Maike Morrison ,Lauren A. Castro and Lauren Ancel Meyers have an article at PLOS Medicine titled "Conscientious Vaccination Exemptions in Kindergarten to Eighth-Grade Children Across Texas Schools From 2012 to 2018: A Regression Analysis."
Why was this study done?
Nonmedical vaccination exemptions for childhood preventable diseases have been rising in the US, presumably fueled by declining health literacy and increasing distrust in medical authority.
Studies in “hotspot” states have found that vaccine hesitancy is positively correlated with both the educational level of the population and the proportion of the population that self-reports as ethnically white.
Recent population growth and declining vaccination percentages in Texas put the state at clear risk for outbreaks of vaccine-preventable diseases. However, the risk is highly variable, and its socioeconomic and geographic determinants of risk are largely unknown.
This research aims to provide actionable insight for policy makers into trends in vaccine exemptions across Texas at a granular scale.
What did the research do and find?
We analyzed publicly available reports of the number of conscientious vaccination exemptions (CVEs) for 318 private, 818 public, and 60 charter school systems in Texas from the 2012–2013 to 2017–2018 school years.
We used regression methods to relate CVE percentages at the school and county scales to 115 socioeconomic and demographic variables available from the US Census Bureau and the Texas Education Agency.
Between the 2012–2013 and 2017–2018 school years, median CVE percentages increased from 0.38% to 0.79%, resulting in more than 24,000 additional vaccination-exempt students. Increases were highest in suburban school districts.
The 2017–2018 statewide public school exemption percentages were best explained by school system resources, the percentage of the students that self-report as ethnically white, and whether the school system was in a metropolitan county. In metropolitan areas, vaccine exemptions were positively correlated with wealth and attained educational level.
What do these findings mean?
Metropolitan communities are at higher risk than rural communities for high exemption percentages across Texas.
County-level averaging of CVE percentages obfuscates pockets of low vaccine coverage; the proportion of high-risk schools is a more sensitive indicator of local risk.
The findings of the study—both the improved metric for detecting high risk communities and the robust socioeconomic predictors of declining CVEs—can inform targeted interventions to combat the rising but heterogeneous risks of disease emergence across Texas.Julia Ries at Vice:
Other health experts believe that privileged people have more time to spend consuming information online, including misinformation about the safety and effectiveness of vaccines—like, that vaccines are linked to autism (false), or that they can overwhelm the immune system (nope), or that natural infection provides better immunity than infection (not true!). After reading up online, many non-medical experts feel they know "what's best" for their child—something experts call “the privilege of choice.” (Low-income, ethnically diverse areas are also often under-vaccinated, but that’s mostly due to access plus financial and religious reasons.)
Texas isn't an anomaly. Early evidence has discovered that pockets in California are seeing the same vaccine hesitancy amongst college-educated white people. These states represent what’s happening in terms of the anti-vax movement across the country. Recent studies have found that hotspotsin other states (like California, Arizona, Oregon, and Colorado) largely consist of well-off white people who don’t trust vaccines.
All 50 states currently require children to be vaccinated for school attendance unless they qualify for a medical exemption; forty-five of those states also allow religious exemptions. Texas is one of 15 states that permits families to use a “philosophical objection”—a personal, moral, or other belief—to get out of vaccination. It’s also one of the only states that doesn’t require education on the risks of going unvaccinated. The states’ lenient vaccination policies allowed for rich white people's invocation of personal reasons to not vaccinate—as a result, vaccine hesitancy—and, so, vaccine-preventable disease outbreaks—have surged.