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October 14, 2014

New York does a better job of vaccinating kids than L.A. Here's why.

Daily Briefing

Despite a steep decline in vaccination rates in many areas of the country, some regions have been able to keep vaccination rates high for school-aged children by implementing strict immunization requirements, Ginia Bellafante reports for the New York Times.

How anti-vaxxers helped breathe new life into old diseases

Background on declining vaccination rates at L.A. schools

Last month, an investigative report published by the Hollywood Reporter  found that vaccination rates in some wealthier areas of Los Angeles are as low as those in war-torn countries—such as Chad and South Sudan—and could be contributing to disease outbreaks in the region.

In California, parents can opt out of vaccinating their children by filing a personal belief exemption (PBE).

The form allows for various reasons not to vaccinate children, based on a "diffuse constellation of unproven anxieties, from allergies and asthma to eczema and seizures," Hollywood Reporter's Gary Baum writes.

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In one of the wealthier regions in the Los Angeles area—which includes Beverly Hills, Malibu, Marina del Rey, Santa Monica and West Hollywood, among other cities—rates of vaccination exemptions for preschoolers increased by 26% from the 2011-2012 school year to the 2013-2014 school year, reaching 9.1%. Meanwhile, exemption rates in Los Angeles County overall were about 2.2% during the 2013-2014 school year, according to the Reporter

Exemption rates were significantly higher in some preschools. For example, the Waldorf Early Childhood Center in Santa Monica had an exemption rate of 68% and the Kabbalah Children's Academy in Beverly Hills had an exemption rate of 57%. Those exemption rates put the schools in line with vaccination rates in some developing countries, according to World Health Organization data.

Over the past year, incidence of whooping cough in the region has skyrocketed. As of Sept. 2, there were nearly 8,000 cases of the disease in California in 2014. More than 1,300 of those cases are in L.A. County.

Meanwhile, California has also experienced an unprecedented number of measles cases.

Meanwhile, some states up their vaccine requirements

Unlike Los Angeles, New York City over the past two years has made immunization requirements stricter. For instance, it is not possible for any parent in the city to obtain a PBE for his or her child.

In addition, the city this year declared that all students age five and older attending both private and public schools had to receive a flu vaccination before Dec. 31. However, parents are able to resist doing so by obtaining a religious exemption.

Furthermore, many New York pediatricians have refused to see patients who are unvaccinated, and some private schools will not accept such children.

For instance, Amanda Uhry, a consultant for Manhattan Private School Advisors, which helps parents enroll children in private schools, says that while no application explicitly states that the school will not accept individuals without vaccinations, the schools "want to keep the anti-vaxxers out." As a result, she says, "I ask people and if they get into the whole anti-vaxxer deal, I say, 'Fine, we can't work with you.'"

Should doctors 'fire' unvaccinated patients?

Meanwhile, Pediatric Associates of NYC—which has branches in various boroughs throughout the city—does not accept children who are not properly immunized.  Physician partner David Horwitz says the practice did so to keep patients in the waiting room safe. He says, "We were spending a lot of time talking to parents who weren't immunizing and who were terribly ill informed," adding, "We ultimately felt ethically uncomfortable seeing people who don't vaccinate. We are advocates for children, not their parents."

Laura Popper, a New York City pediatrician, says her practice has never accepted families who refuse to vaccinate their children as patients and notes that a large-scale epidemic of sorts is likely the only thing that will persuade anti-vaxxers that immunization is a vital issue.

She says, "My feeling is that it will take something... on a very large scale to get upper-middle-class people to realize that this is serious stuff," adding, "You look around and most of the deaths in the world are from contagious diseases" (Bellafante, New York Times, 10/10).

More from today's Daily Briefing
  1. Current ArticleNew York does a better job of vaccinating kids than L.A. Here's why.

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