The number of students opting out of mandatory vaccinations in New York has risen in the past over the last few years despite flat enrollment—putting some schools and districts at increased risk for outbreaks of highly infectious illnesses like measles and whooping cough.
More than 22,000 medical and religious exemptions were granted to students for the 2013-14 school year, up 27 percent from 2010-11, according to the state Health Department.
Exemptions granted by school administrators allow children to attend school without required vaccinations for infections like polio, which has been nearly eradicated in the U.S. since the first vaccine was developed more than 60 years ago.
A New York World analysis of vaccination data for every public school district and individual private school in New York State, obtained through a Freedom of Information Law request, revealed that more than 200 private schools had a decline in the percentage of students considered fully vaccinated of at least 5 percentage points between the 2010-11 and 2013-14 school years. In total, approximately 38 percent of all private schools and 56 percent of all public school districts had a decline in that time period.
In most public school districts whose vaccination rates went down, the drop was often very small, less than 1 percentage point in many cases. Nearly every public school district across the state maintains a vaccination rate of at least 95 percent.
“For whatever reason one chooses not to vaccinate, that increases the risk of getting and spreading diseases,” said Paul Offit, a researcher at Children’s Hospital of Philadelphia and a former immunization adviser for the Centers for Disease Control and Prevention (CDC). “New York is a perfect example of that. You saw pockets of New York with high numbers of vaccine exemptions, specifically religious exemptions, and the incidence of measles has gone up. If you leave your child unvaccinated, you put them at greater risk of disease.”
To be considered fully vaccinated, a child must receive all the age-appropriate doses for nine infections including tetanus, hepatitis B and chickenpox.
Historically, Amish and Mennonite schools, which follow strict rules regarding modern technologies like vaccines, have been among those with the lowest immunization rates statewide. However, the list of hundreds of private schools with declining vaccination rates also includes significant numbers of Catholic, Jewish, Christian fundamentalist, prep, and Montessori schools.
Our Lady Queen of Martyrs School in northern Manhattan reported just 58 percent of students as fully immunized in the 2013-14 school year—down from 98 percent three years earlier. The Roman Catholic school was established in 1927 and has more than 200 students in pre-kindergarten to eighth grade. Calls to the principal of Lady Queen were not returned.
The Progressive School of Long Island is a small K-8 private school in Merrick, New York, with more than 100 students. In the 2013-14 school year, about 83 percent of its student body was completely immunized. In 2010-11, the rate was 96 percent.
“The number of families choosing not to immunize their children has definitely been increasing,” said Benay Deitman, a nurse and school administrator.
More than 20 years ago, she said she called the New York State Department of Health because she was unsure what was required for a religious exemption.
“They made it seem like they were pretty flexible,” she said. “So, because they seemed so OK with it, then I went ahead and never denied any exemptions whenever a parent would quote from a certain law or religious text.”
When asked why the number of families choosing not to immunize is increasing, Deitman said it’s probably fear. “I think they’re afraid of things that have been written about, with autism and things on the spectrum,” she said. “So even though the pediatricians say it’s not related to autism, the parents disagree.”
At some private schools, the vaccination rate is falling from already low levels. Among the more than 100 students enrolled at Congregation Ohr Menachem in Crown Heights, Brooklyn, only 65 percent were fully vaccinated for the 2013-14 school year, compared with 68 percent in 2010-11.
Administrator Chaya Itzhakov attributes the school’s low vaccination rate to those who have received exemptions as part of their Orthodox Jewish faith. “We’re a religious school, and we have religious reasons,” Itzhakov said.
She did not elaborate or provide specific reasons that vaccines violate specific tenets of the Orthodox Jewish faith. “It’s really not a big percentage, most are vaccinated,” Itzhakov said of those receiving exemptions. The school includes students from pre-K to seventh grade.
Public health officials have urged parents to be proactive about adhering to vaccinations in light of recent national and global outbreaks, which have been fatal particularly for infants too young to be inoculated.
More than 600 measles cases were reported to the CDC in 2014, a record figure since the airborne illness was declared eliminated from the U.S. in 2000. The infection remains common throughout developing countries such as the Philippines, where 25 U.S. travelers returned sick in 2014. New York is one of 27 states that reported measles cases in 2014.
