Roxanne Ellis

Roxanne Ellis, is the Kalamazoo County Immunization Coordinator for the Health and Community Services Department. Kalamazoo County has an Immunization Waiver Policy to educate county residents about the risk of preventable diseases. (Mark Bugnaski | MLive.com)

(Mark Bugnaski / Gazette)

LANSING, MI -- The Michigan Department of Community Health is working to force parents to think twice before opting out of getting their children vaccinated.

Under new rules that will take effect Jan. 1, Michigan parents will still have the right to refuse the required shots for their children. But they will have to:

* Be educated by a local health worker about vaccines and the diseases they are intended to prevent.

* Sign the universal state form that includes a statement of acknowledgement that parents understand they may be putting their own children and others at risk by refusing the shots.

On Thursday morning, the Joint Committee on Administrative Rules approved the new requirements.

In making the changes, Michigan is following the example of other states, such as California, Vermont and Colorado, all of which recently have made it more difficult for parents to opt out of vaccination requirements.

In all those states, including Michigan, public-health officials say the reforms are needed because of increasing rates of children not being vaccinated and increasing outbreaks of vaccine-preventable diseases.

Michigan is one of 20 states that allow parents to waive school vaccinations for reasons other than medical necessity or religious beliefs.

But even among those 20 states, obtaining the waiver in Michigan is easier than elsewhere.

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for students who have been vaccinated or were granted waivers, by school, district and/or county.

For instance, California and Washington require a health professional to also sign the form, saying parents have been informed of the risks of not vaccinating. Arkansas and Minnesota require the waiver form to be notarized, and Vermont recently started requiring parents to review online material and to renew the waiver each year.

A 2013 study conducted by researchers at New York University and published in Health Affairs found a correlation between vaccine waiver rates and the ease or difficulty of obtaining a waiver in that state. In fact, states with an easier process had waiver rates twice as high as states with a more complex process.

That suggests, the study said, that "parents' decisions about whether or not to have their children immunized continue to be unduly influenced by matters of convenience." For example, some parents will opt for a waiver simply because it's easier than getting the child his or her shots.

Michigan allows counties to implement their own process for obtaining a waiver, which means the level of difficulty can vary between counties. Some counties make the form readily available, or allow parents to submit their own form. Other counties require parents to pick up the form in person from the health department.

Ten counties, including Kalamazoo, already follow this protocol, requiring parents to sit through an educational session about vaccines before they can obtain waiver -- basically the same as what Michigan's new rules will require starting Jan. 1.

These are documents in support of the Michigan Department of Community Health's plan to change rules to make it more difficult for parents to obtain vaccination waivers for their children to attend school. Letters in support included from the March of Dimes and a health district that covers many northern Michigan counties.

At a public hearing in November in Lansing about the new statewide rules, none of the 25 people in attendance voiced opposition. The rule change was also supported by documents from doctors, nurses, professional organizations and health officials.

"We are so happy the state will have a uniform approach, and I am hopeful it will make a change in waiver rates," said Dawn Smith, Immunization Action Plan nurse for Kalamazoo County.

"It has kept our rates low (in Kalamazoo County)," Smith said. In other counties with higher waiver rates, similar changes at the local level have had "really significant results," she said.

"It will take those convenience waivers out of the equation, and for those who are on the fence it may sway them a little bit," she said.

It also informs parents about the Vaccines for Children, a federally funded program that provides vaccines at no cost to families that might otherwise avoid or delay vaccination because of inability to pay.

Some parents are not swayed, and remain steadfastly opposed to vaccination in spite of the information nurses provide, Smith acknowledged.

"We may not sway those folks," Smith said, "but at least we can give them science-based information."

Rosemary Parker is a reporter for MLive.com. Reach her at rparker3@mlive.com.