Sarah Bennett
In June 2019, New York State passed Senate Bill 2994A, which eliminated non-medical vaccination exemption options from school entry requirements. This means that, unlike some other states, New York does not offer non-medical exemptions for vaccinations. This legislation was passed after two large measles outbreaks threatened the US measles elimination status. The implications of this law have been studied, with results suggesting that it was effective in increasing school vaccine coverage without an increase in medical vaccination exemptions.
| Characteristics | Values |
|---|---|
| Non-medical vaccine exemptions in schools | Repealed by Senate Bill 2994A in June 2019 |
| Impact | Increase in mean vaccine coverage; small decrease in medical exemptions |
| Implications | Not evaluated yet |
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What You'll Learn
New York State (NYS) legislation repeals non-medical vaccine exemptions
In 2019, the New York State (NYS) Senate and Assembly passed legislation to repeal non-medical vaccine exemptions for children. The bill, numbered S2994 or S2994A, was introduced by Senator Hoylman and sponsored by several members of the Assembly. It aimed to repeal subdivision 9 of section 2164 of the public health law, which allowed for religious exemptions from vaccination.
Prior to this legislation, New York State law required all children to receive immunizations for poliomyelitis, mumps, measles, diphtheria, rubella, HiB, hepatitis B, and varicella. However, exemptions were permitted if a physician certified that the vaccination could be detrimental to the child's health. The new legislation sought to remove these non-medical exemptions, ensuring that all children in New York State attending daycare, pre-K through 12th grade, in public, private, or religious schools, would be vaccinated.
The justification for this repeal was based on data from the Centers for Disease Control (CDC), which emphasized the importance of maintaining high vaccination rates among school-going children to prevent disease outbreaks. According to CDC goals, a vaccination rate of at least 95% is necessary to maintain herd immunity. However, state data from 2013-2014 revealed that at least 285 schools in New York had an immunization rate below 85%, with 170 schools falling below 70%.
The bill also included provisions to allow unvaccinated children a grace period during which they could still attend school or daycare, provided they received the first dose of each required immunization series and had age-appropriate appointments scheduled. This legislation took effect immediately upon its passage, demonstrating the urgency with which New York State addressed the issue of non-medical vaccine exemptions.
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Implications of the law for school vaccine coverage
New York State (NYS) recently adopted legislation that eliminated non-medical vaccination exemption options from school entry requirements. This means that, to attend or remain in school or daycare, children who are unvaccinated or overdue must receive at least the first dose of all required vaccines within the first 14 days. They must also receive subsequent vaccines within 14 days of when they are due.
The implications of this law for school vaccine coverage have been examined in a cohort study of 3632 schools, which found that the repeal of non-medical vaccination exemptions was associated with an increase in mean vaccine coverage. Small but significant decreases in medical exemptions were also observed. This suggests that the legislation was effective in increasing school vaccine coverage without being replaced by medical vaccination exemptions. The study used longitudinal school immunization compliance data from the 2012-2013 through 2021-2022 school years, including public and non-public schools with students enrolled in kindergarten to 12th grade.
The passage of this law in NYS was in response to two large measles outbreaks that threatened the US measles elimination status. With the law’s passage, New York became the fifth US state to address increasing pediatric undervaccination by eliminating non-medical vaccination exemptions at schools. Since then, other states have considered similar legislation, including Connecticut, which repealed non-medical vaccination exemptions in 2021.
It is important to note that the results of the NYS vaccination exemption repeal may differ by jurisdiction due to differences in state laws. The evaluation of the repeal's implications focused on NYS schools outside of New York City, as the legislation did not include a grandfather clause for students with existing non-medical exemptions in NYC.
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The increase in mean vaccine coverage at NYS schools
New York State has strict requirements for school immunization. Unvaccinated children must receive their first dose of all required vaccines within 14 days of starting school. They must then receive subsequent vaccines within 14 days of when they are due. The required vaccines include the Diphtheria and Tetanus toxoid-containing vaccine and the Pertussis vaccine (DTaP or Tdap).
Previously, New York State allowed non-medical exemptions from school-entry vaccination requirements. However, this changed with the implementation of Senate Bill 2994A, which repealed non-medical vaccination exemption options. A study of 3632 schools found that this bill was associated with an increase in mean vaccine coverage at NYS schools. The implementation of the bill resulted in an absolute increase in mean vaccine coverage of 5.5% in non-public schools and 0.9% in public schools. There were also additional annual increases in vaccine coverage observed through the 2021-2022 school year.
