On June 30, 2015, California Governor Jerry Brown signed Senate Bill 277 into law. The bill eliminated all non-medical exemptions to vaccines. It prohibits new students or students advancing to the 7th grade from attending school or daycare unless they have the state-required vaccinations or a medical exemption. Students who attend home-based private school or independent study without classroom participation are exempt from the vaccination requirements.
In the year since it took effect, the results have been impressive, to say the least. Overall, the state’s vaccination rates rose from 92.8% to 95.6% for kindergarteners, and the percentage of vaccinated 7th graders rose to 98.4%. The law’s success also stems from school audits ensuring that students who lag behind on immunizations are identified and their parents notified. Still, the bill came on the heels of a Disneyland measles outbreak, and the increase of MMR vaccinations from 92.6% to 97.3% for kindergarteners greatly reduces the chances of measles once again taking root in California.
Like any law, it is not without its limitations. It targets two specific age groups of students, kindergarteners and 7th graders. That leaves those between kindergarten and 7th grade and those older than 7th grade out of the loop. The state also saw an increase in the use of medical exemptions, from 0.2% to 0.5%, but it is suspected that a majority of those are attributed to students who should have been medically exempt all along, but whose parents sought religious or personal exemptions due to ease of attainment.
If South Carolina were to pass similar legislation, what would that do for our vaccination rates? Traditionally, South Carolina has enjoyed a high vaccination rate among kindergarteners, above the 95% threshold needed to keep the most contagious diseases like measles and whooping cough at bay. That herd immunity varies by county, however, and some schools have large gaps in protected and unprotected students. Our adolescents aged 13-17 are well below the 95% threshold, with TDaP vaccination rates at 72.6% in 2014.
County by county, parts of our state have a big problem awaiting them. In Horry County, 1 out of every 31 students is unvaccinated. There were 455 religious exemptions claimed in 2016. They were not the worst.
That dubious award goes to Aiken County. Of the 26,163 students enrolled, 17 claimed a medical exemption and 158 claimed a religious exemption. That figure might not sound like many, but it puts the county’s certified school vaccination rate at 94.26%, not enough to protect medically fragile students from an outbreak of a highly infectious disease.
The most telling characteristic, however, is that areas with a large portion of religious exemptions (Greenville, Spartanburg, Charleston, and York Counties for example) have median household incomes above $40,000. The percentages of students using religious exemptions in those affluent counties are 1.9%, 2.2%, 1.2%, and 1.5%, respectively. In contrast, the poorest county, Williamsburg, has a religious exemption rate of 0.1%. Their median household income is $25,174.
When reviewing the actual numbers for the 2016-2017 school year, it’s quite alarming. Spartanburg County has a median household income of $43,421. With a total of 50,053 enrolled students, an astounding 1,126 claimed religious exemptions. A mere 58 claimed medical exemptions. Greenville County, median household income of $48,438, enrolled 86,244 students and had 1,678 religious exemptions. An additional 213 claimed a medical exemption.
On the other side of the socio-economic spectrum, Marlboro County, median household income of $28,612, enrolled 4,251 students and 3 claimed religious exemptions. There were no medical exemptions on file.
It is well-known that vaccine refusal is a form of privilege, with the wealthy being able to assume the financial risk of having a sick child far more easily than a poor family. If a law similar to that of SB277 were to come about in South Carolina, the biggest beneficiaries would be those in schools and communities with low vaccination rates. It would be much harder for us to fall victim to a whooping cough or measles outbreak. Currently, we have not had a case of measles in South Carolina since 1999, and that’s a result of our 95+% vaccination rate. However, if the trend towards religious exemptions continues, we will dip below the required herd immunity and measles will once again visit the Palmetto State.
It is clear from the data that the religious exemptions are the largest piece of the puzzle when it comes to increasing our vaccination rates. The children claiming medical exemptions deserve our support and our protection in the form of herd immunity. We need to ensure that all children can attend school without fear and we need to do it now.