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Tag: vaccine hesitancy

  • Religious exemptions for school vaccinations have been growing since COVID

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    Despite a growing number of kids getting religious exemptions from required school vaccinations, Maryland still vaccinates a higher percentage of students than the national average. (Photo by Michael Loccisano/Getty Images)

    “No Shots. No School. No Exceptions.” That’s what’s parents are greeted with on the Prince George’s County Public Schools webpage on required vaccinations for the upcoming school year.

    But that’s not entirely true. In Maryland, there are exceptions — specifically, families can easily get religious exemptions to opt their kindergartners out of vaccine requirements in any school year.

    And more Maryland families have been choosing that route for the last four school years, according to Maryland Department of Health data released this week.

    About 1.7% of the state’s 63,000 kindergartners, or approximately 1,075 kids, cited religious reasons to be exempted from required vaccinations during the 2024-2025 school year.

    It’s the highest percentage of religious exemptions since the 2019-2020 school year, when the start of the COVID-19 pandemic not only ushered in a new wave of vaccine hesitancy but also disrupted typical school procedures for many families.

    Since the 2021-2022 school year, at least 1% of kindergartners in Maryland have had a religious exemption – a couple hundred a year – and it’s been rising since.

    While it’s still a relatively small percent of students compared to the rest of the population, and well below the national rate, public health advocates call rising number of unvaccinated kids “concerning.”

    “COVID put us behind the eight ball in terms of vaccination levels in kids,” said Dr. Georges Benjamin, executive director of the American Public Health Association.

    “It’s a very concerning trend because we need to maintain adequate vaccination levels to maintain herd immunity,” Benjamin said Tuesday. “These childhood diseases are not benign. They’re very dangerous.”

    Maryland law requires that children have a handful of vaccinations when they enter kindergarten, in order to protect themselves and their classmates from transmissible diseases, such as measles, polio and chickenpox, among others. Children can be exempted if there is a medical reason they cannot receive a vaccine or a religious restriction against it.

    A medical exemption requires a written statement from a physician that vaccination would be harmful to the student. But invoking a religious exemption in Maryland is simple. Parents can just sign a form that says: “Because of my bona fide religious beliefs and practices, I object to any vaccine(s) being given to my child.”

    Religious exemptions spiked in 2019-2020 when 2.7% of kindergartners, or 1,641 kids, opted out of vaccination requirements. The COVID-19 pandemic did not go into full swing until spring 2020, so those families would have opted out prior to the pandemic in the United States.

    Public health officials and researchers look at nonmedical religious exemptions as an imperfect metric for vaccine hesitancy among families, though tracking such data is a tricky task.

    “To the extent that people are looking at ways to opt out of being vaccinated, you will see a higher increase in people taking advantage of … religious exemptions,” Benjamin said.

    The rate of religious exemptions varies by school district and can be influenced by population size.

    Kent and Garrett counties have the highest rate of religious exemptions in the state, for example, with more than 4% of kindergartners  in those counties getting a religious exemption from vaccines last school year, according to the data.

    But Kent County had just 155 kindergartners in the 2024-2025 school year, so if seven kids had a religious exemption, that would account for 4.5% of Kent County kindergarten students.

    Similarly, Garrett County had 243 students in its 2024-2025 kindergarten class. The 4.12% receiving a religious exemption from vaccinations represents about 10 kids.

    “We have fewer kindergartners,” said Rebecca Aiken, school health services manager for Garrett County Public Schools. “It can really skew the numbers.”

    She said that there could be many reasons why some kids are not up to date on their vaccinations or use a religious exemption to opt out of them.

    She noted that some kids are homeless or do not have a stationary home life, moving between family members or living with grandparents, which can make record-keeping for immunizations challenging. The county tries to help families in those situations get their vaccinations or find their records.

    But with the ease of religious opt-out for vaccines, Aiken said there’s no way to know why someone selects the religious exemption for vaccines.

    “We can’t force them to prove their religion, so we have to take it at face value,” she said.

    She noted that even if the families opt their kids out of vaccination requirements, the county health officials and school nurses help keep the families informed about communicable diseases.

    Sherelle Jones, an official with the Prince George’s County Office of School Health, noted that compliance with the vaccination requirement is down for the upcoming school year, but she has not noticed a rise in vaccine hesitancy specifically.

    She’s hearing that some families who do not have health care coverage have struggled to get their kids vaccinated. Prince George’s County Public Schools has hosted vaccination clinics in hopes of closing that coverage gap.

    Last school year, Prince George’s County’s schools had about 1.7% of its kindergartners getting a nonmedical religious exemption from vaccinations, on par with the state as a whole.

    Jones noted that there is still time for families to comply with the vaccination requirements, as school doesn’t start until Aug. 26 in Prince George’s County.

    But Benjamin noted that families are coming in with more questions about vaccines, which he says is a result of new messaging at the federal level about when to receive vaccines and at what age.

    “There is a very well-organized, well-funded antivaccine community out there,” Benjamin said. “Coupled with some of the mistrust that has been promoted by the current Health Secretary [Robert F.] Kennedy — that has raised the questions in people’s minds about when their kids should get their shots, how many shots they should get and whether they should get these shots.

