Students exempted from vaccinations for conscientious reasons are enrolling at Southwest Austin private schools at a steady rate.

Data for Oak Hill’s Austin Waldorf School shows roughly 49 percent of the school’s students received conscientious exemptions during the 2016-17 school year, the highest percentage in the state.

Kathy McElveen, general school leader for the Austin Waldorf School, said many of her students are either on a delayed immunization schedule or are only exempt from a select number of vaccines; however, those children are still labeled as exempt.

“We don’t talk about [immunizations] as a school with our parent body and take no position,” she said. “We simply badger them to make sure we have all of our records up to date and in compliance.”

In 2003, Texas lawmakers made it legal for parents to seek conscientious exemptions. Previously, only medical or religious reasons were considered.

Austin ISD has seen a slower growth in its rate of conscientious exemptions compared to its private school counterparts. Public school districts, charter schools and accredited private schools are required by law annually to report the number of conscientious exemptions to the Texas Department of State Health Services. In the 2016-17 school year, the rate of AISD students who filed for conscientious exemptions rose to 2.17 percent—more than double the state average.

Dr. Stephen Pont, medical director for AISD Student Health Services and a pediatrician at Dell Children’s Medical Center, said although AISD still maintains a self-imposed vaccination benchmark of 95 percent of students or more, the increase in conscientious exemptions is troubling.

“Pediatricians understand the value, safety and protections immunizations create, so if any child or a number of children are not fully immunized, that makes us very concerned and worried,” Pont said.

THE OPPOSITION

Certain groups advocating for laws requiring doctors to inform patients about the risks of immunizations argue pro-vaccine lobbyists and the media mislead the public through how they publicize vaccine-exemption data.

Exemption rates should be reported based on how many children have received each individual vaccine, according to local advocate Dawn Richardson, co-founder of statewide organization Parents Requesting Open Vaccine Education and director of advocacy for the National Vaccine Information Center.

“A vaccine exemption is required to be filed if a kid is missing one dose of one vaccine, all the way through all doses of all vaccines,” she said. “Saying exemptions are going up is creating misconceptions and fears, when really the number of kids vaccinated for each individual vaccine has stayed the same or gone up [since 2003].”

A state report titled “Vaccination Coverage Levels in Texas Schools” shows although the percentage of conscientious exemptions for each vaccination has increased steadily each year since the exemption legislation passed in 2003, the percentage of fully vaccinated children has remained mostly the same, ranging from approximately 95 to 100 percent.

“There is no effect on Texas vaccine rates based on the institution of exemptions,” Richardson said.

The rate of exemptions for each vaccination based on medical reasons has also remained steady, the data shows. The number of students classified under “provisional enrollment,” or in the process of becoming fully vaccinated, has fluctuated since 2003, but in many cases, such as with the hepatitis B and polio vaccines, exemptions have decreased.

Richardson said two key pieces of information could explain why the rate of conscientious exemptions increased in recent years. First, the vaccinations required as part of the state-mandated immunization schedule has more than doubled since 2000, leading to more conscientious exemptions being filed. Second, the population of Texas has increased, resulting in more families electing for conscientious exemptions.

EXEMPTION DEMOGRAPHICS

A government study of data from the 2009 National Immunization Survey found parents who delay or refuse vaccinations for their children are more likely than the average person to have graduated from college and have an annual household income of at least four times the federal poverty line, among other factors associated with higher socioeconomic status.

In Austin the median 2015 annual household income was $53,889, according to U.S. census surveys. Among adults age 25 and older, 20 percent had at least a bachelor’s degree compared to 30 percent nationwide.

Of the seven accredited private or charter schools in Southwest Austin for which immunization statistics are readily available—Austin Montessori School, Austin Waldorf School, Bannockburn Christian Academy, Regents School of Austin, St. Andrew’s Episcopal School, Veritas Academy and Wayside Schools—tuition cost, excluding fees, ranges from free to approximately $18,000 per year.

