It happens every year: Just when it’s beginning to seem that summer vacation will never end, the back-to-school packet arrives with annual reminders to load a backpack full of binders, folders and pencils; fill out emergency contact information; and update physicals and medical forms. Along with evaluating whether children are growing at a normal rate and ensuring that they haven’t developed any new health conditions that would prevent participation in school activities, the back-to-school physical form includes a section where the doctor is supposed to verify that the child has received a certain number of doses of federally recommended and state-mandated vaccines.
The back-to-school physical is an annual opportunity for public health officials and pediatricians to do more than encourage parents to give their children a growing list of vaccines. During this yearly “Back-to School Push” to vaccinate, how many parents take the time to become educated about the diseases and vaccines doctors are promoting?
The Perfect Time for Questions
Annual school physicals are a perfect opportunity for parents to learn about specific vaccines and the diseases they are supposed to prevent, to evaluate vaccines for potential benefits and risks for their own child, and to get prepared to make confident, informed choices for their children. There are many more choices to be made, now that there are many new vaccines on the market, and it is not always clear to parents exactly which vaccines being promoted by pediatricians are actually required for school attendance.
HPV Vaccine: Recommended But Not Required
For example, in addition to recommending an annual flu shot for all children over six months of age (influenza vaccine is not a requirement for school attendance, and only New Jersey and Connecticut require annual flu shots for children in child care), pediatricians are now implementing CDC policy advising that all boys and girls between 11 and 12 years of age receive three doses of the HPV (human papillomavirus) vaccine, given over a six-month period.1
Despite all the controversy in the news over that particular vaccine, with doctors and public health officials insisting it’s safe2 and others insisting it was not fully tested before licensure and is causing too many reactions,3 4 5 it is important for parents to learn more before taking a child in for a pre-school physical. Since HPV vaccine was licensed in 2006, there have been many attempts by pharmaceutical company and other special interest lobbyists to mandate HPV for sixth grade attendance.6 7 So far, only Washington, D.C. and Virginia have HPV vaccine requirements for girls entering sixth grade. However, in both D.C. and Virginia, parents may “opt-out” and elect not to give the vaccine.
As noted by Dr. Denise Hunnell, arguments can be made both for and against the vaccine, but in the end, “parents have the right to weigh the risks and benefits of the HPV vaccine and make a decision based on their own unique situations. The state has offered no convincing argument to justify usurping parental rights and mandating HPV vaccination.”8
But Then There Are Other Laws…
In all 50 states, public schools are required by law to obtain paperwork that documents children attending schools have received certain state-mandated vaccines or have filed an exemption to vaccination with the state. However, given the nature of one-size-fits-all vaccine policies, full disclosure about vaccine exemptions allowed in vaccine laws may be ignored by pediatricians advocating children receive all scheduled government-recommended vaccines.
Therefore, while the school policy might read something like, “Entry into 7th grade requires proof of compliance with all mandatory vaccinations,” it may not be made clear on school physical forms that exemptions are available, and it is unlikely that pediatricians will mention it during school physicals. While all 50 states require specified vaccines for students, there are legal exceptions for medical, religious or conscientious belief reasons – depending upon the state.9
All state vaccination laws allow medical exemptions but they must be written by a medical doctor (M.D.) or doctor of osteopathy (D.O.) and usually must conform to federally approved contraindications to vaccination, which are very narrow.10 Every state except two—Mississippi and West Virginia—allow religious belief exemptions, but requirements for proof of religious belief can vary from state to state. About one-third of the states (17) provide exemptions for conscientious or philosophical beliefs, but in several states (Washington, California), a medical doctor or other state-designated medical worker must sign the exemptions form.
As more and more vaccines are required by schools, it is increasingly important to understand your legal rights under state laws. You can learn about your state vaccine laws on NVIC’s website, where there is a user-friendly map of the U.S. that visually tells you what kind of vaccine exemptions are allowed in your state for children to attend school. If you want to take action to protect vaccine exemptions in your state public health laws, sign up for the free online NVIC Advocacy Portal.
NVIC.org: A Very Good Place to Start
It can be a challenge to navigate the information overload available on the Internet but, as a starting point, NVIC has gathered straightforward, referenced facts about diseases and vaccines. Information includes vaccine product inserts, and fact-filled articles about the history and serious complications of both diseases and vaccines.
Among many other resources available through NVIC are tools that allow parents to calculate vaccine ingredients, get suggestions for questions to ask pediatricians about vaccination and listings of other resources available to facilitate the search for information. NVIC encourages everyone to consult one or more trusted health care professionals before making a vaccination or other health care decision.
Sign up for the free NVIC Vaccine Newsletter so you don’t miss any of the news NVIC publishes on vaccination and health.
2. CDC. HPV Vaccine Safety. Feb.5, 2013.
3. National Vaccine Information Center. Merck’s Gardasil Vaccine Not Proven Safe for Little Girls: National Vaccine Information Center Criticizes FDA for Fast Tracking Licensure. Press Release: June 27, 2006.
4. Chitale R. CDC Report Stirs Controversy for Merck’s Gardasil Vaccine. Aug. 19, 2009.
5. Judicial Watch. JW Seeks Answers to Payout Made to Victims of HPV Vaccines. Press Release: Feb. 28, 2013.
6. Pettypiece S, Zimm A. Merck Stops Campaign to Mandate Gardasil Vaccine Use. Feb. 20, 2007.
7. National Conference of State Legislatures. HPV Vaccine: State Legislation and Statutes. June 2013.
8. Hunnell DJ. HPV Vaccine Controversy is About Rights and Transparency, Not Sex and Health. CNS News Oct. 19, 2012.
9. National Vaccine Information Center. State Law & Vaccine Requirements. NVIC.org 2013.
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