    “My colleagues that are practicing pediatrics are telling me that more and more parents are coming in with more questions about vaccinations,” he said. “I would not equate that to vaccine hesitancy, although there is certainly more of that.”

    While the rate of religious exemptions is going up in Maryland, state health officials say that vaccine coverage among Maryland kindergartners is still high, especially compared to the rates nationally. The Centers for Disease Control and prevention said 3.6% of kindergartners nationwide were exempt from vaccinations for the 2024-2025 school year, up from 3.3% the previous year.

    “In general, vaccine coverage rates remain high in Maryland. The overall exemption rates remain below the national average and stable at 2.2% compared to the previous school year,” said David McCallister, public information officer for the state health department in a written statement. The 2.2% figure combines both 1.7% of kids who have a religious exemption and the 0.5% who have a medical exemption in the 2024-2025 school year.

    McCallister noted there’s been an increase in exemptions, “specifically non-medical exemptions” since the COVID-19 pandemic.

    “The Department will continue to monitor school exemption trends very closely, especially with regard to their relationship to vaccine preventable diseases,” McCallister said. “MDH continues to recommend vaccinations for all children.”

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  • No shots for Spot? Study finds owners’ vaccine hesitancy can extend to pet dogs

    No shots for Spot? Study finds owners’ vaccine hesitancy can extend to pet dogs

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    Individuals who are skeptical of vaccines for themselves are also more like to question the need or efficacy of getting shots for their four-legged companions, according to a recent study.

    In the study, published in the medical journal Vaccine, researchers asked 2,200 Americans their thoughts on vaccines and whether they were dog owners. If they were, respondents were then asked whether they would vaccinate their dogs for rabies.

    Approximately half of the pet owners surveyed expressed some degree of vaccine hesitancy — with 53% saying they believed vaccines administered to dogs were unsafe, ineffective or unnecessary, the study found.

    That group was 6% more likely to have dogs that were not vaccinated for rabies, and 27% more likely to oppose rabies vaccine mandates when compared with survey respondents who did not express vaccine hesitancy, according to predicted probabilities outlined in the study.

    Matt Motta, an assistant professor at the Boston University School of Public Health and one of the study’s co-authors, said he was not surprised to see some respondents express reluctance regarding canine vaccines, but was intrigued by the raw data.

    “I think we were pretty shocked at just how pervasive it is, and I think what I found even more shocking is how detrimental its health consequences might be,” Motta said.

    Rabies, though relatively rare, is almost always fatal in animals and humans alike, according to the U.S. Centers for Disease Control and Prevention. However, due to vaccines, it’s also highly preventable: Only a few human cases are recorded each year in the United States.

    “The rabies shot is the most important canine vaccination for protecting human health, and yet growing numbers of pet owners are skeptical of it,” the authors of the study wrote for Harvard Public Health.

    Most infections in humans are caused by domestic dog bites.

    California law requires all dogs over 4 months old to be vaccinated for rabies, and similar rules exist throughout most of the U.S.

    Dr. Jeanne Noble, an emergency medicine doctor and COVID-19 response director for UC San Francisco, attributed the recent uptick in vaccine hesitancy in part to the mandates imposed during the pandemic.

    “When public health officials used mandates to increase uptake of COVID vaccines, rather than sticking to broad education campaigns highlighting the tremendous benefits of the vaccine, while also acknowledging the small but measurable risks, we lost the trust of vaccine hesitant communities,” she wrote in an email. “These are folks that previously were cautiously abiding by vaccination recommendations for their children, and their pets, but are now opting out.”

    To build back that trust, Noble suggested meeting people where they are and having honest and complete discussions — answering their questions and concerns without minimizing their fears.

    The authors of the canine vaccine hesitancy study agree, and recommended paying special attention to pet owners.

    “Public health campaigns tackling vaccine hesitancy would do well to consider dog owners in their messaging, and consider drops in pet vaccination, especially for rabies, an important bellwether for gauging public trust in vaccines,” they wrote in their Harvard Public Health post.

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    Jeremy Childs

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  • Why Some Groups Vaccinate Less

    Why Some Groups Vaccinate Less

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    “I heard there’s a microchip in the vaccine.” That’s what a surprising number of people tell Rupali Limaye, PhD, about why they don’t want to vaccinate their child.

    They might also say they’re worried that certain vaccines cause autism (a persistent myth that has no basis in fact) or that recommended vaccine schedules are dangerously fast, or that there are long-lasting side effects, or that the government is withholding vaccine information, or that infections aren’t dangerous, among other things, she says.

    The problem, says Limaye, who studies human behavior and the spread of disease at Johns Hopkins Bloomberg School of Public Health, is that the science simply doesn’t support these ideas.

    Vaccines are a miracle of the modern world that protect against diseases like hepatitis B, diphtheria, polio, measles, and tetanus, which, in previous eras, killed and debilitated millions of people across the world, Limaye says.

    That’s why the CDC, National Institutes of Health, American Academy of Pediatrics, and other reputable health organizations are so clear about a vaccine schedule that almost all parents should follow.

