Vaccines are, to put it simply, small miracles. I am old enough to have cared for children who had contracted Haemophilus influenzae meningitis or congenital rubella – and they suffered permanent damage from these infections. And today, we can see what is happening with SARS-CoV-2 vaccine. In areas with high vaccination rates, infection rates have steadily decreased, whereas in areas with no or low vaccination rates, the infection continues at a high rate.
Public health officials have tried many different strategies to increase vaccination rates for all. And yet there continues to be a sizable population who are undervaccinated or unvaccinated. Vaccination requirements for school or work are important in getting many vaccinated. But most states allow an exemption for medical, religious, and/or philosophical reasons.
Public health officials want everyone vaccinated to protect both individuals and the community, but there is a tension between the good of society and the rights of the individual to say no. However, what if the person who says no changes their mind if they really understood more about the vaccines? What if we provided that education?
That’s what the state of Michigan decided to do. In 2014, Michigan began requiring parents to attend an in-person educational session at the local health department before they could receive a non-medical exemption (NME) for their child.
What happened? Nina Brooks Masters and her colleagues at the University of Michigan, University of North Carolina, and Northwestern University analyzed the data, and they report their findings in an article that is being early released this week in Pediatrics (10.1542/peds.2021-049942).
The number of NMEs decreased in the first year after the new requirement but has been steadily increasing ever since. Sarah Clark and Dr. Katelyn Wells from the University of Michigan note in an accompanying commentary that more education does not, in general, make the vaccine-hesitant less hesitant (10.1542/peds.2021-050445). They speculate that, given that the vaccine educators were rarely successful in changing a parent’s mind, the initial decline in NMEs reflected a decrease in “exemptions of convenience” but did not change parents’ minds.
The data presented in this article provide a glimpse into the trajectories of vaccine hesitancy for different pockets of the population. You’ll be interested to read the details of this study – how the proportion of NMEs changes with the type of schooling (public, private, and virtual – i.e., homeschooled) and with sociodemographics. These data are important for public health officials – and for pediatricians and other physicians who care for children – so that we have a better understanding of how new rules, laws, and policies play out in real life.
