Doctors Warn On Expanded Medical Exemption for Childhood Vaccinations

A bill removing the religious exemption for vaccinations for Connecticut schoolchildren will also increase the number of permissible medical exemptions — a change that some physicians believe has the potential to do more harm than good. 

The legislation, if passed, would require children entering a public or private school in Connecticut to be vaccinated for a number of diseases including diphtheria, pertussis, tetanus, poliomyelitis, measles, mumps, rubella and haemophilus influenzae type B. Children who are already enrolled in school will be allowed to keep their religious exemptions. 

State Rep. Jonathan Steinberg, D-Westport, said during a debate on the floor of the state House of Representatives on Monday that the bill would also allow doctors to grant medical exemptions if the child has an autoimmune disorder or a family member with an autoimmune disorder, or if a child has a family member who has had a bad reaction to a vaccine. 

“Unlike some other states that are narrowing the medical exemption, we’re actually creating a more clear path to that possibility, should it be a legitimate reason,” said Steinberg. 

But Dr. Jody Terranova, assistant professor of pediatrics at the University of Connecticut School of Medicine, said that she doesn’t think that pediatricians will grant exemptions that are outside the guidelines recognized by the Centers for Disease Control. 

“Most providers don’t want to practice bad medicine,” said Terranova, adding that the legislature should not be making medical decisions.   

The CDC recognizes only a handful of medical reasons that an individual should not receive a vaccination. For most of the vaccinations, the only exception is a severe allergic reaction including anaphylactic shock to a previous dose of the vaccine. Severe immunodeficiency can also merit an exemption.

“It’s hard to get a medical exemption because it’s supposed to be hard to get a medical exemption,” said Terranova. 

Data from the Connecticut Department of Public Health shows that an average of 0.2 to 0.3 percent of children entering school in Connecticut receive medical exemptions each year. Medical exemptions represent 8.6 percent of vaccine exemptions granted to kindergarteners and 12.1 percent of the vaccine exemptions granted to 7th graders. 

Steinberg said that the expansion of criteria does not mean that everyone who wants an exemption will get one.

“There are some people who are adamant in their belief that they are eligible for a medical exemption, which may not be based upon fact. And they are going to be frustrated and disappointed,” said Steinberg. 

A basis in fact

Not all physicians feel that expanding the medical exemptions is a bad idea. Dr. Benjamin Cherry, chair of the Health and Public Policy Committee for the American College of Physicians’ Connecticut chapter, said that the CDC can be slow to catch up on the latest developments, and that it would make sense to let pediatricians exercise some discretion. 

“We may not be able to make medically appropriate decisions if there is something in statute that binds us to a slow-moving behemoth like the CDC,” said Cherry. 

Dr. Ada Fenick, associate professor of pediatrics at Yale University, said that if someone has a family history of a reaction to a vaccination, that should be taken into consideration.  

However, she said she worried that the widened medical exemption could create a loophole for doctors who were against vaccinations to approve exemptions that have no basis in science.

“I hope and pray that most of them will stick with the actual do-no-harm and that they will act in the best interest of the children of Connecticut,” she said, “As opposed to using something like this, which really has no basis in fact.”   

Terranova brought up a situation in Florida in which doctors were paid to falsify medical exemptions after the state removed its “personal belief exemption” for vaccinations. 

She said that she believed this was the motivation behind another piece of the bill, which creates a committee within the state Department of Public Health to look at trends in physicians’ use of the medical exemption and to point out any “discrepancies” in the way that the medical exemption is being used. The committee would also evaluate data collected on vaccine exemptions.  

Steinberg said the committee would make sure the law wasn’t allowing any “loopholes that lead to bad outcomes” and would make sure that the medical professionals were well educated.    

Steinberg said he hoped the bill would allow for more conversations between practitioners and families. Terranova and Fenick said they think mandating vaccinations will force parents to discuss their concerns honestly with pediatricians. 

“People don’t really like to talk about it. They read things online that scares them,” said Fenick. “At the very least, this will help us to get to the medical worry that they may have.”

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