On Friday, April 29 the Colorado House of Representatives voted to pass, on concurrence, an amended version of House Bill 1288: Concerning Personal Belief Exemptions to Immunization Requirements for Children Prior to Attending School.
Many parents may be wondering what House Bill 1288, as currently written, means for their families and schools. As a parent of three school-age children who attend three different schools, the issue hits close to home—as it surely does for every parent who has made a vaccine decision on behalf of their children.
How exemptions work today
By way of background, children now are required to enter school or daycare with a complete immunization record. However, parents have the option of claiming an exemption for medical, religious or personal belief reasons. (Personal belief exemptions are the primary reason for exemption from recommended vaccines and account for over 90 percent of all exemptions for Colorado kindergarteners from 2003-2012.) Today, parents need only provide their signature one time to exempt their child from a vaccine.
Currently, Colorado has one of the highest rates of personal belief exemptions in the United States, with nearly 3,000 kindergartners entering school without protection from one or more vaccine-preventable diseases. Schools in some communities across the country report exemption rates as high as 15 to 20 percent.
Why does this matter?
Immunization rates and exemption policies have important implications at the community and individual level.
- Not everyone in a community is able to be vaccinated, but everyone benefits from vaccination. When the majority of people in a community are protected through vaccination, there is less opportunity for diseases to enter.
- Schools with exemption rates as low as 2 percent to 4 percent are at increased risk for disease outbreaks. Today, parents and others simply do not know how prevalent exemptions are within a given school.
- Colorado is experiencing a whooping cough (pertussis) epidemic. In 2013, there were 1,458 reported cases of whooping cough in Colorado. In comparison, an average of 324 cases a year was reported in Colorado during 2007-2011. Studies show that children who are not vaccinated are 19-28 times more likely to get pertussis than their immunized peers.
- Additionally, the U.S. is experiencing a measles outbreak. As of April 25, there have been 154 measles cases reported in 14 states.
- State exemption policies make a difference. States with lenient or less rigorous requirements for claiming a personal exemption have higher rates of exemptions. More troubling, states that made it easy to get exemptions had 90 percent more cases of whooping cough than states with more stringent requirements.
What would change under HB 1288?
First introduced in February, the amended HB 1288 contains several key provisions that—among other things—offer parents, educators and others new ways to access important information about vaccines and school-level immunization rates. The bill does not eliminate or change the process for claiming a personal exemption (except for perhaps changing the frequency with which parents have to submit an exemption). Instead, it focuses on strengthening what we know about vaccine safety and risks and exemption policies and helping parents and others make informed decisions about:
Vaccine risks and benefits. The bill directs the Colorado Department of Public Health and Environment to develop rules and evidence-based vaccine resources, including an online module—akin to a web-based mini-course—devoted to explaining the risks and benefits of vaccines. Although reputable resources exist already, the bill would support a comprehensive, one-stop resource. For parents and others that want to weigh the risks and benefits of vaccines before making their decision, comprehensive resources like these offer an important first step in educating and empowering the public to make informed decisions.
Vaccination and exemption rates in schools. For the first time ever, parents and others would be able to find out what percentage of children are immunized, and what percentage of parents have claimed a personal belief exemption at a specific school or child care center. (This information would be anonymous and in compliance with FERPA and HIPAA privacy laws.) As a parent, I must admit I have assumptions that most kids in their schools are immunized, but in truth, I really do not know. This information is especially important for parents of medically-fragile kids who are at higher risk for vaccine-preventable diseases and for those in child care who are too young to have received all doses.
The bill covers other issues, including support to help schools analyze and interpret immunization data, as well as a requirement that the state develop rules about how often parents must claim exemptions. A regular renewal process makes sense, especially in cases where parents claimed a personal exemption out of convenience—say, they didn’t know if their child had received a particular immunization, they recently moved and didn’t have a doctor, or simply couldn’t get their child into the doctor before school started.
For parents, though, the legislation matters because it offers new tools and credible information to help us make informed decisions. I am not sure how I would react, or what my next steps would be if I learned that my daughter’s school had a high number of under or unimmunized peers. But if knowledge is power, as the adage goes, the bill takes important steps toward ensuring that we have the knowledge and tools we need to make thoughtful, but informed decisions.