Study Finds Demographic Correlates of Vaccine Hesitancy in Texas

Jurisdictions around the United States have a variety of different legal frameworks for vaccine-exemption rules. Texas is one of 15 states which allows families to cite philosophical exemptions to vaccination itself in order to opt children out of immunizations otherwise required to enroll in school.

Vaccine exemptions are a matter of clinical concern, as they raise the risk of vaccine-preventable disease outbreaks.

The investigators of a new study published in PLOS Medicine have identified geographic and socioeconomic drivers of conscientious vaccine exemption choice in Texas. They found that Texans who are college educated, have higher median incomes, live in urban or suburban areas, and are ethnically white are more likely to opt for vaccine exemptions.

The study team used beta regression models to identify who in Texas uses vaccine exemptions and where people who use exemptions tend to live.

Information was taken from the publicly available annual reports of the Texas Department of State Health Services.

Of the 2087 reporting school systems, 850 were excluded due to erroneous entries or lack of data. A variety of demographic and geographic correlates were drawn from the remaining school systems.

The median conscientious vaccination exemption percentage across school systems in Texas more than doubled from 2012 through 2018, from .38% to .79%, representing over 24,000 additional students with vaccine exemptions.

The study authors found that 28% of private schools, 22% of charter schools, and 5% of public schools were at risk for outbreaks of vaccine preventable disease.

Vaccine exemptions increased significantly more in suburban public-school systems than in town public school systems, by a mean of 0.38 percentage points compared to 0.31 percentage points respectively.

The percentage of students in a school system that self-report as ethnically white had a strong positive correlation with vaccine exemptions.

“Our findings support recent national and state-level studies that have similarly identified the white and college-educated demographic as positive predictors of vaccination exemptions,” study authors wrote.

The investigators offered several reasons for the growing rate of vaccine exemptions in Texas, looking closely at the large number of people moving into the state. It is possible that parents with negative vaccine beliefs are moving to Texas specifically over lenient vaccination policies, but study authors called this unlikely.

Another explanation offered was that Texas might attract families from socioeconomic groups with vaccine hesitancy for other cultural and economic reasons. Additionally, the act of moving may result in a lapse in health insurance coverage, leading to vaccine exemptions being chosen out of necessity rather than belief. Other research has linked vaccine hesitancy to certain kinds of social media use.

“While this study does not definitively identify the causes of these trends, it provides measurable predictors of vaccination exemption patterns that can be used to detect risk hotspots and tailor public health interventions,” study authors explained.