Vaccine exemptions have widespread consequences

A study just published in Pediatrics illustrates the consequences of children not being vaccinated because of parental objections. The study looked at pertussis vaccine exemptions based on religious beliefs on a county-by-county basis in New York State from 2000 to 2011. The authors correlated exemption rates with pertussis incidence during the same time period. Several findings were notable:

  • For the state as a whole, the rate of religious vaccination exemptions doubled, from roughly 1 in 400 in 2000 to roughly 1 in 200 in 2011.
  • There was a significant variation in exemption rates on a county level.
  • Counties with a 1% or higher exemption rate had a 65% higher incidence of pertussis than counties with a lower exemption rate (33.1 per 100,000 compared to 20.1 per 100,000).
  • Unvaccinated children had a 14-fold higher rate of pertussis than vaccinated children.
  • In high-exemption counties, even vaccinated children had higher rates of pertussis than vaccinated children in lower-exemption counties.

On a related note, pertussis carries a substantial mortality risk for children, with death rates of 1% for infants up to age 6 months.

Now I am personally all in favor of religious freedom. People should be able to follow the dictums of whatever faith they choose. At the same time, as this Pediatrics study makes clear, when parents choose to not vaccinate their children, there are tangible public health consequences, not just for the unvaccinated children, but for the wider community.

Although the percentage of children who are not being vaccinated because of parental objection remains small, it is increasing at a rapid rate. There continues to be momentum against childhood vaccines which is motivated more by politics than by science or by religion.

How are we physicians supposed to respond? Obviously, we cannot violate legal and ethical strictures and force children to be vaccinated over their parents’ objections. But when parents do object to vaccines, it may be worth counseling them that not only are they putting their children at risk of preventable diseases, they are putting the larger community at risk as well.

Richard Fleming, MD

Imdad A et al., Pediatrics, June 3, 2013.

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