Growing vaccine resistance in Texas: A policy opportunity to involve doctors and protect children

Texas is a hotspot for both preventable infectious diseases and anti-vaccine sentiment. This is especially true in the state capital of Austin, which is experiencing a rise in anti-vaccine groups and the circulation of a new documentary advocating against vaccination. For over a decade, vaccination rates of school children have steadily declined while conscientious nonmedical exemptions, or those obtained only on the basis of religious or personal beliefs, have risen to a record level. Almost 45,000 Texas children received nonmedical exemptions for vaccinations in the 2015-16 school year, compared to 2,314 in 2003-04. This increase affects not only the health of the child, but also that of the community, especially individuals who are immune-compromised, including the sick, elderly and young children. To curb the use of nonmedical exemptions in Texas and protect public health, state legislators should revise the school-entry vaccination exemption policy to require that the form be submitted annually and include a physician’s signature. Furthermore, an exemption should only be granted after a physician has reviewed the risks to the child and the community of opting out of vaccination.

Vaccines present minimal risks and high rewards for society. A vaccine works by mimicking a virus or bacteria in order to build the body’s preliminary immune defense against future exposures. It undergoes rigorous testing by the U.S. Food and Drug Administration (FDA), and vaccine guidelines are developed and reviewed by the Advisory Committee on Immunization Practices in the U.S. Centers for Disease Control and Prevention (CDC). Contrary to the common claims by anti-vaccine groups, CDC-approved vaccines have been determined to be safe and effective with minimal side effects. For instance, the combined measles, mumps and rubella (MMR) vaccine results in a serious allergic reaction in only one out of a million doses. Severe problems are so rare that the CDC is uncertain whether they result from the vaccine itself or are coincidentally timed. What’s more, a high percentage of immunized individuals in a given population protects those who cannot get vaccinated for medical reasons, and prevents and reduces the frequency of disease outbreaks. In contrast, the risk of an outbreak increases with the number of nonmedical exemptions. This was demonstrated by a 2013 measles outbreak originating at a church near Fort Worth, where more than 10 percent of the congregation refused vaccines, as well as the highest annual statewide whooping cough incidence since 1959, also in 2013.

The anti-vaccine movement is rooted in a debunked 1998 study by former British medical researcher Andrew Wakefield, who claim that autism was linked to the MMR vaccine. In addition to pseudoscience and exaggerated testimonials, advocates employ celebrities who garner considerable support in their rejection of vaccines and promotion of alternative practices. Anti-vaccine narratives are a powerful tool for “anti-vaxxers” to instill doubt in, if not entirely discourage, parents who are on the fence.

The Baker Institute report “How Too Much Freedom of Choice Endangers Public Health: The Effect of Nonmedical Exemptions from School-Entry Vaccinations in Texas describes the risks for Texans as vaccination rates decrease, and recommends specific legislative action for the 2017 session. It is critical that our state legislators recognize the cost to the public of Texas’ exemptions policy. Current Texas policy permits opting out after a parent submits an affidavit; this is good for two years. The procedure should be amended to require an annual affidavit submission with a physician’s signature. The physician should also provide information to the parent on the individual risks of and harm to the community from vaccine refusal. The oversight of a health care provider will help inform the decisions of parents, as well as their understanding of the risks that vaccine refusal poses to their child and community. Improving accountability for publishing vaccination and exemption rates will also increase community awareness and better inform parents who are deciding where to send their children to school. Increasing vaccination rates throughout the state will help prevent future outbreaks of preventable diseases, which require millions of dollars for emergency response measures and compromise public and personal health. Reforming school-entry vaccination exemption policies will maximize public health benefits, cut health care costs and uphold personal liberties through increased informed consent.

Jackie K. Olive, a Rice University senior, is an intern for the Biomedical Policy Program in the Baker Institute Center for Health and Biosciences. Kirstin R.W. Matthews is a Baker Institute fellow in science and technology policy.