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Washington State Law Requiring Parental Counseling Led to Decrease in Exemptions from Immunizations


After the state of Washington enacted a law that requires parental counseling for obtaining vaccine exemptions by health care providers, the statewide exemption rate declined significantly, according to a study published in the January 2018 issue of Pediatrics. The study, “Exemptions from Mandatory Immunization after Legally MandatedParental Counseling” (published online Dec. 18) examined the effect of Senate Bill 5005, implemented in 2011. The law requires parents seeking an exemption for a child’s immunizations to submit a “Certificate of Exemption” signed by a Washington-licensed health care provider that documents that the parent had discussed the “benefits and risks of immunizations” with the provider. The authors found a 40.2-percent decrease in exemption rates in Washington after the law was enforced. The absolute statewide reduction in vaccine exemptions declined by 2.9 percentage points. The authors conclude that more states and jurisdictions in other countries should consider adding parental counseling as a requirement for obtaining exemptions to vaccination requirements.

Editor’s Note: A commentary by Calif. State Sen. Richard J. Pan, MD, MPH, FAAP, called, “Restoring Community Immunity to America,” will be published in the same issue of Pediatrics. Sen. Pan authored legislation that abolished non-medical exemptions to vaccinations in California.


The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit and follow us on Twitter @AmerAcadPeds