Capitol Ideas

CSG Knowledge Center

Research Services

MLC Policy Resolutions

Stateline Midwest



State vaccination, exemption policies scrutinized after measles outbreak

by Kate Tormey ~ March 2015 ~ Stateline Midwest »
Last month, a contagious disease that was once thought eradicated in the United States saw one of its largest outbreaks in recent years. The resurgence of the measles has sparked a nationwide discussion about vaccination policy. Each state has different requirements for vaccines that children must have in order to attend school. Likewise, each state has its own set of exceptions.
Across the country, exemptions are provided for health reasons, but state policies vary when it comes to allowing parents to opt out of vaccines for other reasons.
All but two U.S. states (Alabama and West Virginia) allow exemptions for religious reasons. And 19 states — including Michigan, Minnesota, North Dakota, Ohio and Wisconsin in the Midwest — allow parents to cite philosophical beliefs as a reason to opt out, according to the U.S. Centers for Disease Control and Prevention.

Vaccination rates vary in the states

According to CDC data, about 90,000 schoolchildren were granted exemptions from the measles, mumps and rubella (MMR) vaccine in the 2013-14 school year: 12 percent for medical reasons and 40 percent for religious reasons. That means just under half of these children were exempted for philosophical beliefs — a policy that is now being reconsidered in state capitols.
The CDC recommends that children receive two doses of the MMR vaccine before they enter school: one between 12 and 18 months of age and another around age 4. But some parents have decided to delay those vaccines for their children — or skip them altogether.
The rise in the anti-vaccination movement is attributed in large part to a now-debunked study that linked the MMR vaccine to autism. Still, some parents continue to have concerns about vaccinations and want the ability to decide whether or not to immunize their children.
Infectious-disease experts warn, though, that the United States has reached a dangerous tipping point where too few are being immunized against diseases such as the measles, whooping cough and the mumps — all of which have seen a resurgence in recent years.
Scientists point to the theory of “herd immunity,” which says that if most people (around 95 percent) are immunized, a disease is unlikely to spread, even among those who are not vaccinated. This protects not only those who do receive the vaccine, but those who cannot — such as infants, the elderly and those whose immune systems are weakened.
Nationwide, the number of children entering school who have received the MMR vaccine is 94.7 percent. In some states, the rate is even lower. It is below 90 percent in seven states, including Kansas and North Dakota.
In response, state policymakers are considering new laws that tighten immunization exemptions with the goal of reducing the number of people who are not vaccinated against infectious and deadly diseases.
According to a 2012 study in the medical journal Advanced Preventative Medicine, when it is more difficult to obtain an exemption, fewer parents seek it — and rates of disease go down.
Some states have passed laws that require parents to consult a doctor before claiming an exemption. California, Oregon, Vermont and Washington have these laws.
Under legislation introduced this year in Minnesota (HF 393/SF 380), parents would have to submit an exemption application that includes an explanation of their reasons for opting out of a specific vaccine, as well as a statement from a physician proving they have discussed the risks.
The form would also include an acknowledgement that the child could be barred from attending school during an outbreak of the disease.


Article written by Kate Tormey, staff liaison to The Council of State Governments’ Midwestern Legislative Conference Health & Human Services Committee. CSG has also developed an issue brief on state vaccination rates and related state policies.