When she was pregnant, Austin resident Katy Ludlow remembers, many parents were concerned about vaccinating their children. Actor Jenny McCarthy was speaking openly about her belief that her son’s autism was linked to vaccinations, and Ludlow grew worried.

“You’re always worried what you’re putting in your kids,” she says. Ludlow says she was almost convinced not to vaccinate her child, until she had a conversation with her mother.

“She was not on the same team," Ludlow remembers. "'She said, ‘Look, I’ve put up with your hippie ideas about raising children. I’ve got your birth candles ready to go. There’s just no way you’re going to not vaccinate your kid. That’s what science is for.’”

Eight years later, Ludlow says she’s firmly pro-vaccination and has fully vaccinated her daughter, who is now 8. But Ludlow says the debate over vaccinations continues among parents on play dates, where she witnessed a near-fight between two moms with differing opinions on vaccines, and social media platforms like Facebook.

Among Texas’ largest public school districts, Austin ISD has the highest number of students who have been exempted from immunizations. Within the district, these exemption rates are highest at public schools in higher income neighborhoods with higher concentrations of white students, according to an analysis of district data by KUT.

As of June 2, 2016, the highest exemption rate is among students at Zilker Elementary School, where 58 students – 10 percent of the student population – opted out of at least some vaccine requirements. That adds up to more than three classes of students. Zilker Elementary is near three other Central Austin schools with some of the highest rates of exemption district-wide: Barton Hills Elementary (8 percent), Becker Elementary (5 percent) and Travis Heights Elementary (5 percent). These numbers do not include medical exemptions.

Meanwhile, in less affluent neighborhoods, all or nearly all students are immunized at many schools. In Northeast and Central Austin, schools such as Reagan High School, Lanier High School and Guerrero-Thompson Elementary School have a 100 percent immunization rate. The only school on Austin’s East Side with an exemption rate above 3 percent is Garza Independence High School (9 percent), an alternative high school that enrolls students from across the city.

Students are required to receive 10 immunizations to attend school, including vaccinations for measles and mumps, tetanus and whooping cough. Most of these vaccines are required before children start kindergarten.

"When you have a highly educated population of all things, some of them are going to decide that they know better than what our doctors tell us to do."

When parents do not want their children to receive one or all of those vaccinations, they must submit something called a "conscientious exemption" form, which informs the school that their child is not vaccinated. Texas started allowing parents to exempt their children from immunizations in 2003. Since that time, the number of students statewide with immunization exemptions increased from 3,000 in 2003 to more than 45,000 exemptions last school year.

In Austin ISD, nonmedical exemptions are largely drawn along racial and socioeconomic lines, a trend that plays out across the U.S. as well.

Nationally, studies show most students who don’t have immunizations come from white, higher-income families where parents are married and the mother has a college degree. At Austin ISD schools with few white students, immunization exemption rates are much lower than the rates at schools with a higher percentage of white students.

The increased numbers appear to reflect a growing belief among some parents that vaccines can harm their children. Many attribute that anti-vaccination sentiment to the proliferation of a discredited 1998 study that falsely linked some vaccines to autism. The man who conducted that study, Andrew Wakefield, was stripped of his medical license in Britain and now lives in Travis County.

"When you have a highly educated population of all things, some of them are going to decide that they know better than what our doctors tell us to do," says Julie Cowan, an Austin School Board trustee who sits on the district’s School Health Advisory Council. "Because doctors will tell us we should immunize our children."

Ludlow says she’s not surprised the rate of nonmedical exemptions is higher in these areas, where she says there’s more of a “hippie vibe.”

“There’s a privilege of being able to opt out of these decisions and these choices you have to make,” Ludlow says. "They might have better healthcare at a higher income school, so they’re thinking, ‘If we get measles at least we’ve got the health insurance to pay for it.’ And a lot of parents wouldn’t.”

“If a child has a peanut allergy, we get a note home. So, if a kid has a medical reason and they were in a class with 10 unvaccinated children, of course, a parent should know that.”

Ludlow’s daughter attends one of the Wayside Schools, a charter school system in Travis County – 71 students, or 4 percent, are not vaccinated across the system’s four campuses.

Anna Dragsbaek, president and CEO of the Immunization Partnership, says it’s not uncommon for students who are not immunized to live near each other or interact with each other, increasing the risks for disease outbreak in those areas.

“If you look at rate of un-immunized children in Texas we’re hovering at just about 1 percent,” Dragsbaek says. “If you think about Texas' population that doesn’t seem to be of a huge concern, unless you take into account the fact that those children who are not fully immunized are clustering in communities. It’s not one percent across the board. You have to remember these students tend to cluster in schools or in faith communities, and then the rate of immunization can be very, very low.”

Last year, Austin Regional Clinic stopped serving patients who are not vaccinated because of concern about vulnerable patients in the waiting room, but Austin ISD is required under state law to accept students with nonmedical exemptions. According to an Austin ISD spokesperson, schools don't accommodate children based on vaccination status, nor do they notify parents if there are non-vaccinated students in the school or classroom, citing medical privacy concerns.

Ludlow says she understands those concerns, but schools alert parents about other medical-related issues.

“If a child has a peanut allergy, we get a note home,” she says. “So, if a kid has a medical reason, and they were in a class with 10 unvaccinated children, of course, a parent should know that. If my kid can’t get vaccinated, and they’re in a classroom with all of these unvaccinated children, if I don’t know that, I’m not able to make the best decision for my kid.”

Last legislative session, Rep. J.D. Sheffield (R-Gatesville) introduced a bill that would require school districts to report immunization data for each campus to the Texas Department of State Health Services, including the school's non-medical exemption rate. The House passed the bill, but it was never brought up for a hearing in the Senate.

Dallas Republican Rep. Jason Villalba also introduced a bill that would eliminate the conscientious exemption provision, but it did not receive support.

You can view a breakdown of some Austin ISD schools' nonmedical exemptions. We've included all schools with more than five exemptions, as the district doesn't release specific numbers for schools with fewer than five exemptions.

_