State health officials in Michigan are encouraging parents in various counties to vaccinate their babies against measles earlier this spring due to a rise in cases. The outbreaks of this highly contagious virus—known to cause severe complications, including brain swelling and even death—coincided with an alarming trend of parents opting out of vaccinations for their school-age children at an all-time high.
This development is something that state officials have been striving to prevent for over a decade. For years, they’ve attempted to make it more difficult for parents to enroll their children in school without vaccinations.
However, efforts have faced unexpected outcomes in areas like St. Clair County, located in Michigan’s conservative Thumb region. Dr. Remington Nevin, the local medical director, proudly announced a so-called “new era of vaccine choice.” Parents in the county can now bypass traditional protocols to obtain school vaccine waivers through a simple email process, merely days after completing a concise digital form.
Interestingly, state health officials do not seem to be contesting this approach.
In fact, Michigan’s health department has been aiding over 30 counties in moving away from a previous state policy that effectively reduced the number of parents opting their kids out of vaccinations.
In 2015, Michigan implemented a rule requiring parents seeking waivers to attend a vaccination education session in person at their local health department.
However, in the aftermath of the COVID pandemic, these sessions deteriorated, becoming confrontational and at times unsafe for staff, according to local health officials.
A high school even had to call the police last fall due to escalating tensions with parents who refused to obtain a state-recognized waiver for their children; a sheriff’s deputy warned these parents that they might face criminal charges.
In response, the state has initiated a hybrid waiver procedure in numerous counties, enabling parents to complete a brief online vaccination education course while still requiring them to obtain their waivers in person.
This shift is part of a broader strategy within a state known for its divisive COVID restrictions. With vaccination rates as low as 30% to 40% in some Michigan schools, State Chief Medical Officer Natasha Bagdasarian remarked that it’s “simply not possible to keep diseases like measles at bay.” She warns that when measles cases appear in communities with low immunization, the potential for widespread outbreaks significantly increases.
A brief success story
Back in 2014, Michigan had the fourth-highest vaccine waiver rate in the nation. Authorities suspected many parents were simply signing waivers under pressure during stressful school registration periods, not necessarily due to firmly held beliefs.
Norm Hess, executive director of the Michigan Association for Local Public Health, reflected on this saying, “’Oops, I forgot to do this. I’m just going to sign a waiver and be done with it,’ that’s not how we want parents making these decisions.”
At the same time, national attention zeroed in on a measles outbreak tied to Disneyland, where 131 people were infected. In response, California became the first state in decades to eliminate non-medical vaccine waivers.
With Republicans in power in Michigan’s Legislature and governorship, health officials opted to implement a rule mandating local health departments to certify that individuals seeking non-medical waivers had received education about the risks of not vaccinating and the benefits of vaccines.
Initially, this seemed effective; waiver rates for kindergarteners dropped by 32% in 2015, which Hess noted resulted in increased protection against vaccine-preventable diseases. However, waiver rates began climbing again shortly thereafter, exacerbated by the pandemic-induced plunge in immunization rates.
In-person sessions deemed ‘unsafe’
Dr. Juan Marquez, the medical director for Livingston and Washtenaw counties in Michigan, recently faced several measles cases this spring, and he stated that he wouldn’t want to resume in-person sessions for parents seeking vaccine waivers.
“It created unsafe settings for our nurses,” Marquez explained. “They were just doing their jobs, and having someone yell at them or say hurtful things for hours is disheartening.”
As of March, Washtenaw reported seven measles cases and was believed to be the source of an additional case in a neighboring county, totaling 14 cases statewide for the year as of late May.
Since the pandemic began, Michigan has seen an increase in waiver requests. Public health tensions surged during the COVID lockdowns, which many critics described as excessively long and strict. This became a campaign issue for Republicans, with Donald Trump flipping Michigan in the 2024 presidential election.
Some parents felt that being required to attend counseling sessions was patronizing.
Republican state Rep. Jennifer Wortz recalled her negative experience during a session at a vaccine choice rally in Lansing, stating, “We made informed choices based on our research for our children.” This resentment is hindering basic public health operations, such as contact tracing for measles cases.
In the past ten years, the two counties under Marquez’s oversight have issued approximately 10,000 vaccine waivers but he believes the education sessions convinced just a couple of individuals. “If we’re not changing minds, can we do this safely?” he pondered.
Michigan’s new workaround
Initially, state immunization director Ryan Malosh was skeptical when Livingston County health officials proposed replacing in-person sessions with a 20-minute online course about vaccine benefits and risks associated with preventable diseases.
Concerns arose that more convenience in the waiver process might lead to a higher rate of exemptions, potentially resulting in more outbreaks. There was also fear that parents might inundate Livingston County with requests, as waivers could be obtained from any county health department.
However, it didn’t play out that way. Parents engaged with the online course and then scheduled in-person appointments at their local health department to sign their waivers. There was a rise in waiver rates in Livingston County, yet they mirrored increases across the state.
Consequently, state officials commissioned the University of Michigan to create a standardized online course applicable to any county. Parents now complete a 20 to 30-minute course, answer questions on the material, and then go to their local health department to finalize their waivers.
Concerns about the hybrid waiver system
Though around a third of Michigan’s counties have embraced this hybrid system, confusion and conflict still surround the waiver process. Last fall, a Waiver-related conflict involving a family from St. Clair County escalated to the point where school officials sought law enforcement intervention.
Despite residing in St. Clair, the children attended school in Macomb County, which had already adopted the hybrid model. The parents resisted filing documents altogether, fearing local health officials would know their children’s vaccination statuses.
The father, Andrew Eberly, noted during a public health meeting that being compelled to obtain a certified waiver “forces parents like me to register personal health decisions” with authorities, a process he distrusts.
Amidst ongoing disputes, school officials requested sheriff’s department involvement, leading to a deputy indicating that the waiver counseling requirement was annoying and cumbersome. He warned Eberly that refusing to provide state-recognized waivers could lead to charges of contributing to minors’ truancy.
The incident garnered local attention; during a public health board meeting, Dr. Remington Nevin highlighted it as evidence that those skeptical of public health measures “have valid reasons for their concerns.”
So far, state officials have chosen not to clash verbally or legally with Nevin, who has evoked mixed reactions at public meetings regarding his stance on vaccines. Instead, the focus remains on ensuring parents are aware of the risks associated with vaccine-preventable diseases like measles.
Local health departments retain the autonomy to determine what’s best for their residents. Malosh emphasizes the importance of being straightforward and informative for parents to facilitate informed decision-making.
