Policy Eliminating Non-Medical Vaccine Exemptions Linked to Improved Coverage Rates


A 2016 California policy that eliminated non-medical vaccination exemptions for schoolchildren was linked to an increase in vaccine coverage.


A 2016 California policy that eliminated non-medical vaccination exemptions from school entry requirements was associated with an increase in vaccination coverage for children, according to a new study.

The empirical policy analysis, which was published in PLOS Medicine, investigated whether California’s policy affected rates of vaccine coverage among children entering kindergarten in the state.

Vaccine hesitancy is an ongoing challenge in public health, but there is continued debate on whether the government should employ vaccination policies to address this growing problem. There has been limited analysis of the impact of vaccination policies that aim to remove nonmedical exemptions from routine vaccine requirements.

Currently, 18 states allow nonmedical exemptions to school vaccine requirements. All states permit medical exemptions for clinical conditions in which vaccination would be contraindicated.

The analysis used state-level data from the CDC on coverage of measles, mumps, and rubella (MMR) vaccination, nonmedical exemption, and medical exemption for school entry vaccine requirements. Additionally, the researchers used county-level data on overall vaccine coverage and exemptions.

Overall, the analysis showed that, at the state level, the policy implementation was associated with a 3.3% increase in MMR coverage and a 2.4% reduction in non-medical exemptions. The policy was also linked to a 0.4% increase in medical exemptions.

At the county level, the policy was associated with a 4.3% increase in MMR vaccination coverage, a 2.4% decrease in non-medical exemptions, and a 0.4% increase in medical exemptions.

Based on the county-level data, counties with high baseline exemption prevalence and most “at risk” of an outbreak saw the largest increases in vaccine coverage as a result of the policy.

Findings of decreased non-medical exemptions and increased medical exemptions in both the county- and state-level analyses support that the increase in vaccination coverage in California is associated with the 2016 policy, the researchers noted.

Although state policies and removal of non-medical exemptions do not address the larger issue of vaccine hesitancy, the researchers concluded that such efforts can effectively increase vaccine coverage.

“These results support the idea that state-level government policies to remove nonmedical exemptions can be effective strategies to increase vaccination coverage across the US,” they wrote.  



  • Nyathi S, Karpel HC, Sainani KL, et al. The 2016 California policy to eliminate nonmedical vaccine exemptions and changes in vaccine coverage: An empirical policy analysis. PLOS Medicine. 2019. https://doi.org/10.1371/journal.pmed.1002994
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