The rate of Texas students forgoing vaccinations has soared over the past decade, with more parents questioning the wisdom of vaccinating their children, even as public health experts warn of the dangers of opting out.

Slightly more than 1 percent of Texas public and private school students received conscientious exemptions from state-mandated vaccinations during last school year, a fourfold increase from the 2007-08 school year. The statewide rate has increased every year during that time, according to an American-Statesman analysis of state data.

In Travis County, the exemption rate also has quadrupled over the last decade from 0.66 percent to 2.72 percent. Some Austin private and charter schools posted some of the highest exemption rates in the state.

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Parents who have obtained or support the exemptions say they, not the government, should decide whether to vaccinate children. That idea has gained currency among conservative state lawmakers, who have unsuccessfully pushed to make it easier for parents to obtain exemption forms.

Physicians and others who promote childhood vaccinations attribute the rise in opt-out rates to the politicization of vaccines as well as exaggerated and debunked claims of vaccine dangers. Pointing to recent spikes in several infectious diseases across Texas, public health officials say children with conscientious exemptions endanger children who can’t receive vaccines for medical reasons and potentially weaken the immunity of an entire community.

“I see kids with serious infections all the time. I know what things were like before we had some of the new vaccines, and I’ve seen kinds of diseases that were serious in kids go away when we had new immunizations come out,” said Donald Murphey, a pediatric infectious disease physician at Dell Children’s Medical Center. “The public doesn’t trust doctors and the whole medical field. They don’t trust pharmaceutical companies. They don’t trust anybody anymore.”

‘Vaccine choice’

Two years ago, Monica Sanchez criticized the Austin school district for what she said was shaming of parents who decided against getting a flu shot for their children. A form distributed to parents asked them to check one of the following boxes — “Yes, I want to help protect my family and my community from flu by allowing my child to receive a flu vaccine!” or “No, I do not want to help protect my family and my community by allowing my child to participate (reason).”

“I was alarmed. I know what’s best for my children, and that may not always coincide with what the school district thinks is best for them,” Sanchez recently told the Statesman.

Her children — 13 and 14 years old — have followed the government-mandated vaccine schedule so far, but Sanchez is considering obtaining vaccine conscientious exemptions for them. Sanchez said she feared the chemicals in vaccines could cause irreparable harm to her children.

To attend Texas schools, children must receive vaccines that against diphtheria, tetanus, whooping cough, polio, measles, mumps, rubella, hepatitis A and B, chickenpox and meningococcal disease.

Since 1972, Texas has allowed medical and religious exemptions from the immunizations required to enroll in school. In 2003, then-Gov. Rick Perry signed a bill into law allowing students to be exempted because of families’ personal beliefs. To obtain a conscientious or religious exemption, a parent must submit a request online or through the mail for an affidavit form to the Department of State Health Services.

Texas is one of 18 states that allow families to opt out of vaccines for personal reasons.

READ: ‘Civil liberties’ at center of vaccination debate in Texas

Attempts to eliminate conscientious exemptions in Texas in 2015 amid an outbreak of measles at California’s Disneyland spurred a backlash and led to the creation of North Texas-based Texans for Vaccine Choice, which has 6,500 members statewide.

“The state doesn’t own my body,” said Jackie Schlegel, the group’s executive director. “These are the fundamental principles that most Texans can agree on. … We shouldn’t be allowing the government to mandate medical procedures.”

Some members of the group obtain exemptions but get vaccinations for their children anyway. They just don’t want to be told to do so, she said.

School officials at the private Austin Waldorf School, which has an exemption rate of 49 percent, the highest in the state, told the Statesman that many students with exemptions are either fully vaccinated on a delayed schedule or missing one or two immunizations like chickenpox and hepatitis B.

Likewise, at Austin Discovery School, an East Austin public charter school where 32 percent of students have a conscientious exemption, many students with exemptions have some vaccinations but not all, said Deborah Freeman, the school’s registrar. Bundles of “vaccines are typically given to a child … at once. Some parents feel like it’s a lot for their child’s body,” she said.

Children should be immunized according to the government-advised schedule to ensure optimal effectiveness of the vaccines, said Mark Shen, a pediatrician with Dell Children’s Medical Center and medical director of the Austin school district’s school health services program.

Officials with Austin Discovery and Austin Waldorf say they’ve never had an outbreak of infectious diseases.

Public health concerns

Texans for Vaccine Choice has wielded influence at the Capitol, testifying frequently at hearings and rating politicians based on their friendliness to the cause.

