Making an Informed Decision about Immunization Waivers

The following is an excerpt from The Guardian of Public Health, submitted by Cristi Bramer, MPH, MDCH Division of Immunization Epidemiologist.

Schools in the United States have required vaccines for school entry for over 150 years because it helps maintain high vaccination coverage and minimize the risk from vaccine preventable diseases. Currently, Michigan’s public health code requires vaccinations that protect against 10 diseases for children enrolled in kindergarten, seventh grade (this was 6th grade prior to the 2014-15 school year) and those newly enrolled in the school district. Michigan is one of 19 states that allow a parent/guardian to obtain a philosophical waiver for the school-required immunizations.

In the 2013-14 school year, Michigan had the fourth highest waiver rate for kindergarten (5.9%) in the U.S., over three times the national median. As of March 24, 2015, provisional data for the current year shows a kindergarten waiver rate of 5.3%, 7th grade waiver rate of 4.7% and new school entrants are 4.4%. The overall waiver rates vary across the state with the lowest rate at 1.1% and the highest at 17.9%. These high waiver rates are concerning because persons seeking vaccine waivers have been shown to cluster geographically and in recent years we are seeing outbreaks of vaccine preventable diseases. MDCH postedsummaries of school immunization data by school building or childcare site that measure compliance with immunization requirements.

The MDCH Division of Immunization and Local Health Departments are working hard to decrease immunization waiver rates. In December, 2014, new Administrative Rules were passed that require: 1) Local Health Department (LHD) education on the risk of disease and benefit of vaccinations at the time a non-medical waiver is signed and certified by the LHD, and 2) the use of a standardized state waiver form when a waiver is signed. New educational materials were created to support these efforts and LHDs have changed their policies to implement the new Administrative Rules.

A strong provider recommendation is recognized as a powerful motivator for parents to comply with immunization recommendations. The new administrative rules form a partnership between public health and private healthcare providers to decrease the number of school and daycare waivers in Michigan. The hope is by having providers educate the parent/guardian on true medical contraindications and precautions to vaccination and having the LHD work on the education process for the philosophical and religious waivers, we will begin to see an increase in immunization rates and a decrease in immunization waivers. There are new materials on the MDCH website that provide talking points for common concerns parents have on immunizations. The materials are available at www.michigan.gov/immunize under the Local Health Department section.

Click here to read the full April 2015 Newsletter.