With more than 100 cases of measles in the U.S. since January, a hard light is being cast on the growing number of schoolchildren exempted from vaccinations for nonmedical reasons — a number that has tripled in Texas in six years.
Central Texas is among the state’s hotbeds for what are called conscientious exemptions, vaccine waivers allowed for religious and philosophical reasons. Such exemptions at public and private schools in Travis, Williamson and Hays counties were more than double the state rate for most of the last six years, according to an American-Statesman analysis of data from the Texas Department of State Health Services.
Nearly half of the students in one Austin private school have the exemptions, giving that school the second-highest rate in the state. Right behind is another Austin school, where more than a third of the students have such waivers.
Although conscientious exemptions were given to 38,197 students — less than 1 percent of the state’s 5.1 million schoolchildren last school year — rates have risen steadily in six years, from 0.23 percent in 2007-08 to 0.75 percent in 2013-14. The exemptions don’t include medical waivers, which parents request for children who have health conditions that preclude vaccination. There were far fewer medical waivers than the exemptions covering personal and religious beliefs.
“The growing number of folks who waive vaccination is worrisome,” said Scott Lillibridge, a family medicine doctor, professor at the Texas A&M Health Science Center School of Public Health and chief scientist at A&M’s vaccine development and manufacturing center. “We know if vaccination rates fall off, we start to see measles transmitted from person to person.”
Texas is among 20 states granting waivers for personal, moral and religious beliefs. Most other states allow religious and medical exemptions only. And just two states, Mississippi and West Virginia, restrict waivers to medical reasons only.
Of grave concern to public health authorities is the resurgence of vaccine-preventable diseases. Measles is one of them. It was virtually eradicated in the United States in 2000, but last year the federal Centers for Disease Control and Prevention counted 644 measles cases in 27 states. And so far this year, it has reported 102 cases in 14 states, including Texas. Most of those cases — though not the one in Texas’ Tarrant County — are connected to an outbreak last month at Disneyland in California.
California, like Texas, grants conscientious exemptions from vaccination. On Wednesday, U.S. Sens. Barbara Boxer and Dianne Feinstein, both California Democrats, urged state officials to stop the practice.
“While a small number of children cannot be vaccinated due to an underlying medical condition, we believe there should be no such thing as a philosophical or personal belief exemption, since everyone uses public spaces,” the senators said in a letter to California’s top health official. “As we have learned in the past month, parents who refuse to vaccinate their children not only put their own family at risk, but they also endanger other families who choose to vaccinate.”
Since the measles outbreak, some parents who refuse to vaccinate their children say they are being vilified. Some doctors have said they would reject such children as their patients. And a Hastings College law professor told The Atlantic that parents might consider suing parents of an unvaccinated child for causing the serious illness or death of another child.
Conscientious objectors to vaccination cross the political spectrum, just as vaccination supporters do. Some parents object because they favor a more natural way of keeping their children healthy, one that doesn’t include pharmaceuticals. They question the safety and effectiveness of vaccines. Some still believe vaccines cause autism, despite rigorous research to the contrary. Others contend the government has no right to force vaccines on their children.
“A one-size-fits-all forced vaccination policy fails to acknowledge risk based on family history,” said Dawn Richardson of Austin, president of Parents Requesting Open Vaccine Education and director of advocacy for the National Vaccine Information Center. “People should always have a choice and not be forced. They have to evaluate the efficacy of the vaccine, the safety of the vaccine and compare that to their health circumstances.”
Experts say no vaccine is 100 percent effective or free of any side effects. Although some children might have a reaction to a vaccine, such reactions are uncommon, experts say.
“In multiple studies done by the finest institutions, the benefits of immunization far, far outweigh the risks,” Lillibridge said. “In my experience in dealing with outbreaks all over the world, the key issue is: What is the vaccination rate of this population? If it’s low, you’ve got a problem.”
About 95 percent of the population should be vaccinated to promote “herd immunity,” or protection for those who haven’t developed immunity to a disease, including babies too young to vaccinate, Lillibridge said.
Autism claim discredited
People have a choice in vaccinating, but the science sometimes is lost, creating an opportunity to educate the public, said Richard Rupp, a pediatrician and director of the University of Texas Medical Branch at Galveston’s office of vaccine clinical trials. “We need to increase science literacy and teach kids how to critically think, emphasizing that not vaccinating is a selfish act. You’re putting the most vulnerable at risk.”
Measles is a serious illness with symptoms that can include fever, cough, runny nose, sore throat, inflamed eyes, a skin rash and tiny white spots inside the mouth. About 1 in 4 unvaccinated individuals who get measles is hospitalized and 1 in 500 might die, said Texas health department spokeswoman Christine Mann.
In addition to a single measles case this year in Texas, the state had 10 last year and 27 in 2013 — most of them clustered in Tarrant and Denton counties. No one died, Mann said.
“Before the vaccination program in 1963, about 3 to 4 million people in the U.S. got measles, and 400 to 500 died each year,” Mann said.
