Pediatric Infectious Diseases Society Rejects 'Personal Belief' Immunization Exemptions

Research has shown that children who are exempted from vaccinations have a 35-fold higher risk for measles, a 23-fold higher risk for pertussis and a nine-fold higher risk for varicella than do vaccinated children.

Citing these and similar statistics, the Pediatric Infectious Diseases Society, or PIDS, recently released a position statement (7-page PDF; About PDFs) opposing any legislation or regulation that would allow children to be exempted from mandatory immunizations based on their parents' -- or, in the case of teens, their own -- secular personal beliefs.

"More personal exemptions mean more children who aren't vaccinated," said Paul Hunter, M.D., associate medical director for the City of Milwaukee Health Department and one of three former AAFP vaccine science fellows who recently talked to AAFP News Now about immunization policies. "You have to have a high percentage of children vaccinated to have herd immunity and prevent disease spread. If you get clusters of people in a community using personal exemptions, that's when outbreaks happen. That particular community is going to be at risk."

All states allow children who have medical contraindications to immunization to opt out, the PIDS statement notes. Most states also permit parents to exempt their children from vaccination based on their religious beliefs, although the degree to which parents must prove or document such beliefs varies greatly from state to state. In some instances, for example, parents need only state that their religion opposes vaccination to be granted exemption, despite the fact that "no major religions specifically discourage exemptions," the statement points out.

Finally, says the statement, some states allow an exemption to be made based on parents' personal secular beliefs.

As the PIDS statement observes, however, states do not allow religious or personal belief exemptions in other instances meant to safeguard children's health, such as requiring them to ride in car seats until they reach a certain age and weight threshold. "In this context, it is wrong to allow parents to exempt their children from required immunizations based on their personal beliefs," says the statement.

With this in mind, the statement calls for any legislation or regulation regarding personal belief exemptions to contain the following provisions to minimize use of exemptions:

Vaccine science fellow Jamie Loehr, M.D., said 20 percent of families in his practice in Ithaca, N.Y., refuse all vaccines, and 30 percent use a delayed vaccination schedule. Loehr said he tries to overcome vaccine resistance with education, and some parents who had refused to vaccinate their children in the past now are starting to accept immunizations.

"I tell them that if they are coming to me, they have to politely listen to me advocate for vaccines with each well-child visit, even if they know they are going to refuse vaccines," Loehr said. "At the visits, I share stories of vaccine illnesses that have affected children in the U.S., I discuss vaccine success stories, and I refute any misinformation they have about vaccines."

Last year, the CDC, in collaboration with the AAFP and the American Academy of Pediatrics, released free resources to help physicians talk with parents about vaccinating their children. The materials include information for parents about vaccine safety, the diseases that vaccines prevent and the risks associated with not vaccinating.

According to Everett Schlam, M.D., assistant director of Mountainside Family Practice Associates in Verona, N.J., and a 2009-10 vaccine science fellow, listening to parents' concerns about vaccines is an important part of getting them to listen to the physician's perspective.

"A significant percentage of parents can be persuaded if you understand their point of view," he told AAFP News Now. "I find out why they're resistant. Then I validate that reason: 'I understand why you feel that way.' Then I go through the evidence-based information and give them a strong recommendation: 'I receive the vaccine myself and recommend it for my family members. It's an important health care strategy.' It's education. It does take time, but I've found it successful."