By Beth Garbitelli, Legislative Fellow
An adolescent girl received an intramuscular vaccination while her sister, mother, and grandmother watched from the background. Source: Centers for Disease Control and Prevention.
Measles cases continue to surge across the country during the biggest outbreak of the virus in over a quarter of a century. More than 1,100 cases of measles have been reported this year across 28 states — the largest number of people sickened since 1992, according to the Centers for Disease Control and Prevention (CDC). In Massachusetts, officials confirmed two cases, with dozens more investigated. The CDC reports that if the outbreak continues unabated, the United States risks losing its measles elimination status — obtained in 2000.
While overall vaccination rates remain high in the United States and in Massachusetts, outbreaks have occurred due to the growing number of individuals who forgo inoculation. The World Health Organization has identified lack of vaccine confidence as a top threat to global health in 2019.
Individuals avoid vaccination for communicable diseases, like measles, through exemption from mandatory school immunizations. Policies vary widely across the country, but most states, including Massachusetts, allow for at least religious exemptions, in addition to medical exemptions.
Removing the Religious Exemption
“This is a serious public health issue that needs to be addressed,” says MMS President Maryanne C. Bombaugh, MD, MSc, MBA, FACOG, in a recent news article. “Parents who don’t get their children vaccinated not only put at risk the child, but the entire community.” At its 2019 Annual Meeting, the Massachusetts Medical Society adopted policy that calls for advocacy to end nonmedical vaccine exemptions for school attendance in the state.
In Massachusetts, more than 80% of exemptions during the most recent school year were classified as religious and the share of students opting for religious exemption has been growing. Still, the vast majority of Massachusetts students — 96.9% of kindergartners in the last school year — received the MMR vaccine, according to state data.
The AMA has also adopted policy supporting only medical exemptions and the American Academy of Pediatrics identified removing nonmedical exemptions as a top priority during its Annual Leadership Forum.
Following the Lead of Other States
States currently prohibiting religious exemption include Mississippi, West Virginia, California, Maine, and New York. Mississippi and West Virginia, where nonmedical exemptions have been banned for decades, boast two of the highest MMR kindergarten vaccination rates in the country. Research published in JAMA showed that the percentage of California kindergartners without up-to-date vaccination status decreased from 9.84% before interventions to 4.87% by 2017, after strengthening the laws.
Massachusetts legislators are investigating strategies to bolster immunization in the state, including a bill that would remove religious exemptions. The MMS looks forward to continuing to engage on this issue with state lawmakers and working to craft smart public policy ensuring the Commonwealth’s population, especially those most vulnerable, are protected from vaccine-preventable communicable diseases.
