Let me begin today by stating one simple fact: A majority of parents (a VAST majority, in fact) in the United States believe every child, including their own, should be vaccinated completely and on time. I’ll go one step further and state that a vast majority of mothers and fathers around the world believe the same thing, and they would beg for the opportunity, if they didn’t have easy and affordable access to vaccines like we have here in the U.S., to make sure their kids were immunized.

Parents should know that, according to the Centers for Disease Control and Prevention (CDC), less than 2% of American children are either unvaccinated or under-vaccinated by the time they enter kindergarten. Yes, there are pockets within communities where more parents refuse vaccines than in others (Southern California is one famous area, for example). But the numbers of parents who subscribe to the extreme views that vaccines are harmful to children, or don’t work, or both — myths that have been utterly and completely debunked by science, statistics, and common sense — are very small indeed.

Most parents in the United States and around the world recognize that there is an overwhelming consensus among scientists and medical experts that vaccines are safe, effective, and save lives. (They save many, many lives, for those who forget history.) So it’s understandable if parents come away after reading Eric Holmberg’s original investigation article from Public Source (and reprinted in yesterday’s Pittsburgh Post-Gazette) a little confused:

Children going back to school in Pennsylvania could be walking into classrooms where as many as one out of every five classmates don’t have all the vaccines required by the state.

While many parents believe that disease outbreaks in school are rare because of vaccines, there were a record number of measles cases in the United States in 2014, according to the U.S. Centers for Disease Control and Prevention. The 668 cases in 27 states was the highest number since measles were considered eliminated in 2000.

And in the 2013-14 school year, Pennsylvania had one of the worst vaccination rates in the country for the measles, mumps and rubella (MMR) vaccine, according to the CDC.


The problem in Pennsylvania isn’t that more children are being exempted on the basis of medical conditions. Such medical exemptions are actually very rare (0.5%) and require a physician’s note explaining why the vaccine(s) shouldn’t be given. And the rate at which parents refuse vaccines for their children based on “personal belief” or “philosophical” objections has been steady at, you guessed it, two percent. Pennsylvania is one of only 20 states that allow these subjective “opt-outs,” although there is currently legislation pending that should (and eventually will) eliminate them. The reason why Pennsylvania falls behind the rest of the nation isn’t because more parents here refuse to vaccinate their children. Holmberg sites one simple reason that should be simple to fix:

In reality, most of the children without all of the required vaccines fall under a state regulation that allows them to attend school for up to eight months as they try to meet the state’s vaccination requirements.

Over the past eight years, the number of students provisionally allowed to attend school has routinely exceeded 10 percent in many Pennsylvania counties and is sometimes more than 20 percent of a county’s kindergarteners or seventh-graders, according to the PublicSource analysis.

For Pittsburgh Public Schools, the deadline for students to be vaccinated before they’re no longer admitted to school would be around May 1.


In other words, in Pennsylvania, parents are given a grace period in which to complete vaccines. The grace period is understandable for two reasons:

  1. Children may not yet be due for their annual well-child checkups at the start of kindergarten or 7th grade (when completion of immunizations, according to the CDC and AAP, is mandated by law). Since most insurance companies pay for checkups on an annual (365 day) basis, and not one-checkup-per-calendar-year, parents understandably will wait until their child is allowed to have a checkup based on their insurance company’s policy, and get their shots at that time.
  2. The CDC’s own recommendation is that the “kindergarten shots” be given between the ages of 4-6 years old, and the “seventh grade shots” be given between 11-12 years. So while the vast majority of children in Pennsylvania are getting their vaccines between these ages (as they should, according to the CDC), they may not have had their vaccines before the start of kindergarten or 7th grade.


This study makes Pennsylvania look bad when, in reality, school districts, health officials, and physicians are just following the rules. The simplest way to fix this is for pediatricians and other providers who care for kids to give the “kindergarten shots” at the 4-year-old checkup instead of waiting until the year they enter kindergarten (when they are usually older than 5), and the 7th grade shots at the 11-year-old checkup, as close to their 11-year birthday as possible. (There shouldn’t be any expectation of cooperation on this from insurance payors.)

Another reason why Pennsylvania looks bad is that the state’s immunization registry (PA-SIIS), managed by the Pennsylvania Department of Health, is still in its infancy and is having growing pains, mostly related to providers’ electronic health systems that interface poorly (or not at all) with the state’s information systems. Because of the public health importance of having an accurate registry, improvement should be expected.

So parents can be reassured that most fellow parents agree on this one thing: all children should be immunized completely and on time. The number of outliers with extreme views, who deny the scientific, medical, and moral arguments regarding vaccine safety and efficacy and refuse to vaccinate their children, remains very low. Despite the noise you may hear from false experts in the media (including social media) and Internet trolls who patrol websites and blogs dishing out the same old debunked myths, conspiracy theories, and other utter nonsense, parents are hearing, understanding, and agreeing with the overwhelming consensus. Not out of fear but, rather, out of hope for a better and healthier future for their children, your children, and mine.


Read “Who Refuses Vaccines Anyway?” on The PediaBlog here, here, and here.