• Make it easier to avoid vaccines, and people will skip them

    This one is pretty much common sense, but it bears highlighting. “Exempting Schoolchildren From Immunizations: States With Few Barriers Had Highest Rates Of Nonmedical Exemptions“:

    Rates of nonmedical exemptions from school immunizations are increasing and have been associated with resurfacing clusters of vaccine-preventable diseases, such as measles. Historically, state-level school immunization policies successfully suppressed such diseases. We examined state immunization exemption regulations across the United States. We assessed procedures for exempting schoolchildren and whether exemption rates were associated with the complexity of the procedures. We also analyzed legal definitions of religious objections and state legislatures’ recent modifications to exemption policies. We found that states with simpler immunization exemption procedures had nonmedical exemption rates that were more than twice as high as those in states with more-complex procedures. We also found that the stringency of legal definitions of religious exemptions was not associated with exemption procedure complexity. Finally, we found that although there were more attempts by state legislatures to broaden exemptions than to tighten them in 2011–13, only bills tightening exemptions passed. Policy makers seeking to control exemption rates to achieve public health goals should consider tightening nonmedical exemption procedures and should add vaccine education components to the procedures by either mandating or encouraging yearly educational sessions in schools for parents reluctant to have their children vaccinated.

    Readers of the blog know my feelings about vaccines. Get them. They work. They are probably one of the most significant health advances ever. But people still try to avoid them.

    This is a problem, because for vaccines to achieve their full potential, we need a significant percentage of the population to be vaccinated. It’s not enough to get the shot yourself. We also need others to get them. When outbreaks occur, you’re less likely to get infected if you’ve been immunized, but it still happens. The best protection is if everyone is immunized.

    One way we’ve tried to achieve this goal in public policy is to require vaccines for school entry. But, being a free country, we’ve always allowed some exemptions, especially for religious reasons. But exemptions in the past were mostly rare. They’re becoming more common.

    This study looked at immunization rates in states that have various levels of difficulty for obtaining exemptions. What they found isn’t surprising, but it’s still important. States with few barriers to exemptions had higher rates of exemptions than states with more barriers to exemptions. If you make it easier not to get vaccinated, more kids don’t get immunized.

    What surprised me more is the discussion of recent policy initiatives. The bad news is that there are more state level attempts to broaden exemptions than narrow them. The good news is that the only measures that pass seem to be those that narrow them.

    There is a growing movement to make vaccines optional, or avoid them altogether. This is a real mistake. Don’t believe the hype. Get your kids immunized.


    • People still think that getting a vaccine is a totally personal issue, when in fact it is an issue fraught with huge externalities. For one, we do owe it to all our immune-compromised friends to get vaccinated, because they can’t. Second, our vaccination strategies only work if everyone gets them. The polio vaccine we use these days, for example, is only around 70% effective, which means that if we make it optional, it will only control polio about as much as flu vaccines have been able to control the flu. If a large portion of the population stops getting the dead-virus polio vaccine, then those who do want to be protected will have to switch back to the more-effective but riskier live-attenuated oral vaccine, which is simply a risk that they shouldn’t have to take.

    • And, on the other hand, I grew up in Singapore, and they lined us up in elementary school and vaccinated us. For free. There were no exceptions.

      We appreciated it because we got the time out of class, and us boys got to compete for who could bear it the most stoically. And in retrospect, it was also great public policy, and I assume it is.

      They also made us go down to the nurse’s office, and she cleaned our teeth. Once every year.

      Conservatives who tout Singapore’s healthcare financing system, please also take note of this. Liberals also.

    • I would say that the vaccine is probably the most significant health advances ever.

    • I realize more & more that humans, collectively on a civilization scale seem to have a very short memory.
      Again & again, the lesson has to be learned the hard way… or it is forgotten within a generation or less.
      I suppose it’s maybe just a lucky wonder that a number of scientists of various kinds manage to save work that has gone before & build upon it over centuries.

      When I was a kid it seemed vaccinations were just an excepted given, and much admired and revered thing… always if mentioned it was accompanied by horror stories from parents & grandparents, describing what terrifying plight and doom the vaccinations were saving us from.
      Books & documentaries about these things of course are still available. But I guess it’s just not quite the same as hearing it from grandma.