The study also found a small but significant decrease in medical exemption uptake, with a 0.1% decrease at both public and non-public schools. This decrease continued annually, with a 0.02% decrease in medical vaccination exemptions through the end of the study period. The results suggest that the repeal of non-medical vaccination exemptions was effective in increasing vaccine coverage at NYS schools outside of New York City.
The findings of this study have important implications for public health and disease prevention in New York State. By increasing vaccine coverage in schools, the risk of vaccine-preventable diseases is reduced, protecting students, staff, and the wider community. Additionally, the decrease in medical exemption uptake suggests that the repeal of non-medical exemptions did not result in a significant increase in medical exemptions, indicating that the legislation was effective in improving vaccine coverage without compromising the health and safety of medically exempt individuals.
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Small decreases in medical exemptions
In the United States, high vaccination rates among children have successfully reduced the morbidity and mortality associated with vaccine-preventable diseases. This success is partly due to vaccination requirements for school attendance. While all states have implemented such mandates, there is variation in the allowance of non-medical exemptions, such as religious or personal belief exemptions.
New York State requires children attending school or daycare to be vaccinated against several diseases, including measles, mumps, rubella, polio, and chickenpox. Children who are unvaccinated or overdue for their shots must receive the necessary doses within 14 days to remain in school or daycare. While New York does allow medical exemptions from vaccination, there is no mention of non-medical exemptions.
To obtain a medical exemption in New York, a valid request must be submitted by a licensed physician and reviewed by public health authorities. This process ensures that only those with legitimate medical reasons are exempt from vaccination. By making the exemption process more rigorous, New York has likely contributed to decreasing exemption rates and increasing vaccination compliance.
Indeed, studies have shown that states with stricter vaccination laws and more complex exemption processes tend to have lower exemption rates and higher vaccination compliance. For example, after West Virginia implemented a more rigorous exemption process, other states followed suit, resulting in a decrease in exemption rates. Additionally, states with punishments for noncompliance, such as excluding unvaccinated children from public schools, also tend to have lower exemption rates.
While small decreases in medical exemptions may seem insignificant, they can have a broad impact on public health. Even a minor adjustment to exemption requirements can lead to a substantial reduction in exemption rates, as seen in the case of Washington's SB 5005, which resulted in a 40% decrease in exemptions. Therefore, New York's stringent medical exemption process likely contributes to maintaining high vaccination rates and protecting public health.
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Non-medical exemptions in other US states
In the US, federal public health officials at the Centers for Disease Control and Prevention (CDC) make national vaccination policy recommendations. However, the actual legislation regarding their enforcement is decided at the state level, leading to variances in vaccination exemptions from state to state. These exemptions can be broadly categorized into medical, religious, and philosophical, conscientious, or personal belief exemptions.
Medical exemptions typically require a written statement from a licensed medical professional, such as an MD or a doctor of osteopathy (DO), stating that the vaccination would be detrimental to the individual's health. Some states also allow other healthcare workers to provide this certification. Religious exemptions are based on the First Amendment right to freely hold and exercise religious beliefs. However, these exemptions can be withdrawn if the state has a compelling reason, such as preventing the spread of serious communicable diseases. Philosophical, conscientious, or personal belief exemptions typically apply to all vaccinations and are often associated with geographical clusters, leaving these communities at a higher risk of vaccine-preventable diseases.
Parents seeking vaccination exemptions for their children often collaborate with medical professionals and may be required to complete state-provided vaccine education programs. Studies have shown that parents who choose to delay or refuse vaccinations have different beliefs and concerns about vaccine safety compared to those who vaccinate their children. For example, they may fear serious side effects or believe that "children get too many shots." Evidence suggests that higher rates of non-medical exemptions are correlated with an increased incidence of vaccine-preventable diseases.
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Frequently asked questions
No, New York State (NYS) adopted legislation eliminating non-medical vaccination exemption options from school entry requirements.
The NYS legislature passed Senate Bill 2994A in June 2019, after two large measles outbreaks threatened the US measles elimination status.
The law was associated with an increase in mean vaccine coverage at NYS schools and small but significant decreases in medical exemptions.
Yes, California, Maine, and Connecticut have also recently repealed non-medical vaccination exemptions.
No, unlike similar laws passed in other states, Senate Bill 2994A became effective immediately and did not include a grandfather clause.
