The graphics have been updated to reflect that Montgomery Covenant Christian School has a 10.03% conscientious vaccine exemption rate and Montgomery Lifestyle Christian School has a 13.71% conscientious vaccine exemption rate, and the X-axis has been corrected to scale.
Despite being considered eradicated across the U.S. in 2000, the measles virus is back with 1,022 confirmed cases as of June 6 nationwide this year—including at least one in Montgomery County, according to the Centers for Disease Control and Prevention.
Meanwhile, vaccine exemption rates are increasing across Montgomery County, which has the 25th-highest rate of vaccination exemptions in 2017-18 for reasons of conscience out of 254 Texas counties.
As a whole, Montgomery County schools have seen an 83% increase in conscientious exemption rates from the 2011-12 school year to 2017-18, according to the Texas Department of State Health Services.
The rate of conscientious vaccine exemptions at Conroe, Montgomery and Willis ISDs were all higher than the state average of 1.07% in 2017-18.
Misti Willingham, a public information officer for Montgomery County Public Health District, said people who cannot be vaccinated for medical reasons—because they are too young, elderly, immunocompromised or pregnant—are most endangered by the measles virus.
“I’m a mother of three—to think about one of them having a fever that’s 103-105 is really scary,” Willingham said.
Measles is highly contagious and spread by coughing and sneezing, according to the CDC.
Nationally, of the 1,022 measles cases this year—the most since 1992, when cases topped 2,126—about 90% of people were not vaccinated, according to the CDC.
Although this year’s outbreak has caused no deaths so far, 66 people were hospitalized—one-third of them with pneumonia, which also spreads by airborne droplets and can be life-threatening.
“It’s really a public health issue,” Willingham said. “Ninety percent of people who are unvaccinated and come into contact with an infected person will contract the virus—and it’s airborne.”
In terms of public health, Willingham said herd immunity is emphasized. If 95% of a community is vaccinated, it protects those who cannot get vaccinated for medical reasons.
“But now, there are more and more people opting out who don’t have a medical reason to be opting out,” Willingham said. “If that … 95% creeps down, then the measles start creeping back into the community.”
Thanks to conscientious exemptions—passed by the state Legislature in 2003, before which only medical or religious reasons were considered—public and private schools are seeing higher unvaccinated rates. Conscientious exemptions do not require students to have medical or religious reasons to opt out of vaccines such as the measles, mumps and rubella vaccine.
MISD Lead Nurse Shelley Webb said she believes middle-class and upper-middle-class students are more likely to seek exemptions.
“I’m surprised [MISD’s rate] is that low. I thought it would be a little higher,” Webb said of the district’s 2.07% conscientious exemption rate. “A lot of them do it because it’s simpler than to go get the vaccination. They have to make a doctor’s appointment, pay for a doctor’s appointment or make an appointment at a clinic—and I’m finding some just don’t want to do that. It’s easier to go online and request a form and be done with it.”
Webb said in her 13 years at MISD, she has seen exemptions double.
“We do have a very few medical exemptions, but most of our exemptions are the conscientious objectors who just choose not to be vaccinated,” Webb said. “I would bet 0.5% or less would be medical exemptions.”
Barbara Robertson, the coordinator of health services for CISD, said the number of CISD students with conscientious exemptions rose 4.6% from 1,064 students in the 2015-16 school year to 1,113 students in 2018-19.
“Conroe ISD follows the state rules regarding immunization exemptions,” Robertson said. “[Students] must show proof of all age-appropriate required immunizations, a valid medical exemption or a valid Texas Conscientious Exemption affidavit.”
As local conscientious vaccination exemptions rates rise, private schools often have higher rates than public school districts. The DSHS has a one-page conscientious exemption form available online requiring the student’s name, birthday, address and a notary. Alternately, medical exemptions are accepted with a doctor’s note due to physical ailments or allergies.
Montgomery Lifestyle Christian School has a 13.71% conscientious vaccine exemption rate, according to the DSHS—or between 10-15 students out of the 128 enrolled at the end of this school year, according to school secretary Sue Goodman, who looks after vaccination paperwork.
She said anybody can get a two-year conscientious exemption, which at Lifestyle Christian include exemptions for both the hepatitis B vaccine and the MMR vaccine.
“I can’t tell the percentage, but I have had an increase in the last couple of years,” Goodman said. “Two years ago when the health department came … to do what you call an audit, they made the comment that we were over our limit, but we had all the legal documents we needed. It was very, very easy … to get access to the exemption.”
Chris Van Deusen, the director of media relations with the DSHS, said the law allows exemptions for philosophical or religious reasons, too.
“For a reason of conscience, if someone decides [on no vaccine]for themselves, they just have to complete the affidavit and get it notarized—but there’s not a tracking of the details or anything,” Van Deusen said. “If there’s a change in Legislature, we certainly would follow that, but this is the system that has been set up.”
This summer, four state Senate bills and five House bills that would have affected vaccines failed to pass in the state Legislature. House Bill 3551 would have required school districts to report exemptions by campus and the DSHS to make the data available online.
How vaccines work
Dr. Brian Reed, a physician and the chair of clinical sciences at the University of Houston College of Medicine, said there is misinformation about the MMR vaccine from an old study linking it to autism, which was found false and fraudulent.
Reed said the study’s principal investigator lost his medical license, but the misinformation already led communities to skepticism. However, the first dose of the MMR vaccine is 93% effective, and the second dose is 97% effective, Willingham said.
“The way vaccines work is it uses weakened versions of the virus, and it triggers your immune system to produce antibodies, and antibodies hopefully protect you from getting the virus,” Willingham said.
She said she believes everyone should get vaccinated when they can. The age recommendation for a healthy child’s first dose is between 12-18 months and between 4-6 years for the second dose.
The MMR vaccine is available at retail clinics, such as RediClinics, for $115 for children and $93 for adults without insurance.
“Whenever people make a decision to not have their child vaccinated, it’s not only affecting their child, it’s affecting everyone around them—the people who go to day care with them, the people in their school. It affects our entire community,” Willingham said.