BACKGROUND: Personal Belief Exemptions (PBEs) are non-medical exemptions from mandatory school immunizations. Marin County is an affluent community located in the San Francisco Bay Area that has historically had the highest PBE rate (6% in 2015-16) in the surrounding counties. In June 2015, California passed a state law, SB277, which prohibited new PBEs from mandatory school immunizations as of January 1, 2016. Concerns arose that medical exemptions might increase with the elimination of PBEs. We examined perceptions towards SB277 among kindergarten parents and the change in medical exemptions following the law’s implementation to inform local immunization outreach.
METHODS: A survey was developed from existing vaccine beliefs survey instruments and input from local stakeholders. Topics included status of receiving school-required immunizations and SB277 attitudes and beliefs. The survey was sent after SB277 was passed but prior to the law’s effective date, when PBEs were still permitted. Parents opting out of or delaying mandatory vaccines were asked what they would have done if the law were in effect that school year. The survey was disseminated in English and Spanish to all elementary schools in Marin County. Approximately 2,260 kindergarten households received the survey, representing about 80% of potential kindergarten households. Responses were stratified by immunization status and analyzed using proportions and Fisher’s exact tests. The preliminary change in the medical exemption rate was obtained from mandatory immunization reporting data.
RESULTS: The response rate was approximately 33%. Of the 740 responses received, 93% (n=684) reported that their child was up-to-date on all required kindergarten immunizations and 5.8% (n=43) reported that their child had a PBE. Most (82%) respondents supported SB277; respondents with a PBE were significantly less likely to support SB277 (p<0.001) than respondents without a PBE. Among those who did not support SB277 (n=106), the majority worried the number of required vaccines would increase over time (65%) and believed it is unconstitutional to require vaccination (56%). Among parents reporting a PBE, 12% would have sought a medical exemption and 14% would have homeschooled their kindergartener if SB277 had gone into effect during the 2015-16 school year. Preliminary data suggest that the medical exemption rate increased in the 2016-17 school year.
CONCLUSIONS: Although there was a high level of support for the law prohibiting PBEs in Marin, some parents remained vaccine hesitant. California counties should continue tracking medical exemption rates and communicating with the vaccine hesitant community about their immunization concerns.