The Deadly Vaccine Loophole: Religious Exemptions and the Rise of Pertussis in New York

The eradication of smallpox in 1977 raised hopes for the elimination and reduction of similar diseases, such as polio and mumps. Worldwide implementation of vaccines has reduced death, disease, and disability across borders and oceans. In the United States, however, exemptions to vaccines have played a large role in the reoccurrence of diseases previously thought to be under control. In their June 2013 Pediatrics article, “Religious Exemptions for Immunization and Risk of Pertussis in New York State,” Aamer Imdad, Boldsetseg Tserenpuntsag, Debra S. Blog, Neal A. Halsey, Delia E. Easton, and Jana Shaw look at the increased rates of religious vaccination exemptions and their association with rises in the occurrence of Pertussis (whooping cough) in New York State.

In New York State, religious exemptions to immunizations have doubled from 0.23 percent to 0.45 percent over the past decade. The average incidence of Pertussis among exempted children was 14 times greater than the average occurrence in vaccinated children. In low exemption rate counties, the incidence of Pertussis was not significantly influenced by Pertussis infections among exempted children. In comparison to other states, New York is considered a state with “moderate difficulty” to obtain a religious exemption.

The authors note that it is unclear whether the pediatric population exempted for religious reasons in New York is represented by specific religious groups, or by parents who share personal belief objections to vaccinations and use religious exemptions to satisfy the requirement that their children be vaccinated to attend public schools. (This occurs most often in families who make over $75,000 per year). They note that is it is likely a combination of these ethnic, socioeconomic, and religious groups represented in exemption rates.

It is important to note that there were limitations with the study methodology used to draw these conclusions, including its retrospective nature, missing vaccine status for 15 percent of cases in the sample, survey information lacking data on the type of vaccine refused (which could have been just one, or many), the underestimate of the burden of a pertussis patient, and exemptions among homeschooled children. This was also the first study to look at the magnitude of nonmedical exemptions in a state with a standardized exemption process and “moderately difficult” religious exemptions.

It is undeniable that the use of religious exemptions has increased over the past decade in New York State. The counties with higher exemption rates also had a higher rate of reported Pertussis. It is evident that under-vaccination in one community puts both vaccinated and unvaccinated children at risk. The authors acknowledge that more studies are needed to determine the impact of exemptions to school immunizations for other vaccine-preventable diseases in New York State, as well as the religious reasons behind refusal. By uncovering the reasons behind the religious exemptions, it may be possible to prevent some of these exemptions, thus increasing the rate of vaccination in New York State to the benefit of schoolchildren.

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