Associations of Statewide Legislative and Administrative Interventions With Vaccination Status Among Kindergartners in California

Pingali, Cassandra; Delamater, Paul L.; Buttenheim, Alison M.; Salmon, Daniel A.; Klein, Nicola P.; Omer, Saad B.

doi:10.1001/jama.2019.7924

Cited by 24 publications

(16 citation statements)

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“…Safety threats can arise from the spread of infectious diseases like measles (Rowan, 1982) when claims for access are made by unvaccinated students posing risks of harm at local schools with insufficient herd immunity (Becker et al, 2016). Our model explains how government administrators and principals of local schools respond to this inclusion–safety tension through harm-mitigating work, including reviewing students’ vaccination records, canceling extracurricular activities, and quarantining infected students (Pingali et al, 2019). In an extreme crisis, our model shows how fear of spreading an infectious disease can outweigh moral emotions of denying students access to education.…”

Section: Discussionmentioning

confidence: 99%

Maintaining Places of Social Inclusion: Ebola and the Emergency Department

Wright

Meyer²,

Reay

et al. 2020

Administrative Science Quarterly

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We introduce the concept of places of social inclusion-institutions endowed by a society or a community with material resources, meaning, and values at geographic sites where citizens can access services for specific needs-as taken-for-granted, essential, and inherently precarious. Based on our study of an emergency department that was disrupted by the threat of the Ebola virus in 2014, we develop a process model to explain how a place of social inclusion can be maintained by custodians. We show how these custodians-in our fieldsite, doctors and nurses-experience and engage in institutional work to manage different levels of tension between the value of inclusion and the reality of finite resources, as well as tension between inclusion and the desire for safety. We also demonstrate how the interplay of custodians' emotions is integral to maintaining the place of social inclusion. The primary contribution of our study is to shine light on places of social inclusion as important institutions in democratic society. We also reveal the theoretical and practical importance of places as institutions, deepen understanding of custodians and custodianship as a form of institutional work, and offer new insight into the dynamic processes that connect emotions and institutional work.In most Western societies, the democratic state establishes and funds particular places that play a special role in meeting citizens' needs and that contribute to the functioning of societies and communities. For example, citizens can freely access public emergency departments for medical care, public schools for education, public libraries and museums for information and culture, public

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Section: Discussionmentioning

confidence: 99%

Maintaining Places of Social Inclusion: Ebola and the Emergency Department

Wright

Meyer²,

Reay

et al. 2020

Administrative Science Quarterly

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“…As multiple states continue to experience outbreaks of vaccine-preventable diseases, interventions like the California policy that increase vaccine coverage levels above the required thresholds will continue to be vital. A recent analysis of the California policy suggested that legislation may need to consider local differences because areas of northern California continued to demonstrate high rates of students without up-to-date vaccination status despite the state’s intervention [20]. Our county-level analysis found a relationship between income and education, and vaccine coverage, suggesting that socio-demographic factors may play an important role in vaccine coverage.…”

Section: Discussionmentioning

confidence: 71%

“…There was also an increase in medical exemptions (from 0.2% in 2015–2016 to 0.7% in 2017–2018) that might have offset the described decreases in nonmedical exemptions [18, 22]. Two recent studies provided additional descriptive analyses of the impact of the California vaccine policies on vaccination coverage [20, 21]. In one study, the authors used county-level data for California to report the changes in the percentage of children entering kindergarten with up-to-date vaccination status, as well as geographic clustering of unvaccinated children associated with three California vaccination policies.…”

Section: Discussionmentioning

confidence: 99%

The 2016 California policy to eliminate nonmedical vaccine exemptions and changes in vaccine coverage: An empirical policy analysis

et al. 2019

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BackgroundVaccine hesitancy, the reluctance or refusal to receive vaccination, is a growing public health problem in the United States and globally. State policies that eliminate nonmedical (“personal belief”) exemptions to childhood vaccination requirements are controversial, and their effectiveness to improve vaccination coverage remains unclear given limited rigorous policy analysis. In 2016, a California policy (Senate Bill 277) eliminated nonmedical exemptions from school entry requirements. The objective of this study was to estimate the association between California’s 2016 policy and changes in vaccine coverage.Methods and findingsWe used a quasi-experimental state-level synthetic control analysis and a county-level difference-in-differences analysis to estimate the impact of the 2016 California policy on vaccination coverage and prevalence of exemptions to vaccine requirements (nonmedical and medical). We used publicly available state-level data from the US Centers for Disease Control and Prevention on coverage of measles, mumps, and rubella (MMR) vaccination, nonmedical exemption, and medical exemption in children entering kindergarten. We used county-level data individually requested from state departments of public health on overall vaccine coverage and exemptions. Based on data availability, we included state-level data for 45 states, including California, from 2011 to 2017 and county-level data for 17 states from 2010 to 2017. The prespecified primary study outcome was MMR vaccination in the state analysis and overall vaccine coverage in the county analysis.In the state-level synthetic control analysis, MMR coverage in California increased by 3.3% relative to its synthetic control in the postpolicy period (top 2 of 43 states evaluated in the placebo tests, top 5%), nonmedical exemptions decreased by 2.4% (top 2 of 43 states evaluated in the placebo tests, top 5%), and medical exemptions increased by 0.4% (top 1 of 44 states evaluated in the placebo tests, top 2%). In the county-level analysis, overall vaccination coverage increased by 4.3% (95% confidence interval [CI] 2.9%–5.8%, p < 0.001), nonmedical exemptions decreased by 3.9% (95% CI 2.4%–5.4%, p < 0.001), and medical exemptions increased by 2.4% (95% CI 2.0%–2.9%, p < 0.001). Changes in vaccination coverage across counties after the policy implementation from 2015 to 2017 ranged from −6% to 26%, with larger increases in coverage in counties with lower prepolicy vaccine coverage. Results were robust to alternative model specifications. The limitations of the study were the exclusion of a subset of US states from the analysis and the use of only 2 years of postpolicy data based on data availability.ConclusionsIn this study, implementation of the California policy that eliminated nonmedical childhood vaccine exemptions was associated with an estimated increase in vaccination coverage and a reduction in nonmedical exemptions at state and county levels. The observed increase in medical exemptions was offset by the larger reduction in nonmedical exem...

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“…Safety threats can arise from the spread of infectious diseases like measles (Rowan, 1982) when claims for access are made by unvaccinated students posing risks of harm at local schools with insufficient herd immunity (Becker et al, 2016). Our model explains how government administrators and principals of local schools respond to this inclusion-safety tension through harm-mitigating work, including reviewing students' vaccination records, cancelling extracurricular activities, and quarantining infected students (Pingali et al, 2019). In an extreme crisis, our model shows how fear of spreading an infectious disease can outweigh moral emotions of denying students access to education.…”

Section: Discussionmentioning

confidence: 99%