    And yet hesitancy about child vaccination persists.

    And though it’s true that growing misinformation feeds this hesitancy, vaccination rates can also vary by community, tradition, or philosophical belief. American Indian and Alaska Native babies are 10% less likely to be fully vaccinated than white children. And there’s a similar gap for Black children.

    Socioeconomic status can play an even bigger role. Babies from families living below the poverty level are 30% less likely to receive all the recommended vaccines in their first 3 years of life.

    In some cases, this hesitancy stems from exploitive medical history. For example, researchers in the notorious “Tuskegee Experiment” (1932-1972) purposely failed to treat a group of Black men with syphilis simply so they could see the effects of the disease. And in the 1950s, research on the birth control pill used the bodies of Puerto Rican women without their full consent. It’s easy to understand how that kind of history would make someone wary of mandates from the medical establishment.

    Whatever the reasons, when parents skip government-mandated and doctor-recommended child vaccinations, they don’t just take a chance with their own child’s health. They also risk the health of the community, Limaye says.

    Addressing vaccine gaps saves lives. Worldwide, measles deaths fell by 74% between 2000 and 2007, thanks in large part to increased vaccinations.

    In the U.S., marginalized communities seem to bear the brunt of the consequences of vaccine hesitancy. That’s often because they lack adequate access to medical care and health education that can make such a difference during an illness. 

    For instance, flu hospitalizations were 1.8 times more common among Black populations between 2009 and 2022, compared with white populations – American Indians were 1.3 times more likely and Hispanics were 1.2 times more likely. But, research showed, lagging vaccinations in those communities may also be part of the problem as well.

    Vaccination and Religious Identity

    In 2019, just before the COVID-19 pandemic, measles outbreaks reached their highest levels since 1994. It happened because more and more parents were opting out of the MMR vaccine (which prevents measles, mumps, and rubella), often due to false information about its dangers.

    MMR herd vaccination rates need to be around 95% to be effective. Below that, there is risk of an outbreak, especially in areas where kids haven’t gotten both doses of the vaccine – which can be quite common. (For example, data from 2016 showed that in certain Minnesota counties, almost half of all kids under age 7 hadn’t had both doses.)

    These measles outbreaks in 2019 were particularly notable in some Orthodox Jewish communities in Brooklyn, NY, where there were low vaccination rates along with legal loopholes for religious communities.

    Mistaken preconceptions about the safety of vaccination and how it relates to Jewish law were at the root of these outbreaks. But the increased illnesses in children led to a wide-ranging community discussion between the New York State Department of Health, Jewish scholars, local health professionals, and the community at large that helped raise vaccination rates and lower rates of infection.

    Other cases have been harder to deal with. For example, early on in the COVID pandemic, a 2021 Yale study showed that a group identified as white evangelical Christians could be convinced to get vaccines based on the greater good of the community. But the research showed the effect seemed to fade as the pandemic wore on, perhaps as attitudes about vaccines became more closely linked to certain political identities and points of view.

    Still, there’s no reason vaccine education can’t work in religious communities, Limaye says. While research shows a trend to vaccine skepticism among certain religious groups, only about 3% of people believe their religion explicitly forbids vaccination, according to a 2022 University of Michigan study.

    Teach, Don’t Preach

    Vaccine education can turn the tide, but the approach you take can make all the difference.

    Campaigns that focus on a particular religious identity are more likely to provoke defensive reactions, according to research. Better to focus on the universal moral value of caring for others.

    In fact, it’s often best not to contradict points of view directly, however unusual they may seem, Limaye says. So what does she say to someone who’s worried about microchips in a vaccine?

    “I say, ‘I know there’s a lot of information out there and it’s hard to figure out what’s real and not real. Let me explain to you a little bit about the vaccine development process.’ ”

    “Part of it is framing it in this way that it’s a shared decision-making process,” she says.

    Keep providing information, she says. In one case, Limaye saw the mother of a child with asthma decide to vaccinate after hearing of another child with COVID who died because they also had asthma.

    Correcting new myths that spring up can often be a game of whack-a-mole, says Limaye. That’s why she has a few general guidelines on how to speak with a person who may be misinformed about the dangers and benefits of vaccines:

    • Listen to concerns, and don’t correct beliefs that seem based in misinformation right away.
    • Try to address individual concerns with facts from reputable sources like the CDC, National Institutes of Health, or American Academy of Pediatrics. In cases where a person distrusts one of the sources (like the CDC), it’s good to have other reputable choices.
    • Consider providing something to read from a reputable source either in the form of a link or a hard copy. “Whether or not they ask for it, I’d rather give them something to look at than have them go Google something on their own,” Limaye says.
    • Listen carefully to objections to what you say, and understand that persuasion may take much longer than a 15-minute conversation.
    • Give details. Limaye counsels medical students in her class to explain to parents and patients more information about how vaccines are created.

    And don’t talk down to people, Limaye says. Strive to meet them on their own terms. Personal stories are a great way to connect. If you have a personal story about a kid who got really sick due to a lack of vaccination, “I think that’s really powerful.”

     

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