White, College-Educated, Wealthier Parents Less Likely to Vaccinate Their Children, Texas Study Reveals

White, college-educated parents with higher-than-average incomes in Texas are less likely to vaccinate their children than those of other demographics, a study on the state has revealed.

The researchers looked at data on the number of children exempt from vaccinations because of their parents' philosophical beliefs (also known as conscientious vaccination exemption or CVE) across 10 metropolitan areas in Texas between the 2012–2013 and 2017–2018 school years. The figures on 318 private, 818 public and 60 charter school systems in Texas found percentages of CVEs had risen in 41 of 46 counties during that period, with the Austin, Dallas-Forth Worth and Houston emerging as hot-spots.

Children are required to be vaccinated to attend school in all 50 states, but Texas is one of 15 states that allows opt-outs for non-medical reasons or those citing CVEs. To examine non-medical exemption trends in Texas, the authors of the paper published in PLOS Medicine counted the number of individual schools and districts where 3 percent of children weren't vaccinated: the threshold at which there is a risk of a spread of vaccine-preventable disease due to weakening herd immunity. Some 76 percent of the variation in percentages could be explained by the average income of parents, whether they were college-educated, whether they reported they were white, and if they spoke English, the team found.

The study comes against a backdrop of vaccine hesitancy which promoted the World Health Organization to declare the anti-vaccine movement a top health threat of 2019. In 2000, the U.S. declared measles, a vaccine-preventable disease, as eliminated, but in 2019 1,282 cases were confirmed across 31 states: the greatest number reported since 1992 according to the U.S. Centers for Disease Control and Prevention.

"Vaccination exemptions in the U.S. are increasing due to a constellation of factors, including increasing distrust of medical establishments, pervasive misinformation, and declining health literacy regarding the potential severity of vaccine-preventable diseases," the authors said.

Between 2012 and 2018, the average percentage of exemptions on philosophical grounds in Texas more than doubled from 0.38 percent to 0.79 percent, amounting to 24,000 children being unvaccinated. The increases were biggest in suburban school districts, the data revealed. As a result, public schools passing the 3 percent threshold rose from 2 percent to 6 percent; 20 percent to 26 percent for private schools; and 17 to 22 percent for charter schools. In Austin, Dallas-Forth Worth and Houston 13 percent of local school systems were above the risk threshold.

This means 28 percent of private and 22 percent of charter schools in major metropolitan areas "are at high risk for outbreaks of vaccine-preventable childhood diseases due to high CVE percentages," the team said.

The study didn't explain why parents opt out of vaccines. The authors suggested that as well as hesitancy, some parents may apply for exemptions out of necessity, for instance because of a lapse in health insurance if the moved states.

The team acknowledged their study was limited because they had to rely on the available data.

"As public health agencies confront the re-emerging threat of measles and other vaccine-preventable diseases, findings such as ours can guide targeted interventions and surveillance within schools, cities, counties, and sociodemographic subgroups," they wrote.

Co-author Lauren Ancel Meyers, a computational epidemiologist at The University of Texas at Austin, said in a statement: "We wanted to identify potential pockets of hidden risk throughout Texas stemming from declining childhood vaccination rates

She went on: "The study not only provides a window into local vaccination patterns throughout Texas, but also allows us to make predictions. If you don't have data on the vaccination rate for a given community, you can use demographic factors to predict outbreak risks for vaccine-preventable diseases."

Dr. Gary Freed, a professor of pediatrics and health management and policy at the University of Michigan who did not work on the paper, praised the authors for focusing on a small area. He told Newsweek the study is important because as it adds to existing evidence highlighting the demographic in America most likely to be vaccine-hesitant or to refuse vaccines. However, he stressed the vast majority of college-educated parents do vaccinate their children.

"It appears that many of these families have alternative sources of information about health that are not consistent with science as we know it. Parents who may be higher-educated may look to alternative sources of health and health care, which don't include or do not look favorably upon immunization," he said.

Freed explained poorer or less educated parents used to be at a higher risk of not vaccinated their children, but that has changed as almost all children in the U.S. are now insured and there are special programs for uninsured children.

He went on to urge parents to vaccinate their children: "Parents are fortunate today to live in an environment where they can prevent diseases that kill permanently damaged hundreds of thousands of children and years past," he said. Freed suggested parents consult reputable sources such as the CDC and the American Academy of Paediatrics for information on immunization.

Freed added: "I think it is very important for parents to always try and determine the policies of schools and daycare centers where their children go, because parents have a right to know whether or not their kids are going to be in a safe environment."

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