Tonight Public Health Board for Madison and Dane County will be considering the following position statement and making the following recommendations:Here’s the agenda (City Version, County Version.) Here’s the full statement.
POSITION
Public Health Madison & Dane County believes all individuals in Dane County should be immunized against vaccine-preventable diseases, unless medically recommended otherwise.
BACKGROUND
Immunizations are a key element in the protection of public health. Vaccines are the most cost-effective way to prevent disease, preventing millions of hospitalizations and deaths in the United States and worldwide and saving billions of dollars in health care costs. *1 Despite this, the number of children who do not meet the minimum vaccination requirement is growing, making our community increasingly susceptible to disease outbreaks. *2
Low immunization rates threaten herd immunity, which is when a high enough threshold of individuals in a population are vaccinated against a disease in order to protect the entire population (90-92%). With decreasing immunization rates, Dane County will lose or has lost this herd immunity against many infectious diseases. Those most vulnerable in our community, such as the elderly, infants who are too young to be immunized, pregnant women, and people who are immune compromised, are put at the greatest risk of contracting disease.
As outbreaks of various diseases once thought to be eliminated continue to spread across the country, Dane County’s public health is under threat. For example, over 1,250 cases of measles have been identified in 31 states including Illinois in 2019, the highest number of cases since 1994. Three fourths of those infected during the current measles outbreak have been unvaccinated. *3 Measles is associated with significant complications including deafness and encephalitis.
Current Wisconsin law requires children attending school to be vaccinated against various infectious diseases such as measles, mumps, polio, and varicella. Children are in close proximity to each other for large amounts of time during the school day. Many diseases can spread rapidly throughout a school, which puts children’s health at risk.
A challenge in retaining high immunization rates is that Wisconsin is one of just 16 states that allows a personal conviction exemption to required school vaccinations, permitting a parent to simply check a box to exempt their child. Over the last decade the number of students requesting a personal conviction waiver for immunizations has grown from 1.2% of students to 4.6% of students in Wisconsin. The increase in personal conviction waivers has led to an overall drop in the percentage of students who meet the minimum immunization requirements, down to 91%, the lowest in 10 years. *4 This decrease is threatening our herd immunity. The increased use of immunization waivers impacts adult immunization rates as well. The immunization rate for influenza during the 2018-2019 season, a vaccine which manyemployers require unless a waiver is submitted, was 52% in Dane County. *5 The increased use of immunization waivers directly leads to decreased vaccination rates.
Results from recent studies evaluating the association between nonmedical exemptions and vaccine- preventable diseases indicate that more stringent exemption requirements are associated with lower exemption rates, greater vaccination coverage, and a decreased risk of outbreaks. *6 The research suggests promoting practices that are aimed at reducing nonmedical exemptions which include: making exemptions more difficult to obtain, increasing the frequency of exemption submission, and implementing clear and consistent enforcement of exemptions. *7
Immunizations are a foundation of public health. The increasing number of individuals who do not meet the minimum vaccination requirements creates a public health risk in our community and beyond. This is especially concerning for community members at higher risk for vaccine-preventable diseases.
RECOMMENDATIONS
Public Health Madison & Dane County supports efforts to protect the health of Dane County residents, specifically through public health policy in support of immunizations, increased funding to support immunization efforts, and outreach and education to communities with the largest disparities in immunization rates. Public health interventions involving partnerships between community organizations, local government, and vaccine providers show an overall increase in vaccination rates of up to 30 percent. *8
There are a number of strategies regarding exemptions that could help improve vaccination rates in our community, including:
- The removal of all non-medical exemption waivers for school and child care attendance. *9
- Parents/guardians requesting exemptions should receive state-approved counseling that explains the public health benefits of immunization, the scientific safety of vaccines, and the consequences of exemptions on the health of their child and other children.10,11
- Parents/guardians requesting an exemption should be required to sign a statement that delineates the basis, strength, and durations of their belief; their understanding of the risks that refusal to immunize has on their child’s and other children’s health, and their acknowledgement that they are making the decision not to vaccinate on behalf of their child. *10,11
- Parents/guardians who chose an exemption waiver should be required to revisit the decision annually and be required to sign a statement yearly. *10,11
- Parents/guardians who chose an exemption waiver should be required to obtain a second signature by a designated official, such as a notary. *10
- If there is an outbreak of a vaccine-preventable disease, unvaccinated children should be excluded from school and extra-curricular activities until the outbreak is deemed to be cleared by health officials (state and school district policy decisions). *10,11
FOOTNOTES
1 – Centers for Disease Control (CDC). (April 2014). Report shows 20-year US immunization program spares millions of children from disease. Retrieved from https://www.cdc.gov/media/releases/2014/p0424- immunization-program.html
2 – Hill HA, Elam-Evans LD, Yankey D, Singleton JA, Kang Y. Vaccination Coverage Among Children Aged 19– 35 Months — United States, 2017. MMWR Morb Mortal Wkly Rep 2018;67:1123–1128. Retrieved from: http://dx.doi.org/10.15585/mmwr.mm6740a4
3 – Centers for Disease Control (CDC). (October 2019). Measles cases and outbreaks. Retrieved from https://www.cdc.gov/measles/cases-outbreaks.html
4 – Department of Health Services (DHS). (April 2019). Wisconsin school immunization rates 2018-2019 school year. Retrieved from https://www.dhs.wisconsin.gov/immunization/data.htm
5 – Department of Health Services (DHS). (April 2019). Immunization rate data. Retrieved from https://www.dhs.wisconsin.gov/immunization/data.htm
6 – Wang E, Clymer J, David-Hayes C, Buttenheim A. Nonmedical exemptions from school immunization requirements: a systematic review. American Journal of Public Health. 2014;104(11).
7 – Diekema D. Personal belief exemptions from school vaccination requirements. Annual Review of Public Health. 2014;35.
8 – Community Prevention Services Task Force. (October 2014). Vaccination Programs: Community-based Interventions Implemented in Combination. Retrieved from https://www.thecommunityguide.org/findings/vaccination-programs-community-based- interventions-implemented-combination
9 – American Academy of Pediatrics (AAP). (September 2016). Medical versus Nonmedical Immunization Exemptions for Child Care and School Attendance. Retrieved from https://pediatrics.aappublications.org/content/138/3/e20162145
10 – Pediatric Infectious Disease Society (PIDS). (August 2018). A Statement Regarding Personal Belief Exemption from Immunization Mandates. Retrieved from http://www.pids.org/images/stories/pdf/pids-pbe-statement.pdf
11National Association of County & City Health Officials (NACCHO). (November 2006). Statement of Policy- Eliminating Personal Belief Exemptions from Immunization Requirements for Child Care and School Attendance. Retrieved from http://www.naccho.org/uploads/downloadable-resources/11- 06-Personal-Belief-Exemptions-2.pdf
