Skip Navigation


May 2, 2005

Why are Parents Refusing to Vaccinate School-Aged Children?

Researchers from the Johns Hopkins Bloomberg School of Public Health and other institutions have recently explored why some parents request exemptions from vaccinations for their children. The authors examined surveys completed by the parents of 391 vaccine-exempt and 976 fully vaccinated children from Colorado, Massachusetts, Missouri and Washington. They found that most of the children received at least some vaccines and that the childhood vaccine against varicella, the virus that causes chickenpox, was the most likely to be skipped.

When compared to the parents of fully vaccinated children, the parents who requested exemptions perceived vaccines to be less safe and effective. They also believed their children were less susceptible to vaccine-preventable diseases and that the diseases were less severe. Parents of exempt children also had low levels of trust for the government.

“We are currently living in a time where vaccines have eradicated smallpox, eliminated polio and reduced the incidence of other vaccine-preventable diseases and the news now focuses more on potential adverse reactions from vaccines, not the benefits of them. Public health and medical professionals need to educate parents about the utility and safety of vaccines. We need to especially target parents who request non-medical exemptions to school immunization requirements,” said Daniel A. Salmon, PhD, MPH, lead author of the study and associate director for policy and behavioral research with the Institute for Vaccine Safety at the Bloomberg School of Public Health.

“Factors Associated with Refusal of Childhood Vaccine Among Parents of School-aged Children” is published in the May 2005 issue of Archives of Pediatrics and Adolescent Medicine.

And What Are States to Do about It?

Required vaccination programs have made U.S. immunization campaigns extremely successful. If non-medical exemptions are granted without proper public health oversight, the effectiveness of the nation’s mandatory school vaccination programs could suffer. However, public health practitioners know that this is an emotionally charged political and public health issue.

In a commentary in the May 2005 issue of the American Journal of Public Health, Dr. Salmon and coauthors highlighted Arkansas’s law requiring vaccination before children begin school. It included a 1967 religious exemption, but not an exemption based on philosophical grounds. Dr. Salmon and colleagues at the Johns Hopkins Center for Law and the Public’s Health wrote a draft exemption provision that was implemented after the state’s religious exemption was struck down as unconstitutional. The draft exemption intends to balance parental autonomy with the tremendous benefits of vaccines. It also gives health-oriented administrative control over exemptions.

The authors state, “The draft exemption may be useful to other states struggling with the constitutionality of non-medical exemptions and efforts to balance individual interests against the tremendous individual and public health benefits of vaccination.”

“Public Health and Politics of School Immunization Requirements” is published in the May 2005 issue of the American Journal of Public Health.

Public Affairs media contacts for the Johns Hopkins Bloomberg School of Public Health: Kenna Lowe or Tim Parsons at 410-955-6878 or