Research in 1998 that suggested a link between autism and the measles, mumps and rubella vaccine, called the MMR, launched a worldwide vaccine scare. The work led by Andrew Wakefield, who now lives in Austin, has been discredited, and he was stripped of his medical license in England.
Still, the scare lives on.
Richardson said many parents told her over the years their child regressed after vaccination “before Andy Wakefield published anything.”
“The jury is still out on the long-term effects” of vaccines, she said.
Another concern is the number of vaccines and doses required, she said. Some parents who want to spread them out have to get an exemption. “You can’t equate a waiver to unvaccinated child,” Richardson said.
Texas requires schoolchildren to get seven vaccinations, some with multiple doses, Mann said, and parents can request exemptions every two years in the form of a notarized affidavit. Not all students whose vaccinations are late or who enter kindergarten without being immunized have to seek an exemption, Mann said.
MMR vaccination rates among children ages 19 months to 35 months in Texas were 92.7 percent in 2013, according to the National Immunization Survey. The national rate was 91.9 percent.
Whooping cough outbreaks
Travis and Williamson counties have seen serious outbreaks of pertussis, or whooping cough, in recent years. Statewide in 2013, there were 3,985 pertussis cases, the most since 1959. Eleven percent of patients were hospitalized; five died, all babies younger than 1.
Williamson County had a slightly higher rate of conscientious exemptions in 2013-14 — 2.1 percent (2,350 of its students) versus 1.75 percent (2,913 students) in Travis County, according to state data.
Even so, two of the highest exemption rates among private schools and public school districts in Texas last year belonged to Travis County schools: the Austin Waldorf School, where 48.2 percent, or 188 students, had conscientious exemptions, and the Austin Discovery School, where 129 students, or 34.5 percent, did, state data show.
Waldorf general school leader Tim Daulter said he wasn’t surprised at his school’s percentage. “A lot of the families who come here have a natural and holistic view of life and health care,” he said, adding that the school neither encourages nor discourages vaccination.
Smaller populations at schools can cause them to rank high in Texas for exemptions, including Travis County’s St. Mark’s Episcopal Day School and Rawson Saunders School, which had just 12 student exemptions each. The Calvert school district in Robertson County, just east of Temple, is highest in the state with 124 exemptions, a number that represents nearly three-fourths of its students. Superintendent Maxie Morgan said he doesn’t believe the number is correct. He added that the poor, largely African-American district is trying to raise immunization rates.
The Denton school district was the next-highest district in the state, with 12.4 percent, or 3,647 students with exemptions. District spokesman Mario Zavala said the number wasn’t correct because the district reported each vaccination the student skipped, meaning many students were counted multiple times. The correct percentage is 1.3, 352 students, for 2013-14, he said.
Mann said she was unaware of any errors in the data her office reported.
Rupp, the UTMB vaccine expert, said he worries what might happen if more people shun vaccinations.
“I don’t think families believe the diseases are actually out there until it hits home,” Rupp said. “They don’t get to see whooping cough and what it does it to babies … and they don’t know how sick measles makes children and adults.”
Interactive maps and charts show conscientious vaccine exemption rates for Texas counties and how many exemptions are being granted in each private school and public school district.
Mary Ann Roser has provided in-depth coverage of Central Texas health and medical issues since 2000. Her training includes national fellowships at the Massachusetts Institute of Technology, the U.S. Centers for Disease Control and Prevention and the National Library of Medicine. Her awards include a first place in 2012 for specialty reporting from the Texas Associated Press Managing Editors.
Conscientious exemptions, 2013-14
By school and school district:
• In Williamson County school districts where more than 1 percent of the students had conscientious exemption were Coupland, 7.5 percent; Lago Vista, 3.6 percent; Leander, 2.6 percent; Liberty Hill, 1.9 percent; Round Rock, 1.8 percent; Hutto and Jarrell, 1.5 percent; and Georgetown, 1.4 percent.
Among private schools in Williamson, 37 students at Sterling Classical School have exemptions, or 17 percent of the student body — fourth-highest among districts and private schools in Texas.
• In Travis County, the Austin school district reported 1.6 percent of it students had the waivers, more than in Pflugerville, Manor, Eanes and Del Valle but fewer than the 2.7 percent in Lake Travis.
A private school and a charter school in Travis ranked No. 2 and 3 in the state for the percentage of students with conscientious exemptions: Austin Waldorf School, where 48.2 percent of students had waivers, and Austin Discovery School, where 34.5 percent did.
Other private schools in Travis County with double-digit conscientious exemptions last school year were Veritas Academy, 12.3 percent; St. Mark’s Episcopal Day School, 11.3 percent; ACE Academy, nearly 11 percent; and Rawson Saunders School, at 10.4 percent.
• In Hays County, the school district with the highest percentage of conscientious exemptions last year was Dripping Springs at 4.1 percent. Next was the Hays district, with 1.4 percent, according to the data.
• In Bastrop County, the Smithville district had the most, with 1.9 percent.
SOURCE: Texas Department of State Health Services
Correction: This story has been updated to correct the type of school that Austin Discovery School is.