laws and nine states with the least effective ones. The most effective states had lower incidences of pertussis, compared to other states. For policy makers interested in decreasing the number of vaccine exemptions in their state, our findings are of particular interest.

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References

2009Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases 2000Individual and Community Risks of Measles and Pertussis Associated With Personal Exemptions to Immunization 2013A systematic review of interventions for reducing parental vaccine refusal and vaccine hesitancy 2006Nonmedical Exemptions to School Immunization Requirements 2011Confidence About Vaccines In The United States: Understanding Parents’ Perceptions 2011How the case against the MMR vaccine was fixed 2012Vaccination Policies and Rates of Exemption from Immunization, 2005–2011 2001Processes for obtaining nonmedical exemptions to state immunization laws

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2019Direct and Spillover Effects of Middle School Vaccination Requirements 2016Since The Start Of The Vaccines For Children Program, Uptake Has Increased, And Most Disparities Have Decreased 2015Characteristics of Physicians Who Dismiss Families for Refusing Vaccines 2018Immunization Mandates, Vaccination Coverage, and Exemption Rates in the United States 2018Trends and Characteristics of Proposed and Enacted State Legislation on Childhood Vaccination Exemption, 2011–2017

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