Conscientious exemptions to immunizations among grade-school students in Williamson County are at the highest rate they have been in the past eight years, at the same time that Texas health officials have confirmed multiple cases of measles—a highly contagious disease routinely targeted by childhood immunizations—across the state in 2019.

According to data from the Texas Department of State Health Services, 2.33% of Williamson County students in kindergarten through 12th grade received a conscientious exemption to at least one immunization during the 2018-19 school year, which is above the statewide rate of 1.2%.

Dr. Caroline Hilbert, the director of immunization advocacy for the Williamson County and Cities Health District, said the Central Texas area sees lower immunization rates due in part to two particular economic groups: families below the poverty line and those who are wealthier.

“It’s these two extremes where it’s a mix of higher-educated, well-off, misinformed individuals making decisions that are affecting their child’s health and community’s health, and then individuals from families who just are struggling to make ends meet,” she said.

In Georgetown ISD, the conscientious exemption rate was at 2.36% of all students during the 2018-19 school year, an increase from a 1.43% rate reported in 2013-14, according to the state data. The exemption rate at GISD has gradually climbed over the past five years and has consistently remained above the statewide rate each year.

Parents and guardians who seek exemptions for their children often cite concerns over what they see as a lack of assurance regarding the safety of vaccines used for immunizations and an absence of liability for vaccine manufacturers.

Conscientious exemptions

Without exemptions, families of children attending school in Texas are required to prove that they have been vaccinated to the minimum state requirements. Per state law, parents and guardians may elect not to administer vaccines to their children under medical or conscientious exemptions.

Medical exemption statements may be written by physicians to excuse individuals who would be medically harmed by the vaccines, such as due to an allergy or chronic condition. Conscientious exemptions, however, are provided for children of parents who voluntarily decide to decline vaccinations for reasons of conscience, such as a religious belief.

Some local private schools have conscientious exemption rates well above that of GISD. More than 21% of students at Goodwater Montessori School and more than 18% of students at Grace Academy of Georgetown had conscientious exemptions in 2018-19, per the DSHS.

Conscientious exemption rates do not necessarily represent the number of completely unvaccinated children at a school, but rather the number of children with a conscientious exemption to at least one vaccine.

Hilbert said one of the reasons private schools have lower immunization rates could be that parents seeking a private education for their children often exercise similar control regarding their children’s health, she said, even if those decisions are misinformed and negatively impact their children and community.

Raising concerns

There are a variety of reasons why parents and guardians decide to opt out of vaccinating their children. Michelle Evans—the former communications director and founding member of Texans for Vaccine Choice, a political action committee that advocates for conscientious exemptions—said most of the families she knows who opt out of immunizations previously vaccinated, but decided to stop after what they found to be adverse reactions to the vaccines.

Evans, who is no longer involved with Texans for Vaccine Choice in an official capacity, said she followed the recommended vaccine schedule for her first child, who experienced reactions. Evans decided to pick and choose which vaccines to give her second-born child, and after she, too, had a series of reactions, Evans decided not to vaccinate her third child at all.

Representatives from Texans for Vaccine Choice did not respond to interview requests.

She did not seek medical exemptions for any of her children because of the conscientious exemptions available to them.

“It’s a basic human right that we not be forced to undergo any medical procedure,” Evans said. “It’s something that I should have the choice to accept or deny based on any reason I feel is valid; I don’t need to have those reasons validated by somebody else. … It’s not really anybody’s business why I would choose to have this not done for my children or myself.”

Jinny Suh is the founder and leader of Immunize Texas, an advocacy group promoting immunizations. She said the issue is impactful for the entire community because an individual’s decision not to vaccinate can harm others by weakening herd immunity.

“The idea behind herd immunity is at a basic level cutting off the potential places where a pathogen can jump to from a person who’s infected,” Suh said. “When you have drops in immunization rates you’re just allowing for more places for that germ, that pathogen … to continue growing and propagating and continue infecting.”

She said oftentimes people are contagious before knowing they have a communicable disease and thus expose others to it.

“So that’s the reason why we try to focus so much on immunization rates … because as a society we have an interest in making sure our communities don’t suffer from an outbreak,” she said. “In order to have that protection for the community, you have to focus on the immunization rates for the community and not just on an individual vaccination status.”

The World Health Organization lists “vaccine hesitancy” as one of its top 10 threats to global health in 2019. According to the organization, vaccines prevent 2 million-3 million deaths per year across the world, and if coverage of vaccinations improved, another 1.5 million deaths could be prevented.

In 1986, Congress approved the National Childhood Vaccine Injury Act, which reduces liability for vaccine manufacturers and health care providers who are sued by people who believe they have been injured by vaccines. The Centers for Disease Control and Prevention states on its website that damages awarded for vaccine injury claims rose the cost of vaccines in the 1970s, and some manufacturers stopped production, resulting in a shortage that was solved by the passage of the act.

Vaccines must be tested extensively prior to licensure through the Food and Drug Administration, according to the CDC. After licensure and implementation, the FDA monitors vaccine samples and reactions to vaccinations through the Vaccine Adverse Event Reporting System.

Hilbert said the benefits of immunizations far outweigh the risks of adverse effects.

“Nothing in the world is 100% safe, and with vaccines they’ve shown that there’s a one in a million to one in 2 million chance that you can have really severe side effects from a vaccine,” she said. “From a public health standpoint and [with] how deathly a lot of these diseases can be, that’s the individual, very minimal risk that we take on for the protection of our population as a whole.”