A growing number of Texas public school parents are requesting an immunization exemption for their children, raising concerns among health officials and potentially sparking changes in school immunization laws.
Concern has grown amid a measles outbreak at the beginning of the year with at least 102 cases of measles reported in 14 states, including Texas. In 2014, there were 644 cases of measles, the highest since it was declared eliminated from the United States in 2000. There were 10 confirmed cases in Texas in 2014 and 27 in 2013.
While the majority of Texas students are vaccinated, the number of children who have opted out of one or more vaccinations has tripled in six years. According to Texas Department of State Health Services data, more than 38,000 students, or .75 percent of Texas' student population, were exempt from immunizations during the 2013-2014 school year, compared with 10,400 in the 2007-2008 school year.
For a child in Texas to opt out from immunization requirements, parents must sign an affidavit citing one of the following: conscientious reasons, which includes religious beliefs and philosophical reasons; medical reasons; and exemptions for active duty members of the United States armed forces.
Public health officials have attributed the spike in measles cases and increasing vaccination exemptions primarily to a 1998 report that falsely linked vaccines to autism.
"Unfortunately, there's been a decade of misinformation that started with some bad science," said Dr. Jeff Levin, Smith County Health Authority and senior vice president for clinical and academic affairs at UT Health Northeast. "We're having great difficulty recovering from that bad science."
Levin said he personally supports people's individual choices, but notes that some choices come with potential restrictions to protect the welfare of others.
"As a public health person, really it's best not to have any exemptions, unless it poses immediate risk to life and limb," he said.
CHANGING THE LAW
Each state has established its own rules about immunization requirements. All but two states—Mississippi and West Virginia — allow for religious exemptions. Texas is one of 20 states that allow for reasons of conscience. The state already had allowed parents to exempt children from immunization requirements based on religious beliefs, but philosophical reasons were added in a bill signed into law by Gov. Rick Perry in 2003.
In recent years, some state legislators have proposed laws to either restrict or expand vaccination exemptions in public schools.
In Texas, State Rep. Jason Villalba, R-Dallas, is proposing a bill that would disallow conscientious exemptions for public school students.
"This just means if you don't want to provide your child with vaccinations, you don't have to," Villalba said via phone. "All you have to do is sign a piece of paper.
"The problem with that is we've had an uptick in outbreaks of diseases that were previously eradicated in the state of Texas," he added, noting the 2013 measles outbreak in North Texas. "Measles should not exist in the United States."
Villalba said there has been some opposition from civil liberties groups and others who believe vaccines are harmful to children. He said he's surprised by the strength of a minority of parents who object to restricting exemptions.
"We've gotten some pushback but overwhelmingly we're seeing in our communities that moms and dads feel strongly about this," he said.
Villalba said he hopes to file the bill soon.
"I'm confident it will pass, but I recognize in the Legislature there are a thousand ways to kill a bill," he said.
EAST TEXAS SCHOOLS
Compared with other counties across the state, most Smith County independent school districts have a low percentage of students who are exempt from immunizations. However, students who have filed a conscientious exemption in the county have increased slightly each year, going from .47 percent in the 2010-2011 school year to .76 percent in the 2013-14 school year.
Department of State Health Services data show that Tyler Independent School District went from 29 students, or .16 percent, claiming an exemption during the 2007-2008 school year, to 67 students, or .38 percent, during the 2013-2014 school year.
Independent school district exemption rates in the county range from .14 percent to 1.29 percent. Whitehouse ISD tops the county's list with 1.29 percent of students, or 59 students, who have nonmedical exemptions.
Other East Texas school districts with exemption rates higher than the state average include: Big Sandy, 4.87 percent; Canton, 1.53 percent; Harmony, 1.29 percent; Bullard, 1.26 percent; and Lindale, 1.19 percent.
Gladewater ISD has reported 25 students with immunization exemptions, or 1.43 percent of the student population.
"That's a very minute number but for a child who gets sick easily, those 24 other students are endangering the life of other students," said Cassandra Gann, a concerned parent. "It's kind of scary."
Ms. Gann is troubled because her 14-year-old daughter, Kaitlynn, has not been vaccinated because of a medical condition and she worries her health may be at risk. She has contemplated home school because she misses days when other students in her class are ill.
"That's not what she wants because she wants to be with her friends," Ms. Gann said. "She wants outside contact with the world."
Ms. Gann recently spoke with a school principal to allow a homebound program when her daughter stays home.
"Her health has to come first," Ms. Gann said. "It has to be a priority not only for me but for them as well."
Ms. Gann said she is supportive of any law that restricts immunization exemptions.
"Every doctor out there is saying that the risks don't outweigh the benefits. That's what needs to be taken into account," she said. "I think there needs to be a law that says you should vaccinate your children unless you have a damn good reason not to. Just because you don't want to is not a good reason."
But parents such as Kalae Whitman, 28, of Tyler, don't embrace a restriction on vaccine exemptions. Her oldest child, now 8, was immunized until 4 years of age, while her other two children, now 5 and 6, were vaccinated up to 2 months old.
She filled out the first exemption form in 2012 before her oldest child started school.
"The oldest has exemptions for immunizations after 4 years because I did not understand the opt-out process until she was older," Mrs. Whitman said.
The mother of three said she has a holistic approach to preventing disease, which includes a healthy diet filled with vitamin- and mineral-rich foods, physical activity and plenty of sunlight to boost the immune system.
She feels strongly about not taking pharmaceutical drugs in general, but is particularly wary of vaccines.
"I don't want my children to be experimental subjects for something that is still in trial use from year to year, so we don't vaccinate," she said.
With a growing national conversation about parents who do not vaccinate she understands there will be criticism.
"Other people can agree or disagree, (but) at the end of the day, I have to do the best I can to protect my children," she said. "I think as more parents learn about what's really in vaccinations and how they're manufactured, they will give deeper thought to it."
She's also worried about potential adverse effects, contamination (citing a Food and Drug Administration study that investigated viruses in cells used to make vaccines) and feels that information isn't readily available.
"You have to search for the information on your own," she said. "Parents have the right to know first, then choose whether they want to participate or not."
Mrs. Whitman believes parents are unfairly made to feel guilty about not immunizing their children.
"It's such a one-sided story," she said. "If I had one message to every parent, it would be research. Use different sources and compare. Understand that you have a choice. And we have to fight to keep it."
Levin said it's difficult to predict the risk of someone like Kaitlynn getting sick from an unvaccinated person by numbers alone. He said the concept of herd immunity is what will keep disease in check.
"Obviously, the more people who are unvaccinated the much more likely you see a disease rear its head," he said. "In general, we'd like to see vaccinations penetrating at high rates to really sustain the low occurrence of disease or no occurrence of disease, for that matter."