Avoiding Vaccination

Responsible parents everywhere seek to protect their children, and for some, that means avoiding routine immunizations for a host of unsubstantiated reasons. Now a research letter Rick and I discuss on PodMed this week as published in JAMA details a trend that's rather disturbing, where parents in California are seeming to seek medical exemptions for their children since the personal belief loophole regarding avoiding vaccination has been closed. Here's the story:

Prior to the 2016-17 school year, California bill (SB)277 eliminated the personal belief exemption from school vaccine mandates, which had allowed parents to cite religious or philosophical objections to required vaccines but enroll their children in school. The exemption for medical reasons remains, and was in fact expanded somewhat under the bill. The authors examined data from 1996 to 2016 from incoming kindergartners and tallied statewide medical and personal belief exemptions over the time period. In the first year under the new law, medical exemptions increased from 0.17% to 0.51%, while exemptions for personal beliefs dropped from 2.37% to 0.56%. Clearly, while there was an overall decrease in exemptions it appears that some have shifted to a medical exemption. And as Rick opines, that's gaming the system, with physician collusion. It's well known that herd immunity depends upon a large number of us being immunized, so choosing not to do so has potentially deleterious or even deadly consequences for others. We both agree that exemptions need to be closely scrutinized for the good of all.

Other topics this week are all from NEJM: Third Dose of MMR Vaccine, Tiotropium in Early-Stage COPD, and Tezepelumab in Adults with Uncontrolled Asthma. Until next week, y'all live well.