Vaccine exemptions on the rise among Texas students

The number of Texans who exempt their children from vaccination for non-medical reasons rose nearly 9 percent last school year, continuing a now 12-year-long trend that public health officials worry could eventually leave communities vulnerable to outbreaks of preventable diseases.

The new numbers represent a 19-fold increase since 2003, the first year that Texas law allowed parents to decline state immunization requirements for "reasons of conscience." The number of such exemptions are still small, a little under 45,000 of the state's roughly 5.5 million schoolchildren, but they've spiked from less than 3,000 that first year, according to the new state data.

"The trend is going in the wrong direction," said Anna C. Dragsbaek, president and CEO of The Immunization Partnership, a pro-vaccine group. "It's time for the community to step up and take action on this very troubling trend."

Concern has picked up in recent years amid the re-emergence of diseases such as measles and whooping cough. A large measles outbreak last year, linked to an initial exposure at Disneyland in California, sparked particular distress.

Texas is one of 18 states that allows waivers of school vaccine requirements based on parents' conscience or personal beliefs. Only two states - Mississippi and West Virginia - don't grant exemptions from immunization requirements on religious grounds, and all states allow exemptions for medical conditions, such as a compromised immune system.

9 million lives saved

Opponents say they are simply doing what they think is best for their child by avoiding vaccines. They argue that the assortment of shots - Texas children are required to receive 11 immunizations to attend school - are dangerous to developing bodies.

"Do you want to trade a possible acute, fully recoverable normal childhood illness for the probability of an adverse vaccine reaction and a lifetime of chronic, debilitating, painful conditions that your child may never fully recover from?" asks Cypress resident Michelle Guppy, who blames vaccines for her now 22-year-old son's autism. "If I had known all the ingredients in vaccines, how neurotoxic they are, I would have never signed a consent form."

Public health officials emphasize that vaccines are safe, that the theory they cause autism has been discredited. They credit vaccines with bringing seven major infectious conditions under some degree of control - smallpox, tetanus, diphtheria, yellow fever, whooping cough, polio and measles - and saving an estimated 9 million lives worldwide each year.

The overall number of conscientious objectors isn't yet high enough to threaten herd immunity, the idea that vaccination of a significant portion of a population provides a measure of protection for those individuals without immunity to a contagious disease.

But Dragsbaek and public health officials fear clusters of "anti-vaxxers" could leave many children vulnerable, particularly those with medical conditions that prevent vaccination and those too young to be vaccinated.

Pushed by the Immunization Partnership, the 2015 Legislature considered a bill that would have required the Texas Department of State Health Services to post the exemption numbers of every school on its website.

Under the current law, the department is only required to post aggregate numbers for each school district.

The bill passed the House but died in the Senate. Dragsbaek, impressed at the traction the legislation got, said the partnership will push hard on behalf of any such bill again in 2017.

The bill to require school-specific information called for the inclusion of delinquency numbers, also a big problem. At HISD, for instance, more than 3 percent of children in 2015-2016 - who hadn't obtained a conscientious exemption - had not received at least one of each vaccine by the district's age-specified deadline. Enforcement of such deadlines is up to the principal.

"Eleven percent of HISD's prekindergarten students hadn't received their first dose of measles vaccine 90 days into the school year," said Dr. Susan Wootton, a pediatrician at University of Texas Health Science Center at Houston who is leading an HISD task force on immunization delinquency. "That needs to be fixed. Nepal does better than that."

Harris County's overall conscientious exemption rate is still relatively low, just 0.62 percent, but it's doubled in the last five years. So has Montgomery County's, now 1.73 percent. Brazoria County has gone from 0.30 to 0.80. Gaines County in West Texas has the state's highest conscientious exemption rate, nearly 5 percent.

'Danger to children'

Increasing exemptions are occurring nationally as well as in Texas. Following last year's measles outbreak that began at Disneyland, California took action, barring religious and other personal-belief exemptions. The Disneyland outbreak was thought to account for much of 2015's 189 measles cases in 24 states, which was actually down from 2014's 667 cases in 27 states. Measles had been considered eradicated in 2000.

A 2015 Texas bill to eliminate the state's conscientious exemption never got a hearing.

Barbara Loe Fisher, president of the pro-exemption National Vaccine Information Center, expresses skepticism about links between those not vaccinated and recent cases of measles and whooping cough. She said Texas has one of the highest student vaccination rates of all states and said its vaccine laws "strike an appropriate balance between achieving public health goals and protecting both vaccine vulnerable individuals and basic human rights."

Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine and Texas Children's Hospital, responded that Texas' vaccination rates among preschool-aged children, 19-35 months, rank 48th in the nation. He said that Fisher's group "promotes policies that represent a danger to children."

"The bottom line that is that children in the state of Texas are now at great risk for measles and other killer childhood infections," Hotez said. "This is happening because parents are choosing not to vaccinate their kids and are doing so because of erroneous beliefs."