Two North Carolina pediatricians say the state law on childhood vaccinations — which thousands of children have avoided in recent years using a religious exemption — should change. But they disagree on how.
One says the law should be made more restrictive to protect public health. The other says it should be relaxed to protect personal preference.
The number of N.C. kindergarteners opting out of vaccinations on religious grounds more than doubled in the five school years from 2012 to 2016. If all those children remain in North Carolina schools and still have not been vaccinated, that means at least 6,146 students are now enrolled through fourth grade who have not been immunized for religious reasons. Thousands more are likely still enrolled in higher grades who never got the required shots.
Numbers for children who entered kindergarten during the current academic year are not yet available.
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Health officials who support mandated vaccines and parents’ groups that oppose them both say the religious exemption is used by parents whose objection to the shots has nothing to do with their faith. To exercise the exemption, parents need only say that they have a religious objection to immunizations for their children. They don’t have to describe the objection or get a statement from any religious official. The statement is submitted to a child’s school in place of an immunization record. It doesn’t get reviewed for approval or denial.
The only other exemption to the rule is on medical grounds, and that path requires a doctor’s certification of existing conditions that would make immunizations dangerous to a child’s health.
Dr. Rosemary Stein, a practitioner at International Family Clinic Pediatrics in Burlington, which has about 5,000 patients, said Tuesday she has about 20 families who don’t vaccinate, and many more who come to her with questions about whether vaccines are safe and effective.
Stein said she answers the questions, directs the parents to websites to get more information on vaccines and tells them about her personal experience, having suffered with three childhood diseases as an adult, including two she was vaccinated against. Usually, she said, the parents go ahead with the 23 doses of vaccines required for children entering kindergarten in the state.
But while some pediatricians tell non-vaccinating parents they can’t continue to bring their children to the practice, Stein said she works with the parents, who sometimes will allow their kids to get some of the required shots.
‘The safer everybody is’
Dr. David Hill, who practices in a Wilmington branch of KidzCare Pediatrics, which has about 40,000 patients across North Carolina and Georgia, said he too gets questions from parents about vaccines.
“The conversation has to start by understanding their concerns, their fears and their personal experiences with vaccines,” he said. Hill said he tells parents that vaccines are not perfect: that every child who is vaccinated doesn’t develop immunity and that different children react differently to the shots. He reminds them that some children are especially vulnerable to illness because their immune systems are compromised, whether because of immune disorders or cancer treatments.
He said he also tells them that, “When you vaccinate your child, you not only protect him or her, you protect the entire community. The more children who are vaccinated, the more kids are protected, the safer everybody is.”
Stein said she believes state policy on vaccines should serve the interests of the individual child first, and public health second.
She said she has more confidence in the usefulness of some vaccines than others, and would support dropping vaccination requirements for diseases that rarely occur and for vaccines that don’t prove effective long term.
“We have imposed certain vaccines on children that we really need to be talking with our public health people about, to see if this is a legitimate vaccine that we’re asking all our residents to have,” she said. “I don’t necessarily think we should just be vaccinating everybody for everything and hoping for the best.”
Hill said he would not drop any of the vaccines currently required by the state, and he said that for those parents who object to vaccines, he doesn’t think dropping one or two would make them inclined to schedule all the others.
“There is nothing I would remove from the list,” he said.
Relaxed timing of shots?
Stein said the religious exemption allowed by state law should be replaced by an exemption for personal or philosophical reasons, so that parents who don’t truly have a religious objection don’t have to lie. But more importantly, Stein said, the law should be relaxed as to the timing of the shots, allowing parents more time to space out immunizations so they don’t feel they are overwhelming their children with too many vaccines at once.
Stein said her office keeps track of unvaccinated children, and if an illness such as pertussis is reported in a community, staff notifies the parents.
“We tell them it’s time to hunker down if you’re not going to vaccinate,” she said.
Hill agrees that the state law should be changed, but he believes that North Carolina should allow only medical exemptions – no religious, personal or philosophical exemptions.
“We know that when the level of immunity falls below a certain point, the entire community becomes susceptible to preventable diseases,” Hill said, noting outbreaks of measles and pertussis that have affected both those who had been vaccinated and those who had not.
Hill said he understands why North Carolina has a religious exemption to childhood vaccinations.
“This state shows a profound and appropriate respect for people’s religious beliefs, and I understand why any legislator would be very cautious about any legislation that would appear to disrespect people’s beliefs,” he said.
“But the bottom line is the same: the more kids are vaccinated, the safer everyone is.”