School vaccine decisions must be well-informed
Recent reports have highlighted the increasing rate of unvaccinated children in Texas schools including those in the greater Austin area. Close to 1 percent of Texas school children, or about 45,000 students, are exempted from vaccinations for nonmedical reasons. In the Austin Independent School District, it is about 2 percent, or more than 1,500 students.
These numbers may sound low overall but individual schools, including private schools, may have higher numbers, with some schools’ portions of unvaccinated students exceeding 10 percent. This number puts both vaccinated and unvaccinated children at risk of severe and mostly preventable diseases such as measles.
Much of the debate about vaccination has focused on the rights of parents to not vaccinate their school-age children. But we must also consider the rights of those who want maximum prevention against preventable diseases. For example, given this concept of protection of the community from highly contagious infections, California has passed a law making it much more difficult for children to attend school if they have not been vaccinated. Perhaps Texas lawmakers ought to take notice. The American Academy of Pediatrics recently came out strongly in favor of such laws to protect schoolchildren. There is overwhelming evidence that vaccines do not cause autism and government officials in Texas should not be making claims to the contrary, as we saw recently with Bexar County District Attorney Nico LaHood.
As vaccination rates drop, infections increase due to loss of what is referred to as “herd immunity.” This refers to the protection a community has when a sufficient portion of the population is immune to an infectious disease because it makes its spread from person to person unlikely. Even people not vaccinated, such as infants, newborns and people with chronic illnesses, are offered some protection because the disease has little opportunity to spread within the community. But that protection diminishes as more of the population is unvaccinated. What that number is varies from infection to infection, but in general, highly contagious diseases such as measles have a higher threshold than less contagious ones. That is why we have recently had numerous unexpected outbreaks of measles, which are related to unvaccinated populations.
In any case, what we should do is insist on full disclosure of vaccination rates at every school in the state. It is a fundamental right of parents to know this information in choosing a school for their child. We need to expect that parents who sign a vaccination exemption have met with a qualified health care provider and have reviewed the risks of this practice with them. We should insist on this type of review for other medical decisions with important consequences and should do so for vaccination refusal. We need to support the rights of health care providers such as Austin Regional Clinics’ recent decision to decline to have children in their offices who are not vaccinated.
We also need to recognize the real fears that parents have about the risks of vaccinations. We need to continue to support vaccine research and public information campaigns that are fact-based and culturally sensitive. We need to give pediatricians and other care givers reimbursement for spending extended time with families discussing vaccinations, and we need to be sure that we respect one another in the dialogue about vaccinations. It is sometimes incorrectly said that pediatricians have a financial motivation related to vaccination. Let’s give them a financial motivation to support health through open and extended discussions with families about their health care decisions. That is a win for everyone and allows discussions about a range of vaccine decisions regarding preventable diseases such as influenza and HPV, not just those ordinarily related to attending school.
Should parents send their children to a school where high numbers of children are not vaccinated? Is this something that should be factored into school choice decisions based on accurate information for that school? That’s a decision each parent must make, but for us, we would say no to the former and would not send our children to such schools.
Informed decision-making for parents and protection for our children is of the utmost importance. Let’s not erode the progress we’ve made during the past 50 years and keep preventable diseases from spreading.