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Vaccine exemption bills often introduced but rarely passed

By Andrew M. Seaman

NEW YORK (Reuters Health) - Legislation to change whether parents may refuse school vaccinations for their children appears to be common in some states, according to a new analysis. However, those bills are rarely passed into law.

Researchers identified 36 bills that were introduced in 18 state legislatures between 2009 and 2012 to change school immunization requirements. Most of those bills aimed to allow more parents the ability to refuse vaccinations for their children.

"Previous studies have shown that high vaccine refusal rates tend to increase the risk of vaccine preventable disease in the whole community - including for those who are vaccinated," Dr. Saad Omer told Reuters Health in an email. "Therefore, it is in everyone's interest to ensure that their community has high vaccination rates."

Omer is the lead author of the analysis and a vaccine expert from Emory University in Atlanta.

One reason for high immunization rates in the U.S. is the use of school mandates that require children to have certain vaccinations, write Omer and his colleagues in a research letter published in the Journal of the American Medical Association (JAMA).

The requirement that children be immunized to attend school differs from state to state, however. Each state is allowed to set its own rules on vaccine exemptions.

For example, some states allow parents to refuse to have their children immunized because of personal or religious beliefs. Those laws also differ in what states require a parent to do to obtain a vaccine exemption, such as getting a doctor's signature.

For the new analysis, the researchers used information from a database that tracks vaccine-related legislation.

Overall, there were 36 exemption-related bills introduced in 18 states from 2009 through 2012. Of those, 30 bills were introduced in 12 states that did not already allow vaccine exemptions based on personal beliefs.

About 86 percent of the bills sought to expand access to exemptions while the remaining bills sought to restrict exemptions.

None of the bills attempting to expand access to vaccine exemptions passed into law, but Washington, California and Vermont each passed laws to restrict exemptions.

Omer and his colleagues caution that their analysis may have missed some bills introduced during that time even though they used a comprehensive database. But that shouldn't sway the results in one direction over the other.

"Concerted efforts by individual clinicians and professional associations can benefit the legislative process by emphasizing public health considerations and the use of science in developing public policy," Omer wrote.

Tony Yang, who researches school immunization laws at George Mason University in Fairfax, Virginia, told Reuters Health the new analysis may not give an accurate picture of what is currently going on with state legislation.

"The JAMA letter is about the bills introduced between 2009 and 2012," he said. "It looks like things may have changed."

Yang, who was not involved with the new study, said there are currently about 50 laws about immunization requirements in front of state legislatures, but only a handful address childhood vaccinations.

The other bills, he said, address - among other things - who can give people their shots and whether people in certain professions need to be immunized.

He also stressed that bills don't always make it into law and may have little effect on vaccination rates.

SOURCE: http://bit.ly/1kCbUfo Journal of the American Medical Association, online February 11, 2014.

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