Monday, August 12, 2013

Back-to-School means Back-to-Vaccine (Mandates)
This came across my Twitter feed today, originally posted at, about vaccination rates for Kindergarteners. Rates are not uniform across States, which is not surprising, but which States have the highest and lowest rates are.

For example, Mississippi consistently ranks among the highest levels of vaccine preparedness, largely because they have few available exemptions; only medical exemptions, written by a licensed physician, are accepted. No philosophical exemptions, no personal belief exemptions, no religious exemptions. Consequently, Mississippi is at the top of each "Best" list for the rate of vaccine compliance--99.9% in all major categories (MMR, DTaP, Varicella).

This is, of course, of particular interest in the context of Mississippi's health as a State overall. It has high rates of obesity (according to this report, the highest obesity rate in the country, though just reading through some articles on obesity, I'm noticing that there isn't a lot of uniformity in where different outlets are getting their reports on this, which is interesting in and of itself) and hypertension, and its counties have some of the lowest life expectancies in the nation. And child health metrics are not great in Mississippi, especially when it comes to obesity. The Child Policy Research Center reports that 44% of children are obese in Mississippi, and 30% of low-income children ages 2-5 are obese. Although it's not everything, obesity during childhood can have drastic consequences on life-long health outcomes, meaning that many of these children who are obese are at significantly increased risk for issues down the line, such as diabetes, high blood pressure, and all of their related secondary conditions and general pitfalls. (I'd provide more sources and links there, but we already know this, right?) Mississippi is also tied with Louisiana for being the least healthy State in the country according to America's Health Ratings.

At the same time, relatively "healthy" States are ranking among the "Worst" list in the article. Colorado is a particularly curious example, ranking worst in MMR uptake (85.7%), second-worst in DTaP (82.9%), and worst again for Varicella (84.6%). Also consistently on the "Worst" list is Pennsylvania, which, although not quite as bad as Colorado, is a surprising addition to the list. The easiest reason for this is likely Pennsylvania's relatively lax vaccine exemption requirements--according to Pennsylvania code, "

So, vaccines are relatively easy to get out of--just write a note saying you really, really don't think you should be vaccinated, and you don't have to be.

Yet at the same time, Pennsylvania is a healthier State. Its rates of childhood obesity, while not great, are much better than Mississippi's: roughly 30% of children are obese, and about 25% of low-income 2-5 year-olds are obese.

I was struggling with more comparative ways of measuring how Pennsylvania is healthier than Mississippi (something I felt I knew based on news but have been unsure about) and came across a comparison tool at America's Health Rankings. You can play with this too; just go to their website (, go to 2012 Overview, and use the menu on the right-hand side to compare one State to another.

Just a few snippets of data that demonstrate relative healthiness:

Mississippi has

  • More cancer deaths
  • More cardiovascular deaths
  • More incidents of diabetes
  • More incidents of infectious disease (AIDS, Tuberculosis, Hepatitis A and B [which are vaccine-preventable])
  • Substantially more incidents of preventable hospitalizations
I could go on, but you get the point. 

We have an obvious conclusion here: fewer vaccine exemptions=more vaccinated kids, but not necessarily healthier kids. Nice work for a Monday morning, Heidi.

But, an more interesting question to ask based on that (rather obvious) observation is this: what are the differences between a State like Mississippi and a State like Pennsylvania that could produce such radically different preventative health environments--one relatively good and the other the worst in the nation? And how does the least healthy State in the country manage to have one of the most aggressive preventative healthcare policies when it comes to vaccination?

Pennsylvania is, by all accounts that I can reach through some pretty quick searching, a richer, healthier, more populous state. If, as vaccine advocates often argue, increased scientific literacy is all that is needed to convince people that vaccines are safe and effective at producing healthy children and adults, then why would a more educated, richer State allow more permissive vaccine regulations?

So: what's the deal? What is the history of Mississippi's vaccine requirements? It is one of only two States (West Virginia being the other) in the nation that doesn't allow for religious exemptions (in line with what Paul Offit has frequently recommended as the only solution to waning vaccine rates in certain areas). Why? Who fought for that? When? How? Did anyone object?

I'm working in broad strokes here, but what this facet of the issue says to me is that a deeper understanding of the vaccine mandates (or lack thereof) that manifest in different places and historical moments might be an important link to understanding how different controversies are sparked in different places, who the major players are in dictating the debate (if there even is one at all), and who, ultimately, wins. Because, clearly, Mississippi's vaccine policy is not a product of a fastidious attention to preventative health detail as a product of collective social and cultural concern. Otherwise, it would be healthier by other standards as well (one would hope).

Again, another round of questions to be investigated through a deep understanding of the local manifestations of controversy, rather than those that exist more globally.

1 comment:

Starling said...

It may involve intersections of power, education, race, & type of religion. This is off the top of my head, but Mississippi usually ranks at or near the bottom in terms of education with Pennsylvania ranking...well, middle or high? I'm still figuring out this new state. In Mississippi, individuals may be more likely to accept medical & other expertise unquestioningly because the doctors have more education (hence the power characteristic). Again, I'd have to look up sources, so take with a grain of salt.

Also, the prevalence of Amish communities may play a role in the Pennsylvania guidelines being relatively looser. They don't often vaccinate their kids (and a quick Google suggests that they are being held up as an example in the anti-vaccine online community).

Oh, my word, all the variables & complicating factors.