With measles outbreaks leading more states to end or limit nonmedical vaccination exemptions, school district administrators are increasingly finding themselves in the uncomfortable role of vaccination police.
New York ended religious and nonmedical exemptions for student vaccinations in June, joining a growing number of states aiming to prevent the spread of disease—and leaving district administrators to ensure that all students receive required vaccines and to handle pushback from parents.
All 50 states require that students be vaccinated against specific diseases in order to attend school. Exemptions vary by state, but all states offer medical exemptions to students who are allergic to a vaccine. Some 45 states and Washington, D.C., grant religious exemptions for people who have faith-based objections to vaccinations. In addition, 15 states allow philosophical exemptions for those who object based on personal or moral beliefs.
Along with New York, which saw nearly 600 confirmed cases of measles during the spring, California, Maine, Mississippi and West Virginia prohibit opting out of immunizations based on personal beliefs.
“It’s our duty and responsibility to let parents know about the changes and what their child needs, and provide them with the resources to make sure students are immunized and ready to start school before their first day,” says Sosse Bedrossian, director of nursing services for Los Angeles USD.
Navigating a disease outbreak
In April, the North Sanpete School District, a rural Utah district of 2,500 students, had two confirmed cases of mumps. The county health department asked the district to offer two options for students who had not received the measles, mumps and rubella vaccine: Get it immediately and come to school, or stay home from school for the 26-day incubation period.
More than 10% of the district’s population were not immunized, says Superintendent Sam Ray. Some parents decided to keep their students home from school even if they were already immunized. Other parents asked for a medical exemption.
“When parents pushed back, we said, ‘Don’t shoot the messenger,’” Ray says. “This was the state health department telling us what to do. We offered to help get students vaccinated, and had a bunch who did. We’re not here to judge; we’re just here to help kids and parents.”
Nearly half of the students who were not previously vaccinated did get the vaccine, and the other half said they were not going to do so and waited until the incubation period was over, Ray says. “Those parents understood what they decided when they decided not to vaccinate, and knew it was a possibility, so they didn’t try to fight us,” he adds.
Students who were kept home from school received recorded lessons, and they completed homework on tablets, Ray says.
Providing vaccination info resources
When the personal belief exemption was banned in California in 2016, some Los Angeles USD parents opted to home-school their children instead. For the most part, students who previously had personal belief exemptions received immunizations so they could attend school, says Bedrossian.
Students can receive the required vaccinations for free at district health clinics, which are open before the start of school. Parents are informed of the state’s regulations and this option via information sessions, automated messages, phone calls and letters.
“It boils down to educating parents and community members about the importance of vaccinations,” Bedrossian says. “The way things are going, more states are talking about making laws more strict.”
Administrators should discuss with parents their district’s constraints and what options are available, Ray says.
For more information, administrators can consult the Centers for Disease Control and Prevention’s Vaccines and Immunizations webpage.
