On Aug. 29, 2016, the American Academy of Pediatrics (AAP) released new policy statement that urged states to eliminate all non-medical exemptions to vaccine requirements. While the Academy had opposed nonmedical or ‘personal belief’ exemptions in the past, this was the first policy statement on the issue.

Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance is authored by the Committee on Practice and Ambulatory Medicine, Committee on Infectious Diseases, Committee on State Government Affairs, Council on School Health, and Section on Administration and Practice Management. It was published in the September issue of Pediatrics.

The Academy supports medically indicated exemptions but says nonmedical exemptions are inappropriate for individual, public health and ethical reasons. To protect those who cannot be vaccinated, community or “herd” immunity requires at least 90% of the population to be immunized (95% for highly contagious diseases such as measles and pertussis).

Dr. MaldonadoIn late 2014 to early 2015, a large measles outbreak linked to a Disneyland park in California highlighted the dangers of unvaccinated children. Yvonne A. Maldonado, M.D., FAAP, said because of that experience, people became even more aware of the need to reduce the number of children at risk of disease.

Still, some vaccine-refusing parents aggressively fight to loosen vaccine mandates, asserting religious or personal beliefs. Dr. Maldonado said in some schools in her home state of California, as many as 20% of children were not vaccinated. It was a long road, but California eventually passed a law in 2015, which took effect in July, allowing only medical exemptions. “It’s the right thing to do,” she said. “We have to protect children if we have the means to do so.”