Since 2015, the group’s political action committee donated at least $42,000 to political campaigns. Many of the recipients are members of the conservative Texas Freedom Caucus.

The Texans for Vaccine Choice PAC has raised $126,478 and spent $135,000 so far this year.

“We should be looking toward the medical experts about the best way to protect the health and safety of our families and not look to the political whims,” said Allison Winnike, head of Katy-based Immunization Partnership.

Public health experts say misinformation fuels opposition to vaccines. Research in 1998 that suggested a link between autism and the measles, mumps and rubella vaccine launched a worldwide vaccine scare, but the work has since been discredited. The study was led by Andrew Wakefield, who was stripped of his medical license in England and now lives in Austin.

Still, some Austin-area activists continue to say vaccines are dangerous. Shawn Siegel, who hosts a radio show and authors a blog on the topic, points to the National Vaccine Injury Compensation Program, which has paid $3.9 billion to settle 6,000 claims among billions of vaccines administered since 1988.

Federal officials note, however, that the U.S. vaccine supply has never been safer and that only in very rare cases do people experience serious side effects, such as allergic reactions.

“These are women whose children were seriously injured by vaccines,” Siegel said. “Parents feel like they stand a better chance coming from the perspective of if there’s a risk, there should be choice.”

READ: Flu season is Travis County’s deadliest on record, data shows

Numerous studies have shown that children rarely get sick from vaccines, Murphey said.

Physicians agree that not all vaccines are 100 percent effective, but vaccinations can decrease the severity or length of symptoms for someone infected with the disease.

“In general, no vaccine is perfect, but assuming that my child receives the appropriate vaccination according to the recommended schedule, it’s very unlikely they will contract the disease,” Shen said. Last school year, 2.25 percent of Austin district students had a conscientious exemption from vaccines.

That’s why having as many people vaccinated as possible, particularly in a close setting like a classroom, is important, he said.

About 95 percent of a population should be vaccinated to promote “herd immunity,” or protection for those who haven’t developed immunity to a disease, including babies too young to vaccinate, doctors say.

“Nonmedical exemptions cluster in certain school districts and counties and by no coincidence, we also are seeing outbreaks in those same school districts and in those same counties. That is what doctors have warned against. We have to have a certain high level of community immunization,” Winnike said.

In 2013, 21 people affiliated with a small North Texas church contracted measles, a respiratory disease that causes fever, rash and coughing, after a visitor to the church traveled to Asia where the disease is more prevalent. None of the 11 children who were infected with measles was vaccinated.

Whooping cough also has seen a resurgence in recent years. In 2009, 3,358 cases of whooping cough were reported statewide, 701 of them in Travis County. In 2016, the latest data available from the Texas Department of State Health Services, there were 1,286 cases of whooping cough and 96 in Travis County.

Mumps, a viral disease that causes puffy cheeks and jaw due to swollen salivary glands, increased tenfold in Texas, from 20 cases in 2015 to 191 cases a year later.

Legislative battles

The fight over vaccines is likely to play out again when the Legislature convenes early next year.

Murphey would like the Legislature to eliminate all exemptions to vaccines, while Siegel would like to criminalize vaccinations, but it’s unlikely there’s political will to do either.

State Sen. Charles Schwertner, R-Georgetown, an orthopedic surgeon, said he would rather have families be more educated on the safety of vaccines than take away their choice to opt out.

“Vaccines are responsible for saving countless lives over the last century, and as a practicing physician, I believe that immunizations represent a critical component of protecting the public health,” Schwertner said in a statement. “At the same time, I would prefer to increase education about the safety of these vaccines rather than imposing new mandates that would ask Texas parents to act against their own conscience or their deeply-held religious beliefs.”

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Siegel said he would like doctors to present to parents information about injuries detailed in the National Vaccine Injury Compensation Program before administering vaccines.

Karen Schwind, a registered nurse with the New Braunfels school district and a member of the Texas School Nurses Organization, said she would like conscientious exemption rates to be reported at a campus level. This mandate was included in about 20 vaccine bills that were proposed last year but never received a vote.

Other bills that also didn’t gain traction included two proposed by state Rep. Donna Howard, D-Austin, which would have required students to opt out of the state’s immunization registry rather than opt in and physicians to counsel parents on vaccinations before they obtain an exemption. Schwind would like both bills to be resurrected when the Legislature reconvenes next year.

Opponents feared the bills would reveal private information about conscientiously exempted children.

“I don’t know why people choose not to vaccinate. It’s hard for me to understand it especially as a medical professional … when the data and statistics tell us that vaccinations do not cause disease or do not cause autism,” Schwind said.