No amount of objective discussion or scientific data will ever be enough to convince some people that vaccines are indeed safe and effective in eradicating a host of hellish and deadly diseases. But what seems to work to convince people to vaccinate their children? Bureaucratic hassle.
By adding an extra, personal step to the process of obtaining a vaccine waiver (which allowed a child to forgo necessary vaccinations), Michigan quickly and significantly increased its vaccination coverage, as Kaiser health news reports.
In the 2013-2014 school year, the state had the fourth highest percentage in the country of children entering preschool with a vaccine exemption. But just a year after the extended exemption application process went into effect in 2015, the number of exemptions granted fell 35 percent statewide. Vaccination coverage rose accordingly.
By one common measure — looking at children who received the state-required fourth round of immunizations for diphtheria, tetanus and whooping cough — Michigan children’s vaccination rates rose from about 78 percent to 85 percent. The increased rate is around the national average for that vaccination measure.
“The idea was to make the process more cumbersome,” said Mark Largent, a Michigan State University health policy specialist who has written extensively on vaccines. KHN. “Research shows that if you make applying for an exemption more difficult, fewer people will receive it.”
Waivers may be medically necessary if a child has a severe allergy or compromised immune system, but such cases are in the minority. Most people who get waivers do so based on ideological reasons or false (and repeatedly debunked) ideas that vaccines are unsafe.
But Largent says there’s no need to engage in messy debates with vaccine opponents. “Moral claims and ideology don’t matter much when it’s inconvenient,” he explains.
State lawmakers added the discomfort factor after outbreaks of whooping cough and measles hit children in Michigan. At that time, parents who did not want to vaccinate their children could easily apply for an exemption via the Internet, by sending in a form, or in some places even by telephone. But in a calm, no-nonsense ruling in December 2014, the state’s Joint Committee on Administrative Rules changed the procedure for applying for an exemption to require parents to personally consult with a county health educator before granting an exemption.
The rule change went unnoticed until it went into effect on January 1, 2015. Opponents of the vaccine were dissatisfied. “We were not aware of the rule until the day it happened,” Suzanne Waltman, Michigan president for Vaccine Choice (an anti-vaccine organization), told me. KHN. “We thought it was a stealth move.”