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Our vaccine exception rates keep going up

A small change to the law in 2003 has had a big effect over time.

As measles cases hit a 25-year high in the United States, Texas medical experts fear the state could see the next outbreak of a vaccine-preventable disease. Texas has reported 15 confirmed cases of measles so far in 2019, six more than in all of 2018.

Health officials are watching pockets of Texas closely because of the number of parents requesting exemptions under Texas’s broad vaccine exemption law. Texas is one of 16 states that allow parents to bypass vaccine requirements for enrolling their kids in school by claiming a conscientious exemption, along with citing medical or religious concerns. Just last month, Washington ended conscientious exemptions on the heels of a large measles outbreak with over 70 reported cases. Three states — California, West Virginia and Mississippi — only allow medical exemptions.

Texas’ exemption law used to be stricter. In 2003, a state senator proposed loosening restrictions via a three-page amendment to a 311-page bill. After five minutes of discussion, the amendment was approved. The bill was soon signed into law. Sixteen years later, former state Sen. Craig Estes said the change to Texas’ vaccine laws that he helped enact should be reviewed in the current public health climate.

“Obviously we didn’t ever imagine what would happen,” Estes, a Republican from Prosper, told The Texas Tribune. “With what’s happened recently, I would encourage the legislature in the future to revisit that issue and debate it.”

The speedy way in which the Texas Legislature weakened the state’s vaccine exemption rules suggests that, like Estes, few in office at the time thought it would put Texas at risk for future outbreaks. However, while experts suggest Texas is now vulnerable, efforts to change the exemption law have been dead on arrival in the Capitol.

“There will be a terrible measles epidemic in Texas, and children will be hospitalized in intensive care units, just like they are in New York right now,” Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, said last month. “That will wake up the state Legislature to realize that there’s a problem and close those exemptions.”

Kindergarteners must have 10 immunizations to be enrolled in Texas schools. Since 2006, when the state first started reporting the data, the exemption rate for kindergarteners in Texas has risen from 0.3% for the 2005-06 school year to 2.15% for the 2018-19 school year.

In Texas, school districts, private schools and charter schools are required to report their vaccine exemption rates per vaccine. The data collection is done through a survey administered by the Texas Department of State Health Services, but some schools don’t report consistently, leaving gaps in the data.

The data shows certain communities — like the Dallas Independent School District — have seen a recent spike in conscientious exemptions for kindergarteners. Others — like El Paso ISD — have seen exemptions recently plummet. Some smaller private schools, meanwhile, have exemption rates that are significantly higher than those of other schools. The Austin Waldorf School had the highest vaccine exemption rate for the 2018-19 school year, at 52.9%. Alliance Christian Academy had the second-highest rate at 40.6%.

When enough of a community is immunized against a disease, that group has what’s known as herd immunity, meaning there is a low risk of a disease spreading. Vaccine-preventable disease have different herd immunity thresholds. Measles, which is highly contagious, has a high herd immunity threshold of 95%. According to a state report for the 2018-19 school year, Texas kindergarteners statewide had coverage levels higher than 95% for all required vaccines. Yet the data from individual school districts and private schools suggests that some communities may fall short of meeting that threshold for some vaccines.

The fact that a Waldorf school is atop this list shows the problem is very much bipartisan, though the main anti-vax legislators these days are all Republicans. I’ve repeated this a million times, but the only way to improve things is to throw those anti-vax legislators out of office. Next year is a great opportunity to do that as three of them – Jonathan Stickland, Bill Zedler, and Matt Krause – all had close elections in 2018. The rest is up to us. Now go read the rest of the story for the history of how we got to this point.

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