Research Findings: James Colgrove

Exemptions to school vaccination laws—provisions that allow parents who object to vaccines to send their children to school unimmunized—have provoked bitter debates in state legislatures around the country. Almost all states allow parents to opt out of vaccine requirements on the basis of religious or philosophical beliefs. But in the wake of the 2015 Disneyland measles outbreak, which was blamed in part on compromised herd immunity resulting from high numbers of parents claiming exemptions for their children, many states are considering revoking these provisions. In an article in the February 2016 issue of Health Affairs, Professor James Colgrove and SMS MPH alumna Abigail Lowin analyze this issue and offer “lessons learned” from the unique experiences of two states.

For guidance on how states should approach this issue, Colgrove and Lowin turned to a policy anomaly: For more than three decades, only two U.S. states, Mississippi and West Virginia, allowed no religious or philosophical exemptions. Their stance ran contrary to the conventional wisdom among many public health officials who believe exemptions are a political necessity. Unless states provide some mechanism to allow strongly opposed parents to opt out of compulsory vaccination laws, the reasoning goes, the laws will provoke divisive and time-consuming battles that will erode trust in vaccines and public health more generally. But this fear was not borne out in either state. Based on a review of legislative histories, legal rulings, media accounts, and interviews with health officials in the two states, Colgrove and Lowin conclude that, contrary to conventional wisdom, it is possible to limit exemptions without damaging the public health system.

So should other states follow the examples of Mississippi and West Virginia? Last year, California did just that, and efforts by anti-vaccination activists to overturn the new law have so far failed. Nevertheless, legislators in other states should proceed with caution. “Revoking a legal right that people have previously enjoyed,” the authors write, “presents a different set of political circumstances than maintaining a status quo in which the right has never existed. In both Mississippi and West Virginia, the absence of nonmedical exemptions predates the rise of contemporary vaccine controversies and highly mobilized anti-vaccination groups.” 

Colgrove JK, Lowin AM (2016). A Tale of Two States: Mississippi, West Virginia, and Exemptions to Compulsory School Vaccination Laws. Health Affairs 35(2): 348-355. Read the full article here.