The number of Polk County students with religious exemptions from required school immunizations continues to rise. Students who opt out of the immunization requirements due to religious beliefs have more than doubled since 2018. From 2023-2024, the total number of religious exemptions rose by 19%.
Public schools are seeing slight decreases in vaccination rates. But nonpublic school vaccination rates are now at 88%. While herd immunity thresholds vary between vaccines, the target minimum is typically a 90% vaccination rate, according to Iowa Immunizes Coalition Director Elizabeth Faber.
“We are always concerned when there are disease outbreaks that those children that are not protected by immunizations would be affected, and then that could spread and affect those in our community that are immunocompromised or too young to receive a vaccine,” Faber said.
Medical exemptions from vaccines — which require a physician’s approval — have dropped by almost half since 2018. Polk County Health Director Juliann Van Liew said that it’s unclear whether the trend between religious and medical exemptions are related.
Each year, nurses with the Polk County Health Department perform an audit of student vaccination certificates and exemptions for students within the county limits, as mandated by the Iowa Department of Public Health.
Van Liew said that the current children’s vaccination schedule is “incredibly safe and effective.”
“The consideration of the greater public and all of us, versus the needs and consideration for the individual, that tug and pull is at the heart of what we do in public health,” Van Liew said.
What’s behind the rise in religious exemptions in Iowa?
As of July 2024, parents do not need a notary to witness their signature on a Religious Certificate of Immunization Exemption. The certificate states that a child will be granted an exception based on a “genuine and sincere religious belief” and “not based merely on philosophical, scientific, moral, personal, or medical opposition to immunizations.”
The state policy made it easier for people to opt out of required vaccines for public schools, Faber said.
As a county health department, Van Liew said that they are obligated to stay in compliance with state code, which means that the department cannot ask to confirm someone’s religious beliefs.
"We’re still trying to overcome purposefully falsified research from a few decades ago that erroneously linked autism and vaccines."Juliann Van Liew, Polk County health director
“We’re still trying to overcome purposefully falsified research from a few decades ago that erroneously linked autism and vaccines — an incredibly unfortunate piece of purposeful misinformation spreading that has caused an incredible amount of damage,” Van Liew said. “Unfortunately, we're still seeing folks relying on that misinformation and continuing to spread ideas that vaccines aren't safe.”
Van Liew said she’s monitoring a chicken pox outbreak at a private school, something she wouldn’t traditionally see if enough students were vaccinated against chicken pox.
“The more we've got kids not fully up to date on vaccines, the more we're going to see communicable disease spread,” Van Liew said. “It simply is what it is.”
Individual rights versus public protection
Vaccine hesitancy is at the center of the debate over parental rights, Van Liew said, not just in Iowa but nationwide. She said parents’ fears about safety are motivated by a desire to do right by their kids.
“I just want to encourage folks to stay engaged in the conversation, to not vilify either side, to realize that this is an important public health issue that really strikes at the heart of individual rights versus public protection,” she said.
Both Faber and Van Liew said that using trusted messengers to reassure parents helps them consider their vaccination decisions. Both praised school nurses for having those hard conversations with parents.
“We need to figure out that sweet spot and that balancing act of how we honor and respect people's individual choices and unique situations, but also decide together that we need to do things to protect one another that maybe aren't always the thing we love to do or want to do, but that we have a responsibility to do,” Van Liew said.
