SALT LAKE CITY — The mother of two loved California. The state’s health-conscious values resonated with her. She bought organic produce, tried to avoid food with GMOs and brought her own bags to the grocery store. But there was one thing the mother, who asked that her name be withheld to protect the medical privacy of her children, did not like about California: its approach to vaccines.

She did not want to vaccinate her children, and in 2015 the state passed Senate bill 277, banning all but medical exemptions for vaccines.

Her son was 4 years old, had never received a single vaccine, and would not be able to attend school the following year under the new law unless she got him up-to-date.

She would either have to comply, find a doctor to write a medical exemption or homeschool her kids. But, there was one other option: pack up and move. If she stayed in California, her children would not be afforded the same educational opportunities, she believed, because she couldn’t send them to school.

“Rather than fighting we left,” she said.

She and her family moved to northern Utah at the end of 2016, where both personal and religious exemptions are allowed. There are other parents like them who are moving from California in pursuit of what they call “medical freedom.”

They consider themselves vaccine refugees. But as more parents seek out exemptions, are they putting the health of others at risk?

California refugees

In February, the Idaho Statesman reported that families were moving from California to Idaho to take advantage of the state’s lax childhood immunization laws. In a series of public hearings, the parents asked lawmakers to think twice before placing any restrictions on vaccine exemptions. Some of the parents referred to themselves as “refugees” of the Golden State, and said they were pushed out by the new restrictive laws.

“I’ve been told my kids need to be exterminated and I should go to jail.” — Shalee Brindley, mother in Idaho

Shalee Brindley, a Bay Area transplant with two unvaccinated children, was among those parents.

Brindley said vaccines weren’t the only reason she left California — Idaho better fit her conservative values and her family struggled to find affordable housing in California, but when SB277 passed, it gave her the final push she needed to finally try and make a life in Idaho.

Despite the more “liberty-minded” attitude in Idaho, Brindley said she still faces backlash when she talks about her stance on vaccines. “I’ve been told my kids need to be exterminated and I should go to jail.” She has tried to keep their medical records private, but also wants to be an advocate for “medical freedom.”

Utah is also an appealing place for parents seeking exemptions, said Kristen Chevrier, leader of Your Health Freedom, a group that advocates for vaccine choice, and also organizes events — from movie screenings promoting unvaccinated children to symposiums on natural health.

In Utah, both philosophical and religious exemptions are allowed — and parents don’t have to specify what religious beliefs or philosophical justifications they use to seek an exemption, according to state law.

Parents who want an exemption in Utah, first have to watch a 20-minute video about vaccine preventable diseases. After watching the video, a certificate is sent, which parents then forward to their child’s school. Until 2017, when HB308 passed and allowed parents to fill out vaccination exemption forms online, it was more difficult to get an exemption: parents had to make a trip to their local health department clinic in person and get a signed note.

Rich Lakin, immunization program manager at the Utah Department of Health, said he wishes the video could be longer, but is glad that it exists and is providing parents with more accurate information than what they might find on social media.

Multiple Utah mothers who did not vaccinate their children said that while they did not mind being required to watch the video, they did not believe the information presented was true. Instead, they came away even more convinced of their beliefs that vaccines are harmful and should be avoided.

Is it dangerous to others?

The harder it is for parents to exempt children from vaccinations, the lower exemption rates are at the state level, Dr. Jana Shaw, a pediatric infectious disease specialist based in New York, said. In 2018, Shaw published an analysis of state laws and exemptions. Her study concluded that the most effective laws were those based on standards set by the CDC and included evidence-based education on why parents should vaccinate their children.

In 2018, 5.2% of students entering kindergarten received exemptions in Utah. Almost 95% of those exemptions were personal (also known as philosophical), according to the 2019 Immunizations Coverage Report published by the Utah Department of Health. While the overall number of exemptions in the state decreased from 2017 to 2018, they increased in the same period of time in Salt Lake, Bear River, Southwest, Summit, Tooele, Wasatch and Weber-Morgan counties.

Salt Lake City and Provo were both considered “hotspot metropolitan areas” due to the high number of nonmedical exemptions provided according to a report published in Plos Medicine in 2018.

To prevent an outbreak 90-95% of a population needs to be vaccinated, although some scientists argue that it actually needs to be above 95% to achieve true herd immunity.

“If you have a low immunity herd … the likelihood of being exposed is going to be much higher,” a pediatric infectious disease expert at Stanford told Science News Magazine.

“We do worry that if you remove all opportunities to parents, they will either simply just rebel or move out, which some parents have done in New York State.” — Dr. Jana Shaw, pediatric infectious disease specialist based in New York

In order to prevent outbreaks, both California and New York nixed all but medical exemptions in the wake of measles outbreaks that spread across the country. In 2019, there were 1,282 cases in 31 states, according to the CDC.

After California eliminated philosophical and religious exemptions, vaccination rates of children rose from 92.9% to 95.1%, according to The Los Angeles Times. However, medical exemptions tripled.

Now, California is also trying to crack down on medical exemptions, which could be issued due to severe allergic reactions to a vaccine, a history of seizures, or other nervous system issues. Lawmakers and public health officials accused some doctors of abusing their authority to write medical exemptions — sometimes charging fees in exchange for the note.

This past fall, California Gov. Gavin Newsom signed SB276, which requires a standardized certificate from doctors and reviews those who write more than five exemptions a year.

“We do worry that if you remove all opportunities to parents, they will either simply just rebel or move out, which some parents have done in New York State,” Shaw said.

There is a balance between making vaccine exemptions difficult to obtain, and causing an exodus.

Maya Grace, a mother of a 6-year-old unvaccinated son, a current Northern California resident and self-described “health freedom activist,” is already concerned.

“A lot of parents have left. Some of us aren’t able to leave as easily,” Grace said. She was able to obtain a medical exemption for her son, but is worried that a crackdown under SB276 may nullify it. If that happened, Grace was unequivocal about what she would do: “We will move and uproot our lives before we comply with these laws.”

Anti-Vaxxers

On a frigid Thursday night in February, “Vaxxed: The People’s Truth,” played at the Thanksgiving Point Megaplex theater in Lehi. The film depicts children with a variety of illnesses which parents claim were caused by vaccines. That position was popular at the screening, but runs counter to the CDC.

From 2006-2017, for every million vaccine doses administered, only two claims of injury were made through the National Vaccine Injury Compensation Program. According to the CDC, vaccines are safe, with “rare exceptions.”

The screening was organized by Chevrier, of Your Health Freedom. The location was kept secret until the night before — if it got out too soon, people might try to shut the showing down, she said.

Despite the lack of advertising, the auditorium was so packed extra folding chairs were placed along the walkway. It was the third, completely sold-out screening of the film in Utah, Chevrier said.

A man with a baby on his lap sat on one of the folding chairs. He kissed its head every so often, and nodded when the film’s star proclaimed how healthy unvaccinated children are.

In a Q&A following the screening, one of the panelists emphatically told the crowd that no vaccination was safe, which generated applause.

Afterward, a small crowd gathered around the “Vaxxed” bus, which has been making its way across the country, to buy copies of the film.

Women like Chevrier are organizing, bringing their ideas to the forefront, and are determined not to let Utah go the way of the coastal states. They are creating a movement, they say, sometimes fighting in secret, to maintain current exemption laws.

They know families that have moved from California to escape vaccination requirements. They say it’s just the beginning, and that more are on the way.