If you have been following the news, or even this blog, you probably are aware of SB 277, a bill sailing through the California legislature which, upon enactment, will essentially eliminate the California vaccine personal belief exemptions (PBE) to vaccinations of children entering in public schools or day care centers.
One of the favorite tools of the vaccine deniers is a personal belief exemption that allows them to essentially refuse to vaccinate one’s child based something other than a valid medical contraindication to vaccinate a particular child. These exemptions, at least in California, can be for almost anything, including the nonsense “religious exemption.” Ironically, it’s difficult to find a real mainstream or even non-mainstream religion that is opposed to vaccinations.
Court case after court case has supported vaccination of children and has generally rejected many attempts at using religious exemptions to refuse vaccinations. So California, which has experienced some measles outbreaks because of unvaccinated children, has decided to get tougher on vaccinating their children, and eliminate California.
Abusing the vaccine personal belief exemption
Recent protests against SB 277 were overwhelmingly white.
A recent peer-reviewed article published in Pediatrics examined California parents who used the California vaccine personal belief exemptions to exclude their children from routine vaccinations. The researchers found that they are typically white and well-to-do, living in some of the most politically liberal parts of California.
These results confirmed what other studies have suggested in California (citation, citation, citation and citation)–the abuse of California’s vaccine personal belief exemption is strongest among wealthier white families. I guess not needing a vaccine is a white privilege sentiment.
Orac mentioned this study in a recent post. He remarked that “the stereotype (of the typical vaccine denier) is that it’s a bunch of liberal, hippy-dippy lovers of “natural” living, but that’s not quite it.” I’ve seen many memes (I hate memes, they’re trash) that have a photo of a hipster/hippy young woman who obviously is opposed to vaccines.
Basically, this study examined the rate of PBEs in over 5000 kindergarten schools across the state. They then compiled data on the location of the school, the white ethnic make-up of each, income, and other factors.
This study found the demographic that uses vaccine personal belief exemptions to avoid immunizations for their children to be at odds with the stereotypical hippy.
- The schools with the highest rate of PBEs also had the highest percentage of white students. In fact, the highest percentage of schools with the highest PBE rate were over 75% white.
- The schools also clustered in areas that are generally considered to be “liberal,” although not always so.
- Some of the schools had PBE rates up to 79%. A successful herd effect–a scientific theory that states when a small number of people remain unvaccinated, they are still protected by the “herd immunity” that builds when most people in a community are immunized–requires around 95% vaccination uptake, so many schools fail to meet that standard.
Clustering of PBEs
This study gave us a graphic that dramatically establishes how PBEs cluster in the wealthier, whiter and more liberal areas of California:
But the data from the study has even worse news. California schools with high rates of personal-belief exemptions often had high rates of exemptions for medical reasons. Why? It’s unknown, but one could speculate that some pediatricians in the area might also be antivaccine, and they sign off on a lot of medical exemptions.
You think I’m inventing a conspiracy where there is none? Some physicians advertise that they will fill out vaccine exemption forms. Bob Sears, antivaccination cult doctor, actually lists physicians (and quacks like chiropractors and naturopaths) who will “consult” on vaccines. It’s not that hard to provide a disingenuous vaccine medical exemption to vaccinations.
Of course, I am concerned that some children exempted for medical reasons could be put at risk if their classmates are not vaccinated against diseases like measles, mumps, whooping cough and chickenpox.
As of 1 May 2015, 169 people in 20 states and Washington, D.C., had been sickened by measles, according to the CDC. As is well known, the main outbreak was traced to the Disneyland amusement park in Anaheim, California. The CDC states that the outbreak probably started with an unvaccinated traveler who became infected in another country before coming to Disneyland, where came in contact with other unvaccinated children and adults.
Opponents of the restriction of PBEs argue that parents should be able to choose for their own children. However, there are a number of issues with that argument:
- Some vaccine personal belief exemptions are based on fake religious arguments invented by vaccine deniers – most religions are strongly supportive of vaccines.
- PBEs are based on unfounded beliefs that there are risks to vaccination that simply do not exist (like the discredited vaccines and autism link).
- In reality, people are not allowed to put their children at risk of harm. That’s why we require everything from car seats to proper nutrition for our children.
- It is not a personal choice to put others at risk. Courts have supported the state in mandating vaccines for the benefit of the community over and over and over.
Dr. Margaret Carrel, Ph.D., the main researcher for this study and a member of the Department of Epidemiology at the University of Iowa, states that “vaccines protect not only an individual child but the children around them, and they constitute an enormous public good.”
Conclusions
- Most of the schools with a higher rate vaccine personal belief exemptions are overwhelmingly white.
- Most of these schools are generally in wealthier and more liberal areas of the state (thought political affiliation is more scattered, with wealthy conservative areas also having higher PBEs).
- The rate of medical exemptions is frequently correlated with high vaccine personal belief exemptions which may indicate that some healthcare professionals are signing off on medical exemptions.
Key citations:
- Buttenheim A, Jones M, Baras Y. Exposure of California kindergartners to students with personal belief exemptions from mandated school entry vaccinations. Am J Public Health. 2012 Aug;102(8):e59-67. doi: 10.2105/AJPH.2012.300821. Epub 2012 Jun 14. PubMed PMID: 22698009; PubMed Central PMCID: PMC3464858.
- Carrel M, Bitterman P. Personal Belief Exemptions to Vaccination in California: A Spatial Analysis. Pediatrics. 2015 Jun 1. pii: peds.2015-0831. [Epub ahead of print] PubMed PMID: 26034242.
- Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE. Individual and community risks of measles and pertussis associated with personal exemptions to immunization. JAMA. 2000 Dec 27;284(24):3145-50. PubMed PMID: 11135778.
- Jones M, Buttenheim A. Potential Effects of California’s New Vaccine Exemption Law on the Prevalence and Clustering of Exemptions. Am J Public Health. 2014 Jul 17:e1-e4. [Epub ahead of print] PubMed PMID: 25033149.
- Omer SB, Pan WK, Halsey NA, Stokley S, Moulton LH, Navar AM, Pierce M, Salmon DA. Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence. JAMA. 2006 Oct 11;296(14):1757-63. PubMed PMID: 17032989.
- Zipprich J, Winter K, Hacker J, Xia D, Watt J, Harriman K; Centers for Disease Control and Prevention (CDC). Measles outbreak–California, December 2014-February 2015. MMWR Morb Mortal Wkly Rep. 2015 Feb 20;64(6):153-4. Erratum in: MMWR Morb Mortal Wkly Rep. 2015 Feb 27;64(7):196. PubMed PMID: 25695321.
