cians and family physicians for the Austin Diagnostic Clinic also do not accept patients from families who choose not to immunize their children. Dr. Terk says parent vaccination opposition is at a considerably higher level
today than it was when Cook first implemented its policy. “The timbre of the conversation has changed,” he said. “I think things are a bit
more at a fever pitch because of what has happened with outbreaks of disease, and there’s the hardening of the fringes of this culture war, basically. I don’t think [it was] the same dynamic that exists now.” The results of that culture war may be showing up in data Texas schools
submit to the state’s Department of State Health Services (DSHS). The state’s data show child vaccination exemptions for conscientious reasons are still an overwhelming minority, but also a growing one. (See “Vaccination Exemptions on the Rise,” page 27.) Texas law allows vaccination exemptions for schoolchildren if a physician
provides a written statement that the injection would be harmful or injurious to the child or a member of the child’s household, or if a parent or guardian chooses to be exempt for “reasons of conscience,” including religious beliefs. Each fall, DSHS collects self-reported immunization data from the state’s
public schools and accredited private schools and compiles the information into the department’s Annual Report of Immunization Status. The 2014–15 annual report shows a little more than 41,000 students, or just 0.79 percent of total reported enrollment, had a conscientious exemption filed at their school. That exemption percentage, however, is significantly higher than the one
DSHS collected for the 2003–04 report, which showed 2,314 students, or 0.08 percent of enrolled students, with conscientious exemptions. And conscientious exemptions are nearly four times as common as they were in the 2007–08 school year, when the report accounted for 10,400 students with the exemption. Dr. Ziari says ARC began noticing an increase in unvaccinated pediatric pa-
tients more than a year ago, although ARC doesn’t have hard data on how many more patients were unvaccinated. ARC treats around 400,000 patients of all ages and employs about 350 physicians, 70 of whom are pediatricians. “I really can’t give you a good number, and the reason is because we actually
see lots of patients, for example in our after-hours, [for] whom we’re not the primary care doctor, and so it’s hard to quantify,” she said. “I’ll tell you that talking [to] the doctors in our group, we know that the number of unvaccinated children is going up.”
CHANGING MINDS Of course, not every physician will take the same route as ARC. Austin family physician Guadalupe Zamora, MD, says he believes in immu-
nizing every child and that the studies have shown that vaccinations don’t cause autism. Dr. Zamora, who doesn’t practice at ARC, says he understands where ARC is coming from with its new hard line on immunization. But he also feels parents have the right to decline vaccinations, and he says he’ll continue seeing patients whose parents feel that way. “Those children need to be seen. I’m not going to turn them away. I’m going
to see those children,” he said. “If there’s even a hint that a child may have a preventable disease, we’re going to bring that child in through the office right away, bring equipment in an exam room where we can isolate and see the child, and then get the child home.” Dr. Zamora says he tries to educate parents as much as he can about the po-
tential ramifications of unvaccinated children. “I have several families for whom, in their eyes, one of their children was well, and after immunization, that’s when the child had a neurological decline,” he
September 2015 TEXAS MEDICINE 29
“This has not been something we did haphazardly. There was a lot of very thoughtful discussions that went into it.”
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