As a matter of public health, everyone who can getvaccinatedsafely shouldso that’s the vast majority of people.
Why some people need medical exemptions from vaccinations
In theory medical exemptions are pretty straightforward.
These requirements are not federal law, however, and therefore vary from state to state.
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So if you want to send your child to any kind of school, they need to be vaccinated.
However, there are some exceptions.
A step down from contraindications, there are also precautions for vaccination that can similarly result in medical exemptions.
Its really a case-by-case thing.
Youll see why this distinction matters so much in a bit.
For now, lets dive into medical exemptions.
What counts as a medical exemption
Heres where things start to get a little more complex.
Its goal is to best protect childrens health across the United States.
Live, attenuated vaccines use alive but extremely weak versions of the pathogen in question rather than dead versions.
Then there are various precautions for vaccination, which can fall into a few different buckets.
Remember those one-in-a-million odds of a severe allergic reaction to a vaccine?
Skipping the flu vaccine in this case wouldnt be warranted.
Another overarching precaution is if you’re sick with something else at the timeeven just a mild cold.
It can be easy to misattribute these symptoms to an unrelated illness or vice versa.
This is a great example of how medical exemptions can get a little hazy.
How medical exemptions work
The details of this whole process depend on where you live.
We dont have a standardized way of doing things across states because theyre state laws, Salmon says.
(If youre wondering what the difference is, we have a whole deep dive for youright here.)
Some also allow nurse practitioners, physician assistants, and other medical professionals to write them.
Then you have the issue of what happens to those exemptions, Salmon points out.
The steps involved in the review and approval process are not standardized and depend on the jurisdiction.
When medical exemptions are misused
Now were at the part where medical exemptions get really controversial.
The concern is whether the term medical exemption is being abused, Dr. Orenstein says.
As with medical exemptions, the ease of getting nonmedical exemptions differs among states.
(Theyre the first states to take such action sinceCaliforniaandVermontdid in 2015, according toNCSL data.)
California in particular provides a telling case study of this problem.
In 2015 the state passedSenate Bill No.
277 (SB-277), which got rid of the personal belief exemption for existing immunization requirements.
Evidence suggests some of these exemptions may not actually have been medically necessary.
In a 2018Pediatricsstudy Omer coauthored, researchers interviewed 40 health officers and immunization staff throughout the state of California.
Beyond that some interviewees reported seeing doctors advertise medical exemptions in exchange for a fee.
We also have evidence that people do take advantage when there is a low bar for medical exemptions.
No vaccine gives100 percent immunity, Dr. Orenstein explains.
This is a phenomenal win for public health.
And of course the decisionnot to vaccinatealso affects the child who should be vaccinated but instead is left unprotected.
Non-vaccination is not a benign decision.
This story is part of a larger package called Vaccines Save Lives.
you’re free to find the rest of the packagehere.
