Washington state health officials credit new regulations that made it more difficult for parents to obtain an exemption from the requirement that children to be fully immunized before entering school.

Under the old rules, to obtain an exemption parents only had to sign a certificate indicating that they object on medical, religious or philosophical grounds.

Proponents of the new law said the ease with which exemptions could be obtained in Washington is one reason why the state has the highest vaccine exemption rates in the country.

Under the new law, parents seeking an exemption must get information from a health care provider about the benefits and risks of vaccine before the provider signs a Certificate of Exemption form.

Kids with exemptions tend to cluster geographically, often living in the same areas, going to the same schools — creating “pockets of under-vaccinated children at risk of outbreaks,” Washington state health officials say.

Click on map for more information about exemption rates

Schools with higher exemption rates have higher rates of diseases like measles and whooping cough (pertussis).

Currently, Washington state is in the midst of a whooping cough epidemic with more that 1,000 cases reported so far just this year.

At this rate, the state is projected to see more than 3,000 cases in 2012, the highest rate seen in decades.

Important points:

• All recommended vaccines for Washington children under age 19 are provided at no-cost through the state’s Childhood Vaccine Program.

• Health care providers may charge an office visit fee and a fee to give the vaccine, called an administration fee — but people who cannot afford the administration fee can ask their regular health care provider to waive the cost.

• For help finding a health care provider or an immunization clinic, call your local health agency (doh.wa.gov/LHJMap/LHJMap.htm), visit the ParentHelp123 resource finder (https://resources.parenthelp123.org/) or call the Family Health Hotline (www.parenthelp123.org/resources/family-health-hotline) at 1-800-322-2588.

• Information about the exemption law (www.doh.wa.gov/cfh/Immunize/) is available online.

Davis

Seattle’s global health organization PATH announced today that Steve Davis has been appointed president and CEO.

In his new position Davis will oversee PATH’s annual budget of $305 million, a staff of nearly 1,200, and a portfolio of projects based in PATH offices in 22 countries.

PATH projects include the development of an affordable meningitis vaccine, improved screening and treatment for HIV/AIDS and tuberculosis, and low-cost filters for safe drinking water.

Davis comes to PATH  from McKinsey & Company, where he was global director of social innovation.

In that position, Davis led a global team that consults for nongovernmental organizations (NGOs), governments, and the private sector, with a focus on global health and development, research and development, and Asia and Africa.

Previously, Davis was a long-term CEO of Corbis, a global digital media leader, and served as interim CEO of the Infectious Disease Research Institute, a nonprofit biotech working on vaccines, diagnostics, and drug discovery for infectious diseases of poverty.

His previous experiences also include serving as interim director of PATH’s India program, practicing law with K&L Gates, and working on refugee and human rights issues.

Mr. Davis earned his bachelor’s degree from Princeton University, his master’s degree from the University of Washington, and his juris doctor from Columbia University.

Davis will join PATH on June 11 and be based at PATH’s Seattle headquarters.

He succeeds former president and CEO Dr. Christopher J. Elias, who led PATH through significant growth for ten years.

Dr. Elias left PATH in January to become president of the Global Development Program at the Bill & Melinda Gates Foundation.

By Michelle Andrews

When Rep. Michele Bachmann (R-Minn.) recently suggested that the human papillomavirus vaccine — recommended for girls and young women to protect against cervical cancer — was dangerous and might cause mental retardation, the American Academy of Pediatrics pushed back hard. The AAP, which represents 60,000 pediatricians, issued a statement saying the claim had “absolutely no scientific validity.”

Bachmann’s is only the latest attack on vaccine safety, as anyone knows who has tracked the persistent and discredited claims that vaccines cause autism, among other problems.

Public-health experts insist that childhood immunizations are safe, but widespread misinformation by self-described safety advocates and others is one reason pediatricians frequently find themselves fielding questions from anxious parents.

When repeated efforts to educate parents fail, some pediatricians are now taking action: They’re refusing to treat children unless their parents agree to have them vaccinated according to guidelines set by the Centers for Disease Control and Prevention.

Pediatricians who go this route say they’re concerned about more than the health of the children. They’re also worried about other patients in the waiting room, some of them too young to be immunized or with health problems that compromise their immune systems. Unvaccinated children put those kids at risk.

“It’s my job to do the very best we can with patients in this practice,” says Dr. Harry Miller, a pediatrician with Four Seasons Pediatrics in Clifton Park, N.Y., whose practice stopped treating unvaccinated children last year. “Exposing that small percent who don’t vaccinate to those who do is a disservice.”

Most parents have supported the decision, he says, which was spurred in part by a rise in the number of the practice’s parents who refused immunizations. That number was very small, and those who felt strongly about avoiding all vaccines — about 0.5 percent of the families — have left the practice.

The AAP doesn’t think doctors should take such a hard line. “Over time, parents may be willing to reconsider previous vaccine refusals,” says the group’s policy statement.

More From This Series: Insuring Your Health

When vaccination rates fall below roughly 80 or 90 percent, a population loses the benefit of “herd immunity,” which protects even those who can’t be vaccinated or for whom the vaccine didn’t work, experts say.

According to the CDC, vaccination rates for children ages 19 to 35 months were at or above 90 percent for many illnesses, including polio; measles, mumps and rubella (MMR); and hepatitis B. Fewer than 1 percent of children received no vaccines. Vaccination rates for teens are significantly lower but increasing, the CDC found.