Richardson said high exemption rates are more common at private schools because many parents who elect for conscientious exemptions seek to surround themselves with other likeminded individuals who believe in non-pharmaceutical-based health and alternative education philosophies.

“Typically at private schools you have families less interested in traditional forms of education, and, in some cases, alternative and complimentary medicine,” she said.

The study also found parents who delayed and refused vaccines are more likely to be white than those who neither delayed nor refused vaccines.

Kelly Hood, operations director at Veritas Academy, said a variety of reasons may cause Veritas parents to elect for conscientious exemptions for their children, including adverse reactions to previous shots or concerns about new or large-combination vaccines.

Since 2012 conscientious exemptions at Veritas Academy have fluctuated between 8 to 18 percent, or 47 to 96 students. School year 2016-17 statistics show approximately 15 percent of students electing for conscientious exemptions, nearly double the percentage from the previous school year.

“We are aware of our rate of exemptions and find it to be in the low range of the reports of other private schools in our area, some of whose exemptions rates are in the top 20 to 40 percent,” she said. “Our office staff remains apprised of our rate of exemptions and follows the protocol for schools that the state provides for reporting cases of communicable diseases.”

Data from the 2016-17 school year show nearly 16 percent of students at Bannockburn Christian Academy electing for a conscientious exemption, almost double the percentage of students exempted from the prior school year. Principal Bobbi Flowers said the school ensures the health of its students by adhering to state immunization requirements.

“If children show symptoms of communicable disease, the child is isolated, and parents are contacted for an immediate pickup,” she said.

THE ALLEGED RISKS

The Centers for Disease Control and Prevention analyzed survey responses from a sample of 11,206 children and determined vaccinations were less likely across the board if the child’s parents believed vaccinations could result in serious side effects or that too many vaccines could overwhelm a child’s immune system.

Pont pointed to the alleged link between immunizations and autism as a primary concerns for parents electing for conscientious exemptions.

“That has absolutely never been proven, and there have been many studies showing there is no link,” he said.

Still, advocates, such as Richardson, refer to statistics showing an increase in the number of children diagnosed with diseases, such as autism, childhood cancers, diabetes and auto-immune diseases, and she claims parents have a right to a healthy amount of suspicion about those increases.

“We have reached an all-time high of vaccination rates at the same time the health of our children has plummeted,” she said. “It’s a fair question.”

HERD IMMUNITY

The trend of conscientious exemptions, if it continues on its current trajectory, threatens to undermine what vaccine researchers call herd immunity. A population’s high vaccination rate helps slow the spread of vaccine-preventable diseases, protecting the unvaccinated and people for whom vaccines are not fully effective.

According to Pont, when the rate of vaccinations decreases, it puts not only the children who are not immunized at risk, but also other children.

“The additional impact [of vaccines] is that if everyone else is immunized, it gives me even more protection, because it makes it less likely that I will encounter an illness and my immune system will have to fight against it.”

Richardson disputed the legitimacy of herd immunity, claiming that because immunization requirements have increased over the years, many adults today do not have the same vaccinations as children on today’s immunization schedule.

“We don’t have herd immunity for any disease because we don’t have high enough vaccination rates across all age groups, and we are all a part of the herd,” she said.

MITIGATING EXEMPTIONS

The state agency that compiles the district exemption rates each year does not analyze the data in great detail, leaving that up to independent researchers, DSHS spokesperson Chris Van Deusen said.

Because state law allows exemptions, there are limited tools for addressing vaccination rate increases.

“We can’t twist people’s arms, and we can’t force vaccinations because exemptions are legal—that’s a right that people have,” Van Deusen said.

The unintended consequences of immunizations, Pont said, is that they have been so effective in preventing life-threatening diseases that the general public no longer worries about the consequences of not being vaccinated.

“Immunizations are so effective, society has forgotten its memory of what these illnesses look like,” he said. “We don’t want to forget the seriousness of these illnesses that immunizations are preventing.”

Daniel Houston contributed to this story