Public health officials are looking more closely at rising conscientious vaccine exemptions among school-age children as the number of measles cases nationwide and locally continues to climb this year, reaching its greatest peak in the U.S. since 1994, according to the Centers for Disease Control and Prevention.
Although the CDC declared measles as being “eliminated” nationwide in 2000, 971 individual measles cases have been confirmed across 24 states in 2019 as of May 30, according to CDC data. At least 15 of those cases occurred in Texas, four of which occurred in Harris County—the most of any county in Texas, according to Department of State Health Services data as of April 29.
At the same time, a growing number of parents in Spring, Klein and Cy-Fair ISDs as well as local private schools have filed for vaccine exemptions since 2003, when state lawmakers made it legal for parents to seek vaccine exemptions for their children for reasons of conscience. Prior to 2003, only religious or medical reasons were considered.
Dr. Richard Lyn-Cook, who serves as a medical director for Harris Health Pediatric Clinics, said he has experienced the trend firsthand during his 20-year tenure in the health care field.
“It is a major concern—especially in the cases of measles … [because]a certain percentage of the population [needs to be]vaccinated in order to prevent rapid spread [of measles], and a 2017 report … suggests there are quite a few municipalities and counties in Texas that are approaching less than that 95% threshold,” Lyn-Cook said.
In terms of measles, mumps and rubella vaccine coverage, local school districts in Spring and Klein are still above that 95% threshold. For the 2018-19 school year, KISD kindergartners had an MMR vaccination coverage rate of 97.04%, while seventh graders were at 98.81%. Likewise, SISD kindergartners were at 97.3%, and seventh graders were at 99.01%, while CFISD kindergartners were at 97.47%, and seventh graders were at 98.91%.
In hopes of maintaining herd immunity and avoiding a widespread measles outbreak, health officials are pushing to better inform parents about vaccines without hindering personal freedom.
Children enrolled in public and accredited private schools are required by state law to receive certain vaccinations—such as MMR, tetanus and polio—unless the parent submits a notarized affidavit for these exemptions, according to DSHS.
“The idea is to make sure schools don’t become somewhere that can harbor these kinds of infectious diseases that can be prevented through immunizations,” DSHS Media Relations Director Chris Van Deusen said.
Over the past seven school years, Spring, Klein and Cy-Fair ISDs have experienced rising vaccine exemptions. SISD’s conscientious vaccination exemptions increased from 0.13% in 2012-13 to 0.8% in 2018-19, while KISD’s exemptions jumped from 0.77% to 1.53%, and CFISD’s rose from 0.62% to 0.98%.
While the county and state averages are not yet available for 2018-19, the average vaccine exemption rate for reasons of conscience across Harris County was 0.83% in 2017-18. That year, both KISD and CFISD surpassed the county average, while only KISD surpassed the state average of 1.07%.
“We respect the rights of our parents to make decisions on behalf of their children,” said Jeanne Parker, SISD’s director of Nursing and Health Services. “However, the growing number of unvaccinated children puts other children, especially those who are immunosuppressed, at risk.”
Lyn-Cook said the most common reasons parents have for declining vaccinations include concerns regarding what ingredients are in a vaccine and the effect receiving so many vaccines at once has on the immune system.
School district and health officials agreed misinformation is one of the propellers behind this upward trend.
“Social media allows for parents to participate in discussion boards with others outside of their local community,” KISD Coordinator of Health Services Yvonne Clark said.
However, school officials also agree the increasing vaccine exemptions are not a concern, as exemptions make up less than 1%-2% of each district’s population, and those students are spread throughout each district’s various campuses and grade levels, meaning herd immunity is still intact.
“[However], exemption rates need to be closely monitored,” CFISD Director of Health Services Christiane Bernal said. “The higher the rate of unvaccinated individuals, the more likelihood that a vaccine-preventable disease can spread in a community.”
Bernal added the 2003 law that allows for conscientious exemptions may need to be revisited by legislators if the state experiences a resurgence of vaccine-preventable diseases.
A personal choice
Christina Marie, whose 13-year-old daughter attends KISD, said as an infant, her daughter had a bad reaction to vaccinations sending her to the emergency room twice.
“Parents used to say to me they didn’t want my daughter by their kids, but if vaccines are 100% [effective]and protect their kids, then they shouldn’t be worried about their kid getting anything from anyone else,” Marie said.
However, KISD parent Christopher Conaton said it was never a question for his family of whether they would vaccinate their children or not.
“These [measles]outbreaks around the country are enough to convince me to continue to do every recommended vaccine for all of my children,” Conaton said.
While public school districts do not have a say in whether they can accept vaccine-exempt students, private schools do.
Sarah Benson, Trinity Klein Lutheran School’s nurse, said private schools that do not receive state funding have the option to allow for exemptions.
“We strongly feel that students who have major medical issues should be able to have the ability to enroll,” Benson said. “In addition, we have a culture that encourages and applauds adoption. It is common for children who have been adopted to be on delayed or catch-up immunization schedules.”
For the 2018-19 school year, 7.44%, 3.49% and 1.34% of students at Providence Classical School, Trinity Klein Lutheran School and The Banff School, respectively, received vaccine exemptions for reasons of conscience.
At the same time, no students at Frassati Catholic High School and St. Edward Catholic School received exemptions for reasons of conscience, in accordance with current Texas Catholic Conference of Bishops Education Department policy, which does not allow Catholic schools in Texas to accept conscientious exemptions.
All other private schools did not respond to request for comment.
While district officials said they are not concerned about rising exemptions, health officials said otherwise.
Rekha Lakshmanan, the director of advocacy and policy for The Immunization Partnership—a Katy-based nonprofit that educates the public about the importance of vaccination—said the current trajectory threatens to undermine the concept of herd immunity.
“Research shows that nonmedical exemptions cluster geographically—in neighborhoods, in schools and other smaller groups,” she said. “These [rate]increases are happening in pockets, like the suburbs of Houston, and that’s what we worry about.”
Because of the cluster effect, Lakshmanan said The Immunization Partnership advocated for two state companion bills—Senate Bill 329 and House Bill 3551—which would have required school districts to provide the DSHS with conscientious vaccine exemptions by campus as well as the district total and make the information available on the agency’s website. Both bills failed to become law in Texas’ 86th Legislature, which concluded May 27.
On the other side, Jackie Schlegel, founder and executive director of political action committee Texans for Vaccine Choice, said the organization supported HB 1490, which would have made the filing process for vaccine exemptions easier by requiring the DSHS to make exemption forms available for download on the agency’s website and in all public schools.
HB 1490 also failed to become a law this legislative session.
“It’s very dangerous when we start allowing the government to mandate any medical procedures … and vaccines should be no exception,” Schlegel said.
However, Lakshmanan said exemptions for reasons of conscience increase the risk of vaccine-preventable diseases making a comeback in the U.S.
“There’s this compelling need to discuss vaccines from two different points of view, but time and time and again, researchers and scientists who have spent their careers studying the efficacy and safety of vaccines continuously come back with the same conclusions: The benefits of vaccination significantly outweigh the risks,” she said.