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By JoNel Aleccia, Kaiser Health News
As measles outbreaks continue in the northwest and across the country, Oregon's newly released health records suggest that it is surprisingly easy to avoid mandatory vaccines in that state – as in many other countries. .
In Oregon, where the vaccine exemption rate for preschool children is highest in the United States, about 95% of parents whose children forget one or more vaccines use a personal printing certificate to do so .
According to data from the Oregon Health Authority, showing that out of more than 31,500 non-medical vaccine exemptions submitted last year, nearly 30,000 were documented by parents who viewed an educational video online and then printed a form to do yourself.
The second option was chosen by fewer than 2,000 people: talking to a health care provider and getting a signature.
The state, where 7.6% of kindergarten children were exempted from one or more vaccines during the 2017-2018 school year, applies since 2013 an instructional duty. for non-medical exemptions.
Mitch Greenlick, a Democrat who proposed a bill to eliminate exemptions for non-medical vaccines, criticized the online training module.
"It's obviously leaving too many people," he said.
The reason parents overwhelmingly choose the online option, said Dr. Saad Omer, Vaccine and Infectious Disease Specialist at Emory University in Atlanta: Convenience.
Omer and other public health officials find this trend worrisome, as unvaccinated children can contract – and spread – dangerous diseases such as measles, which pose a risk to themselves and the community.
In the United States, this year, at least 387 cases of measles have been detected in 15 states, according to the Centers for Disease Control and Prevention. Most cases are grouped into six homes, including a home located in Clark County, Washington State. The county is part of the metropolitan area of Portland, Oregon, which is a hot spot known for reluctance to vaccination. At least 78 cases of measles were associated with this outbreak, four of which were confirmed in Oregon. The state reported six other measles cases unrelated to this outbreak.
In the United States, almost all cases of the highly contagious disease have occurred in unvaccinated children, officials said.
Evidence however shows that making it more difficult to obtain a vaccine exemption can reduce the rates of those who disengage.
"The exemption facility is an important predictor," said Omer, who was named the first director of the Yale Institute for Global Health, starting in July.
It advocates the advice of a health care provider, which is a good way to strengthen the requirements. This not only makes it more difficult to obtain exemptions, but also puts parents in touch with "the most reliable source of information," Omer said.
In the state of Washington, vaccine exemption rates have generally decreased by about 40% following the adoption of a 2011 law requiring health care providers to sign exemption forms, according to a study conducted in 2018 by Omer.
Oregon is one of 17 states that allow derogations based on philosophical opposition to vaccination, as well as on religious or medical grounds. Only three states – California, Mississippi and West Virginia – prohibit all non-medical exemptions.
In 10 states that allow for personal or philosophical waivers, a parent's signature on a statement or form is all that is required to withdraw. In three states, paperwork must be notarized. Only two states – Washington and Michigan – require consultation with a health care provider.
Since 2015, when Michigan began requiring parents to participate in an education session within their local health department, vaccine abandonment rates went from 4.8% in 2014 to 3.6% in 2017, said Lynn Sutfin, spokeswoman for the Michigan Department of Health and Human Services. .
Three states, Arkansas, Oregon, and Utah, offer an online education option, which includes scientific information compiled by state health officials.
Utah, with a 5.2% exemption rate for kindergarten, has begun allowing the use of the 20-minute e-learning module last summer. Since then, more than 8,700 certificates have been printed, said Rich Lakin, immunization program manager for the Utah Department of Health.
But the new option is plagued with problems, Lakin said. People have submitted fictitious names such as "Mickey Mouse" in the system, he said. Others have used the web portal to blame health officials for requiring documents to qualify for exemptions.
In Oregon, Greenlick's proposed ban on non-medical vaccine exemptions sparked a storm of opposition. Hundreds of parents have come forward during recent public hearings. The action is pending.
Jennifer Margulis, 49, of Ashland, Ore., Said she used the state e-learning module to exempt her four children from certain vaccine requirements. She said the video, which takes about 40 minutes, requires active participation – by clicking on a series of screens.
"You really have to be careful. It's a lot of information, "she said. "I did not find it practical. I found it interesting and taking a lot of time. "
According to her, the online option is a good alternative for parents who wish to make their own choice regarding vaccination, despite scientific evidence and advice from public health officials.
Senator Jeff Golden, a Democrat from Margulis District, opposed the bill banning exemptions for non-medical vaccines, calling for "less radical and authoritarian options".
But a legislative assistant, Adam Lohman, said Golden was not aware, so many Oregonians have decided not to be vaccinated through the online module. "He would be interested in an option that preserves the parent's choice and makes it more strict," said Lohman.
Kaiser Health News is a non-profit news service covering health issues. It is an independent editorial program of the Kaiser Family Foundation which is not affiliated with Kaiser Permanente.