title: Some state vaccination laws contribute to greater exemption rates and disease outbreaks in the United States.
abstract: Health officials attest that immunizations are among the most successful interventions in public health. However, there remains a substantial unvaccinated population in the United States. We analyzed how state-level vaccination exemption laws affect immunization rates and the incidence of preventable disease. We measured the association between each component of state kindergarten vaccination exemption laws and state vaccination exemption rates from 2002 to 2012, using the Centers for Disease Control and Prevention's annual school assessment reports. We found that policies such as requiring health department approval of nonmedical exemptions, requiring a physician to sign an exemption application, and having criminal or civil punishments for noncompliance with immunization requirements had a significant effect in reducing vaccine exemptions. Our exemption law effectiveness index identified eighteen states with the most effective laws and nine states with the least effective ones. The most effective states had lower incidences of pertussis, compared to other states. For policy makers interested in decreasing the number of vaccine exemptions in their state, our findings are of particular interest.
authors.affiliation: W. David Bradford (bradfowd@uga.edu) is the Busbee Chair in Public Policy in the Department of Public Administration and Policy at the University of Georgia, in Athens.
authors.forename: W David
authors.initials: WD
authors.lastname: Bradford
authors.affiliation: Anne Mandich is a PhD candidate in the Department of Applied and Agricultural Economics at the University of Georgia.
authors.forename: Anne
authors.initials: A
authors.lastname: Mandich
mesh_terms: D002648:Child; D004196:Disease Outbreaks / Q000517:prevention & control*; D006291:Health Policy; D006801:Humans; D012067:Religion; D013219:State Government; D014481:United States; D014611:Vaccination / Q000331:legislation & jurisprudence*; D014612:Vaccines / Q000008:administration & dosage / Q000276:immunology*
chemical_list: D014612:Vaccines
keywords: Children’s Health; Health Promotion/Disease Prevention; Legal/Regulatory Issues; Public Health