Recently we’ve been looking at preschools, and I’ve been increasingly disturbed by the lax attitude and bizarre public policy around immunization here in California.
Despite the fact that vaccinations are indisputably important to public health, and that fears that they cause autism have repeatedly been shown to be unfounded, California persists in offering the Personal Beliefs Exemption (PBE). To be clear, this is not an exemption given for medical reasons (that’s the PME).
The PBE is an enabler that allows herd-immunity freeloaders to enroll their children in school despite the risk posed to public health. This includes public schools.
School and county-level data is available to the public, so I pulled down the last ten years of CA Department of Public health immunization data.
Let’s dive right in with California’s county-level vaccination trends over the past 10 years. This chart shows the increasing prevalence of using the Personal Belief Exemption to avoid vaccination.
This chart shows the rates of kindergartners entering school with exemptions rather than shots
Here it is in map form.
All states, with the exeption of Mississippi and West Virginia, offer religious exemptions. 18 states additionally offer “beliefs” exemptions, with varying degrees of ease to obtain one. States with the “easy” freeloader pass have non-medical exemption rates more than twice as high as those in states with more arduous requirements – arduous, as in having to consult with a doctor before the PBE is granted.
California has been an “easy” PBE state for decades – the antivaxxer simply signed an affidavit stating that vaccines are counter to his or her “beliefs.” The fact that this process elevates beliefs above a) the facts, and b) the well-being of the community, is what makes the PBE so absurd.
Statewide, we’re seeing vaccination rates hovering at 92.3% for MMR and 92.2% for Pertussis. That isn’t something to be proud of. Bizarrely, the CA Department of Public Health publishes an annual fact sheet proudly proclaiming CA’s >= 92% status without mentioning that immunization rates have been declining for the past 10 years, while PBE instances have risen.
California is one of 21 states with personal exemption rates exceeding 2%. The nonmedical exemption rate was 3.1% among kindergartners for the 2013-2014 school year – 17,253 little kids whose parents chose to enroll them in school with exemptions. The number of who weren’t up-to-date overall was 51,791. There are around 533,000 kids in CA kindergartens.
Across all US states, California is below average on coverage for most vaccines – including DTaP, Polio, and MMR, according to the CDC’s Estimated Vaccination Coverage report.
Recognizing that statewide vaccination rates are approaching dangerously low levels – the herd immunity threshold
the measles is 83-94%, for pertussis is 92-94% – California’s legislature has recently taken baby steps to change this – as of the Sept 2014 school year, PBEs now require a doctor’s signature, stating that the parent has been made aware of the risks and been given information about vaccines. In response, antivax sites have begun to disseminate list of doctors willing to sign the form without “pushing” vaccines.
This more stringent requirement is a step in the right direction, but not enough. The PBE has no place in California schools – particularly not taxpayer-funded public schools, where parents who vaccinate their children have no recourse to insist that the school enforce a sensible immunization policy.
The winner of the public school with Highest PBE % in California: San Geronimo Valley Elementary in Marin, at 79%
Looking at the most recent data from the 2013-2014 school year: 542 schools with 10 or more pupils (6129 reporting) had PBE rates over 10%. You can look your school up here.
Here’s the overall public vs private breakdown.
As CNN put it when looking at private schools in LA, “LA’s wealthiest neighborhoods have child vaccination rates lower than West Africa.” The Hollywood Reporter did a deeper investigation into private schools for the wealthy in LA; administrators admitted fears that wealthy parents would enroll their children in other schools if they were pressured to vaccinate.
“The irony is that normally people with lower socioeconomic status have an increased risk of infectious diseases, but with vaccine-preventable infectious diseases, the risk is higher for those higher in socioeconomic status,” noted Dr. Kenneth Bromberg, director of The Vaccine Research Center, in yet another article on the topic…this one specifically covering whooping cough outbreaks among the unvaccinated wealthy.
I’d like to specifically call out the ticking time bombs that are the Waldorf schools. There are approximately 20 in the state of California with “Waldorf” in the name, though there may be more that practice the philosophy. Of these, only five have >50% of the student population up to date on immunizations. Six have rates in the teens. One, Maple Village Waldorf, has zero students who are up to date (and an 87% PBE rate).
So, out of the 677 kindergartners enrolled in California Waldorf schools, there were two with PMEs, and 349 with PBEs. Only 235 (35%) were up to date on their shots. That is fucking ridiculous.
Felix Salmon wrote a great post highlighting the idiocy among Waldorf parents two years ago, but not much has changed. The Waldorf brain trust responds to their abysmal vax rates with…nothing. No comment. They do, however, halt classes temporarily when Pertussis outbreaks occur.
Calls to eliminate the PBE are generally met with pushback from antivaxxers who argue that parental rights would be violated by eliminating “vaccine choice.” That’s false. The Supreme Court has already repudiated that. There is precedent for compulsory vaccination, both historical and recent, as evidenced by a 2014 case in New York…which understands what it means to be a city. 😉
The goal of this post – if you’ve stayed with me this long – wasn’t just to rant about California’s stupid policy and lousy vaccination rates, it’s to invite people to help make a change. Look up your school and county rates, and demand accountability from your administrators. They shouldn’t be pandering to science denialists.
If you want to go further, fire off an email to your representative and tell them the PBE is terrible policy – that it puts the unsubstantiated beliefs of some above the welfare of others, puts the young, the elderly, and the immune-compromised at risk, and that it should be eliminated.