'Anti-vaxxers' in the waiting room | Behavioral Healthcare Executive Skip to content Skip to navigation

'Anti-vaxxers' in the waiting room

June 25, 2014
by Terry L. Stawar, Ed.D. CPRP
| Reprints

Here’s the scenario: You have a child in your outpatient waiting room, whose parents refuse to allow him to be vaccinated against common childhood illnesses. They have decided this due to a personal belief that vaccinations constitute a risk for autism or other significant health hazards. What would your organization do?

This issue may be even more significant if you operate a children's or adolescent residential program. According to a 2012 study from Emory University, 20 states allow personal-belief vaccination exemptions for enrollment in public schools or child care programs. In nine states parents simply have to sign a form. Researchers suspect that some parents sign exemption forms just because it’s more convenient or cheaper than taking the child to the doctor. Home schooling is also a way to bypass state immunization laws for school attendance. The   states where you can most easily get exemptions are North Dakota, Wisconsin, Massachusetts, Rhode Island, Connecticut, Maryland, Missouri, Colorado, and Arizona. All states allow medical exemptions and all states but West Virginia and Mississippi also allow religious exemptions.

The Emory study found that opt-out rates in states allowing personal-belief exemptions are 2.5 times higher than in states only permitting religious exemptions. The study also reported that whooping cough rates were twice as high in states with personal-belief exemptions than those with only religious exemptions. Exemptions are highest in western states and the upper Midwest. Marin County, California, has a personal-belief exemption rate four times the national average and the second-highest rate of whooping cough in the state. As well as risking infection and serious illness, children who are not immunized can also transmit   diseases to infants who are too young to be vaccinated, as well as children with medical exemptions who cannot be immunized because of   medical conditions or the small number of children whose vaccines are for some reason just not effective. Adults, whose immunity has “worn off”, are also at risk.

Traditionally, these vulnerable groups have been protected by what is known as “herd immunity.” Herd immunity refers to a situation in which a critical mass (about 80% to 90%) of the community has been vaccinated (or have natural immunity from having the disease). With such an immunity rate, the spread of the disease is unlikely. Herd immunity, however, can be dangerously weakened by vaccine refusal, putting the vulnerable at risk.

Much of the current vaccination opposition seems to have stemmed  from a discredited 1998 British study linking vaccinations to autism and from anecdotal accounts. The British gastroenterologist   Andrew Wakefield,who wrote the article, eventually had his medical license revoked and turned out to be a paid consultant to attorneys of parents who believed vaccines had caused their children’s disorders. Also highly influential have been the expressed opinions of celebrities, such as Jenny McCarthy, who maintained that vaccinations cause her child’s autism, and politicians such as U.S. Rep. Michele Bachmann, who has stated that the human papillomavirus vaccine is dangerous and can cause mental retardation.

According to Lawrence Madoff, director of Epidemiology and Immunization for Massachusetts. “When immunization rates fall, it doesn’t take long, even in a developed country, for diseases to resurge.” Such diseases are “only a plane ride away."

Personal freedom or free riders?



Terry Stawar

President/CEO (LifeSpring, Inc.)

Terry Stawar



Terry L. Stawar, EdD, is President and CEO of LifeSpring Health Systems, a community behavioral...

The opinions expressed by Behavioral Healthcare Executive bloggers and those providing comments are theirs alone and are not meant to reflect the opinions of the publication.