Personal belief exemptions (PBEs) from school enrollment immunization requirements are permitted in 19 states. In the 2011-2012 legislative year, bills to tighten or eliminate PBEs have been introduced in 3 states while bills to expand or allow PBEs have been proposed in 8 states (D. Peterson, BS, written communication, March 2012). Bills expanding or allowing PBEs have often been introduced by those opposed to all immunization mandates, while those that tighten or eliminate PBEs are usually supported by immunization advocates. Too often the ensuing debates generate more heat than light. Prudent PBE policies have the potential to facilitate thoughtful, informed vaccine decision-making by parents, sustain public support for immunization programs, and, thereby, help to realize the full potential of modern vaccinology to improve both individual and public health. Seeking to eliminate PBEs will likely foster an adversarial relationship between immunization advocates and vaccine-hesitant parents, increase claims for religious or medical exemptions, and make for more challenging public discussion of the optimal balance between individual freedom of choice and protecting the public health.
Figure. Immunization coverage and philosophic exemptions: Coverage with 4:3:1:3 Series—2010. (ie, ≥4 doses diphtheria, tetanus, and pertussis; ≥3 doses poliovirus; ≥1 dose measles, mumps, and rubella; and ≥3 doses Haemophilus influenzae type b vaccine). Data from US National Immunization Survey 2010.3.
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