Recently, I responded to one of our reader’s vaccination choice concerns regarding college bound young adults and many of these young adults will soon be deciding which college to attend in the fall. I have these concerns myself now, as my youngest is also off to college this year. As a parent, I have learned that the informed consent movement that NVIC founded and the values we in turn have taken into our home really transfer to our college bound daughter. It is not easy to step aside, but as we do, we are empowering our daughter to ask the right questions as she decides which college to attend.
This article will address concerns held by families and young adults who are college bound and choose to alternatively vaccinate, or do not vaccinate at all. As they enter college, they will face pressure to receive vaccines for meningitis, HPV, and influenza, among others. Whatever decisions our sons and daughters make in this respect, make no mistake - it is their decision to make and defend.
Although parents are no longer directly involved with these healthcare decisions, parents can help their sons and daughters find accurate information and resources regarding:
- the risks of the vaccine they are being asked by the college to receive;
- the risks of the disease for which they are considering vaccination;
- and their rights to informed consent in the vaccine decision-making process.
For reliable facts helpful in evaluating the risks discussed in the first two points above, our webpage on diseases and vaccines is an excellent resource and should be recommended to prospective college students. When a decision is made to decline a vaccine, it is crucial for the incoming college student to understand what the legal and policy requirements are in order for them to be able to continue to be enrolled and meet their program requirements.
College Vaccination – What is Required?
Understanding college vaccination policies and state exemption laws are a critical part of the information gathering process. Having taken calls from parents of students suspended from attending college until their vaccinations are up to date, we are not leaving admission to our daughter’s dream college to chance. We have personally found it helpful to proactively:
- ask the admissions officer for the school’s vaccination policy in writing (should be on the institution’s letterhead);
- and research the state’s exemption laws when considering colleges.
In general, college vaccination policies must comply with the legal exemptions to vaccination outlined in each state's public health laws. Unforeseen trouble may come up later if the student is going into a health profession that requires clinical practice during their course of study. In that instance, the facility providing the clinical experience necessary for graduation requirements could have vaccination requirements for students, who are in direct contact with patients. It is better to have this information in advance. There are times when exceptions are made for medical contraindications and/or proof of existing antibodies, but these exceptions are on a case-by-case basis and policies governing vaccination could change before graduation.
Helpful Tips for Gathering Information
Below are guidelines to assist families in gathering information that empowers their college bound student’s understanding of the vaccination landscape in their state. Much of the information below can be found on our website under FAQs and although NVIC continually updates our website, state laws and rules change frequently and the website content may not reflect all recent changes to laws.
- Research the state exemption laws for colleges under consideration. Le gal requirements of vaccination laws differ state to state. Recognized legal exemptions are medical, religious and conscientious, philosophical or personal belief exemptions. Wording and scope of exemptions can differ from state to state, so do your homework!
- State laws that govern exemptions sometimes don’t extend to private schools, which can institute any vaccine requirements they deem appropriate. Exemptions differ state to state and are dependent on the laws of each state.
- Be aware of the difference between a legal requirement and a recommendation. For example, while vaccine policymakers at the Centers for Disease Control (CDC) have included the meningitis vaccine in their recommendations for first year college students living in dormitories, the state of Alaska requires only that college students receive information on the disease, vaccine and their increased risk of contracting meningitis if living in student housing. In this example the student must either agree to be vaccinated for meningitis, or sign a waiver verifying that they received the information and have waived vaccination.
- Some states allow exemption from vaccination, or revaccination, if there is proof of existing antibodies. These antibodies can sometimes be determined by a private laboratory with a blood test to check titers. Titer tests are not available for all diseases for which a vaccine is available and acceptance of titer test results vary state to state. Again, check with the public health laws governing the state in question to determine what titer tests are acceptable.
- Stay up-to-date on state exemptions and vaccination issues in the state of attendance, as requirements can change! NVIC maintains a webpage updated with state-by-state exemption information. NVIC has also recently launched its State Advocacy Portal and individuals can sign up to receive free eNewsletters on vaccine policy and law changes underway in their state, as well as tips for protecting your legal right to obtain an exemption to vaccination.
There are three types of vaccination exemptions:
- Philosophical Exemption: There are 18 states which allow exemption to vaccination based on philosophical, personal or conscientiously held beliefs. In many of these states, individuals must object to all vaccines, not just a particular vaccine in order to use the philosophical, conscientious or personal belief exemption. This type of exemption is being threatened in some state legislatures due to pressure from government health officials, drug company lobbyists and medical organizations to revoke this exemption.
- Religious Exemption: All states except Mississippi and West Virginia allow for a religious exemption to vaccination. The religious exemption is intended for people who hold a sincere religious belief opposing vaccination but those beliefs can be personally held and church membership or adherence to an organized religion is not required. However, you should be able to articulate in your own words why your sincerely held religious or spiritual beliefs do not allow you to vaccinate yourself or your child with one or more vaccines. Sometimes obtaining a letter from your pastor or spiritual advisor attesting to the sincerity of your religious beliefs about vaccination is helpful, as well. Some religious exemptions are broadly defined and similar to philosophical or conscientious belief exemptions.
- Medical Exemptions: All 50 states allow medical exemption to vaccination. Proof of medical exemption must take the form of a signed statement by a medical doctor, or doctor of osteopathy that the administering of one or more vaccines would be detrimental to the health of an individual. Some states will accept a private physician's written exemption without question. Other states allow the state health department to review the doctor's exemption and revoke it if health department officials do not think the exemption is justified.
My advice to our readers is to take the time to research the vaccination laws of the state in question, the specific policies of the college and program being considered and empower your student with information well in advance of selecting the college of their dreams and beginning their journey into adulthood.
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