Families with children who have had personal or philosophical exemptions to the vaccine for measles, mumps and rubella will have to vaccinate their children or get a different exemption as school starts this fall.
But the requirement for a new exemption can be easily bypassed, as parents can use the same form to request a religious exemption rather than a personal or philosophical exemption.
As was true of the personal or philosophical exemption to the MMR vaccine, the religious exemption does require the signature of a health care provider.
Washington families can also still get a medical exemption or a second type of religious exemption for those who “belong to a church or religion that objects to the use of medical treatment.”
Washington state lawmakers cut the philosophical or personal exemption for the MMR vaccine earlier this year after measles outbreaks flared up around the state.
Without one of the three remaining exemptions, the MMR vaccination is required for children to enter preschool, child care or school in the state. Child care providers also have to get the MMR vaccine if they do not currently have it.
Families can still invoke a personal or philosophical exemptions to other vaccines, including those for polio, tetanus and pertussis.
About 8% of the 75,305 enrolled students in all Spokane County school districts had some type of vaccine exemption in the 2017-18 school year, according to the state Department of Health.
That means more than 6,000 students in Spokane County schools had one of the four types of exemptions to any one vaccine. Of those students with exemptions in Spokane County, 3,311 of them have an exemption to the MMR vaccine.
While state data do not say how many of these exemptions are personal or philosophical, these exemptions are known to make up the majority of the total exemptions in Spokane County and statewide.
Susan Sjoberg, program manager at the Spokane Regional Health District, said that very few states allow exemptions beyond medical necessity. Personal exemptions, she said, are likely the highest in Washington because they are the easiest to get.
Brian Coddington, Spokane Public Schools communications director, said the district will not know exactly how many students the elimination of the personal or philosophical exemption will impact until school starts. But the district is trying to prepare families that might be affected.
Like districts around the state, Coddington said Spokane Public Schools has been reaching out to families to ensure they are complying with the changes in the law since before school got out for summer.
“We sent letters out to the families we thought would be impacted,” he said.
The new law took effect on July 28, but families technically have a 30-day grace period to comply with the new regulation, Coddington said. In Spokane Public Schools that grace period ends on Oct. 11, the district’s official immunization exclusion date.
Allison Hahn, a nurse in the Cheney School District, said that letters were sent out before school ended in her district, giving families all summer to get into compliance with the new law.
“It is a small percentage of our students,” she said.
School districts will not be able to tell if the new law affects their vaccination rates until later this fall.
Measles is the most serious disease that the MMR vaccine protects against.
Danielle Koenig, health promotion supervisor at DOH, said people who are most at risk for serious complications due to measles are children under the age of 5 and adults. It is an airborne illness, which can stay in the air for up to two hours. Sjoberg said one measles case is considered an outbreak because it is so contagious.
So far in 2019, there have been 85 confirmed cases of measles in four counties in Washington state, although none of those cases were east of the Cascades. Two cases of measles were reported in June in Moscow, Idaho, however.
The MMR vaccination is administered when a baby is between 12 to 15 months old, which means that infants are at particular risk to catch the disease. The MMR vaccine is taken in two doses, with 28 days between doses at a minimum. For kids, the second dose is usually administered when they are 4 to 6 years old, according to the CDC.
“When we make sure we have as many people vaccinated as possible, not only does the person who gets vaccinated get protection, but they are also protecting people around them,” Koenig said.
The MMR vaccine also protects a person from mumps, which is spread by coughing, sneezing or sharing eating and drinking utensils.
Mumps is not an illness associated with life-threatening consequences, but it can have life-changing consequences, Sjoberg said. A few cases were reported this year at Eastern Washington University.
“It can oftentimes have an impact on ovaries and testes, which leads to sterility,” she said. “But it’s preventable.”
Eighteen states offer nonmedical exemptions to vaccinations, and a 2018 analysis of immunization data from states with nonmedical exemptions found that in 12 of the 18 states, the rate of nonmedical exemptions continues to rise.
Washington, Idaho and Oregon all allow nonmedical exemptions, and Spokane is among the 15 metropolitan areas that had more than 400 kindergarten students with nonmedical exemptions in the 2016-17 school year. Idaho is home to eight of the top 10 counties with the highest nonmedical exemption rate for kindergarteners.
The study, published in PLOS Medicine, recommends strict policy changes to decrease nonmedical exemption rates but uses the example of Washington state in 2011 to show that not all policy changes work.
“In 2011, WA enacted a more rigorous requirement of a physician’s signature prior to obtaining a (nonmedical exemption). Although the rate declined in the following school year, the outcome was short-lived, and the rate plateaued in subsequent years,” the study says.
The state’s personal exemption rate for all vaccinations has decreased for all students, albeit gradually, over the last decade. In 2009, rates of exemptions peaked in the state and have slowly declined since then.
In the coming months, data from school districts will show whether or not the 2019 law change has a similar or stronger impact on MMR vaccination rates throughout the state.
Children and teens younger than 19 can get vaccinations covered by the state’s childhood vaccine program with the state’s health plans, Koenig said.
The Spokane Regional Health District hosts several vaccination clinics in the community, with partners, and several school districts also plan to offer clinics for families with children who need vaccinations. CHAS Health is hosting a clinic at Riverside Elementary on Aug. 27 and at the Cheney School District on Oct. 19.
Uninsured adults in the state can also get vaccinations free of charge.
The Department of Health partnered with Safeway and Albertson’s stores to provide the adult MMR vaccine to uninsured child care workers. In Spokane, the pharmacy at Safeway at 1616 W. Northwest Blvd. is offering the MMR vaccine free of charge through June 2020 to uninsured child care staff.
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