Although overall refusal rates may be low, they vary widely by location. In Washington state, for example, the rate of nonmedical exemptions from school vaccination requirements was 6 percent in 2007, with one county recording a 27 percent refusal rate.

Under the Affordable Care Act, starting last fall vaccines that are recommended by the CDC’s Advisory Committee on Immunization Practices must be provided at no chargeto people in new health plans.

Melissa Henriksen says she would be thrilled to encounter a doctor who took a proactive stance on vaccines, but the Charlottesville practice where she takes her 5-year-old daughter, Jaya, has no such requirement.

Noting that there was a recent measles outbreak in the city, she says, “I feel like these parents don’t get it: It is your own decision [whether to vaccinate], but there is a consequence for your community.”

An assistant professor of biology at the University of Virginia, Henriksen conducts cancer research using human cells. She occasionally has encountered undergrads who wanted to work in her lab but hadn’t been immunized against hepatitis B, which they might contract working with the cells. When she suggests getting the shot, they decline, often citing their parents’ concern about vaccinations.

States require that children be vaccinated before attending school, but in 2008, 48 states allowed parents to sidestep the requirement for religious reasons, and 21 states permitted exemptions for philosophical or personal reasons, according to a studypublished in the New England Journal of Medicine. (All states permit exemptions for medical reasons.)

Parents may have concerns about vaccines, says Douglas Diekema, a professor of pediatrics at the University of Washington School of Medicine. But in general, “they don’t have a strong philosophical objection.”

And that’s where the AAP thinks pediatricians can make a difference: by addressing parents’ concerns and educating them about the importance of vaccines. Ideally, that will convince them to go forward.

But even if it doesn’t, pediatricians shouldn’t turn them away, says the AAP. “If the goal is to get children vaccinated, you don’t accomplish that by asking them to leave the practice,” says Diekema, the lead author of the AAP policy statement.

Nor is Diekema persuaded by the waiting-room argument: “Presumably these kids will get treated somewhere,” he says. “Maybe you’re keeping your own waiting room clean, but you’re not preventing the spread of disease.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Although children can be exempted from the school vaccination requirements for medical, religious or personal reasons, obtaining a certificate of exemption has become more difficult under a new law that went into effect July 22nd.

In the past, a parent or guardian could obtain a certificate allowing a child to enter school without the required vaccinations simply by signing a form.

Under the new law, parents must get information from their health care provider about immunizations. The health care provider must then sign a Certificate of Exemption form for most types of exemptions.

But health officials warn that vaccination are advisable especially after recent outbreaks of vaccine-preventable diseases such as whooping cough and measles.

All recommended vaccines for children under 19 are provided at no-cost through Washington’s Childhood Vaccine Program, Department of Health officials note.

Health care providers may charge an office visit or administration fee, but this can also be waived for those who cannot pay.

To learn more:

• For information about the form and the new law (www.doh.wa.gov/cfh/Immunize/default.htm).

• For help finding a health care provider or an immunization clinic, go to the Department of Healths health agency locator (www.doh.wa.gov/LHJMap/LHJMap.htm) or the WithinReach (www.withinreachwa.org)

• Or call the Family Health Hotline at 1-800-322-2588.

According to the new report, kindergarten coverage in Washington State for required vaccines (including polio, whooping cough, measles, hepatitis B, and chickenpox) ranged from 88 percent to 93 percent, below the state and national goal of  95 percent or higher for all vaccines.

One reason for Washington’s poor showing, health officials said, is that the state’s high vaccine exemption rate, with 6.2 percent of children entering kindergarten having been opted out of one or more vaccines by their parents — the highest exemption rate in the nation.

Other states with high opt-out rates were Oregon (5.4 percent) and Vermont (5.8 percent).

All told, vaccine exemptions were obtained for 5,015 kindergarteners in Washington State.

Until this year, obtaining an exemption in Washington state was relatively easy. All a parent or guardian had to do is sign a certificate to exempt a child from one or more vaccines and the child could enter school unvaccinated.

According to the CDC, almost all of the exemptions in Washington were for non-medical reasons, such as philosophical or religious objections to vaccinations.

Concern over the state’s low vaccination rate and recent outbreaks of vaccine-preventable diseases such as pertussis and measles prompted the State Legislature to pass a new law to make obtaining an exemption a bit harder.

Under new rules that go into effect July 22, parents or guardians who want to exempt their child from school or child care immunization requirements must first get information from a licensed health care provider about the benefits and risks of vaccinations.

The health provider must then sign a form or letter confirming that the parent got this information and the form must be turned in to the school or child care.

Washington state health officials hope the new requirements will encourage more parents to have their children fully immunized and reduce the number of “convenience” exemptions, when parents turn in the exemption form rather than spend time gathering up the child’s immunization records.

The Washington State Department of Health notes:

• All recommended vaccines for kids under 19 are provided at no cost through the state’s Childhood Vaccine Program. Health care providers can charge an office visit or administration fee; this may be waived for those who are unable to pay.

• School nurses have access to Washington’s CHILD Profile Immunization Registry and can help parents turn in complete and accurate immunization records.

To learn more:

• For help finding a health care provider or an immunization clinic, contact the local health agency (www.doh.wa.gov/LHJMap/LHJMap.htm) in your community or call the Family Health Hotline at 1-800-322-2588.

• More read about the exemption rules go to www.doh.wa.gov/cfh/Immunize/schools/default.htm.

• For more about childhood immunizations in general go to: www.doh.wa.gov/cfh/Immunize.