An ongoing outbreak of measles in California with more than 60 reported cases has been linked to initial exposures at the Disneyland theme park in Anaheim.
Pertussis, or whooping cough, hit a peak in 2012 with more than 48,000 U.S. cases—the highest number reported since 1955.
And while researchers have not found any links between vaccines and disorders such as autism, concerns over vaccine safety have continued to permeate parenting websites and forums.
Some popular parenting books have also encouraged parents to stray from the current immunization schedule out of fear of adverse medical reactions or to avoid vaccinations entirely.
New York is among 48 states that allow both religious and medical exemptions. Unlike 19 other states, New York does not allow exemptions for philosophical reasons.
In New York, exemption applications are reviewed directly by school principals and superintendents, who approve or deny requests.
While medical exemptions require licensed physicians to certify physical harm resulting from vaccines, religious exemptions require only a short, notarized explanation from a parent describing why the child’s vaccination would violate the parent’s “sincere religious belief.” Extra documents, such as a letter from a religious leader, may be requested by the reviewing principal, but they aren’t required.
In New York City public schools, principals and nurses must forward requests to the New York City Office of School Health for a final determination. For private schools, the decision is left to the school principal.
The complete vaccination rate at Highland Central School District in Hudson Valley was 98 percent during the 2013-14 school year, but Aron Gorden, a nurse at the Highland Middle School, said she has seen an increasing number of exemption applications on religious grounds.
Gorden said some exemptions appear to stem from genuine religious beliefs, but others are from parents with objections to vaccines based on their own research or other personal concerns. The state’s religious exemption form clearly states that, “philosophical, political, scientific, or sociological objections to immunizations do not justify an exemption.”
“A lot of times it’s not a case of this is definitely against my religion, it’s just that ‘I don’t believe that these shots are good for my child,’” Gorden said of religious exemptions received from Highland parents. “Religion isn’t necessarily the reason we classify the student as exempt.”
The increasing number of exemptions is having an impact, according to a study that found a higher incidence of pertussis among New York counties with higher exemption rates. The study, which was published in a 2013 issue of Pediatrics, found that the number of religious exemptions granted nearly doubled from 2000 to 2011.
“People are more concerned about vaccine safety for some reason,” said Jana Shaw, one of the study’s authors and a professor at SUNY Upstate Medical University. “Part of it can be attributed to lenient school policies, and some of it is people reading misleading articles on the Internet.”
The study also noted that 34 of the 62 New York counties reported high increases in religious exemption rates. Nationally, exemption rates have remained relatively stable until recent years, the authors added.
In a separate analysis of similar data Shaw and other researchers found that private schools had a higher exemption rate than public schools.
Offit, who helped develop a vaccine, RotaTeq, against gastroenteritis rotavirus, remains vehemently opposed to religious exemptions across the country.
“How does putting a child at risk for a potentially fatal infection count as a religious act?” Offit said. “It’s a profoundly un-religious act, and as such it shouldn’t be given the legal protection that religion is afforded in this country.”
When exemptions are denied, parents can either appeal the decision to the Education Department or have their children immunized within a certain time period. Those who remain unimmunized can be barred from attending school.
Neither the state Health Department nor the state Education Department tracks the number of students excluded from school for vaccine-related reasons. A federal judge last year upheld the city policy barring children who have not been immunized from attending public school.
Despite campaigns encouraging timely vaccinations, some think that today’s parents are too far removed from the fear that existed decades ago when infections like polio ran rampant.
“I really think that people aren’t going to change until they’re actually afraid of these diseases,” Offit said. “You can show pictures or tell stories, but they aren’t going to be scared until it’s knocking on their neighbors’ doors.”
Federal officials point out vaccinations are still the norm nationally. A 2014 CDC survey showed immunization coverage has increased or stayed flat nationwide, with more than 90 percent of preschool-age children inoculated against infections like measles and chickenpox.
“Most parents are choosing to vaccinate their kids,” said Amanda Cohn, a pediatrician and deputy director of immunization services at the CDC.
She said unvaccinated children pose threats primarily to themselves or to younger children not yet immunized. Infants under 3 months old are especially vulnerable to pertussis.
Cohn said “pockets” of communities that opt out of vaccinations for personal or medical reasons have always existed, but she urges parents to review medical literature that shows vaccines to be highly effective and safe. “We want to make sure those are educated decisions,” she said.