School-level perceptions and enforcement of the elimination of nonmedical exemptions to vaccination in California

Taylor A Holroyd^{1

2}, Amanda C Howa³, Tina M Proveaux^{1

4}, Paul L Delamater⁵, Nicola P Klein⁶, Alison M Buttenheim⁷, Rupali J Limaye^{1

2

4

8

9}, Saad B Omer^{10

11

12}, Daniel A Salmon^{1

4

9}

Affiliations

¹ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
² International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
³ Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁴ Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁵ Department of Geography and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁶ Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA.
⁷ Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
⁸ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁹ Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹⁰ Yale Institute for Global Health, Yale University, New Haven, CT, USA.
¹¹ Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
¹² Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.

PMID: 33493075
PMCID: PMC8189058
DOI: 10.1080/21645515.2020.1857202

School-level perceptions and enforcement of the elimination of nonmedical exemptions to vaccination in California

Taylor A Holroyd et al. Hum Vaccin Immunother. 2021.

. 2021 Jul 3;17(7):1986-1993.

doi: 10.1080/21645515.2020.1857202. Epub 2021 Jan 25.

Authors

Affiliations

¹ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
² International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
³ Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁴ Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁵ Department of Geography and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁶ Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA.
⁷ Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
⁸ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁹ Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹⁰ Yale Institute for Global Health, Yale University, New Haven, CT, USA.
¹¹ Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
¹² Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.

PMID: 33493075
PMCID: PMC8189058
DOI: 10.1080/21645515.2020.1857202

Abstract

In 2015, California passed Senate Bill 277 eliminating all nonmedical exemptions to school vaccinations. We aimed to explore school-level modes of SB277 enforcement, characterize vaccination knowledge, attitudes, and beliefs of school officials, and identify whether school vaccination policies are associated with medical exemptions being granted. Surveys were mailed to a stratified random sample of 1,450 schools in California. School personnel (n = 752) reported their medical training, vaccination beliefs, enforcement of vaccination policies, and school rates of medical exemptions. Multiple logistic regression was used to assess whether school policies are associated with the likelihood of medical exemption requests being granted. Nurses were more likely than non-nurses to hold beliefs recognizing the importance of vaccination. A school where the survey respondent was a nurse was more likely to have granted a medical exemption request compared to a school where the respondent was not a nurse (OR 2.11, 95% CI 1.34-3.36). The training of school officials and school-level practices may impact the enforcement of medical exemptions. Equipping school officials as competent sources of vaccine information for concerned parents will be valuable in improving parental vaccine uptake.

Keywords: School vaccination law; vaccine hesitancy; vaccine policy.

PubMed Disclaimer

Conflict of interest statement

Dr. Klein has received research support from Merck, Pfizer, GlaxoSmithKline, Sanofi Pasteur, and Protein Science (now Sanofi Pasteur).

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School-level perceptions and enforcement of the elimination of nonmedical exemptions to vaccination in California

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School-level perceptions and enforcement of the elimination of nonmedical exemptions to vaccination in California

Authors

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Conflict of interest statement

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