CHARLESTON, W.Va. (AP) — With rampant diabetes and obesity, Mississippi and West Virginia have struggled with health crises. Yet when it comes to getting children vaccinated, these states don't mess around.
The states, among the poorest in the country, are the only ones that refuse to exempt school children from mandatory vaccinations based on their parents' personal or religious beliefs. Separate efforts to significantly loosen those rules died in both states' legislatures last week.
Mississippi has the highest immunization rate in the country for children entering kindergarten at 99.7 percent, while West Virginia is at roughly 96 percent, according to the Centers for Disease Control and Prevention. The figures cover vaccines for measles, mumps and rubella; diphtheria, tetanus and pertussis; and varicella, or chickenpox.
Public health officials say a 90 percent immunization rate is critical to minimizing the potential for a disease outbreak.
"Mississippi is not traditionally viewed as a leader on health issues. But in this area, they should be proud of the fact that they have not changed this law. Mississippi and West Virginia could be role models for other states," said Dr. Mark Schleiss, a pediatrician and vaccine researcher at the University of Minnesota.
A recent measles outbreak that has sickened more than 100 people has brought attention to policies in 48 states that allow parents to opt out of vaccinating their children because of their religious beliefs or personal beliefs, or both.
But in West Virginia and Mississippi the rules are firm: Barring a significant medical reason, kids who haven't been vaccinated can't attend school — public or private.
Dr. Rahul Gupta, West Virginia's state health officer, said the limit on exemptions is the reason his state has been spared from any measles outbreaks for decades. And the policy has been relatively uncontroversial.
"The overwhelming majority of the public ... support having more of their children protected through vaccinations than less," he said.
Some parents in West Virginia are perplexed that people wouldn't vaccinate their kids.
"I don't think it's a big deal," said Paula Beasley, whose daughter attends fifth grade in Cross Lanes, West Virginia. "Everyone needs to. It's all for the greater good."
Mississippi lawmakers are considering a proposal to let doctors grant medical exemptions that would allow children to skip or delay a vaccination. Currently, only the state Department of Health can grant an exemption. Though all 135 requested exemptions were granted for this school year, a group called Mississippi Parents for Vaccine Rights said the department has ignored its concerns that the state requires too many immunizations too early in life. The activists' demand for a philosophical exemption was stripped from the bill last week.
Tracey Liles of Grenada, Mississippi, who has a 13-year-old daughter and a 3-year-old son, is among those pushing for the change because she thinks the health department has been too stingy in granting medical exemptions. Liles said her daughter is fully vaccinated but ran a high fever and slept for two days after a round of vaccinations about 10 years ago. Her daughter, who is now in eighth grade, had to get a state-mandated booster shot for diphtheria, tetanus and pertussis before entering seventh grade.
"Obviously, I wasn't going to pull her out of school, being a cheerleader and everything. So, we did it," Liles said. "Basically, I feel like I was forced to do it, but I didn't have a choice."
Dr. Mary Currier, the state health officer in Mississippi, has urged legislators not to weaken the immunization requirements, particularly with measles spreading in other states.
Mississippi enacted a strong vaccination law in the 1970s. In 1979, the Mississippi Supreme Court blocked a father's request not to vaccinate his son because of religious beliefs.
The protection of students "against the horrors of crippling and death resulting from poliomyelitis or smallpox or from one of the other diseases against which means of immunization are known and have long been practiced successfully, demand that children who have not been immunized should be excluded from the school community until immunization has been accomplished," the court wrote.
Republican Dean Kirby, chairman of the Mississippi Senate Public Health Committee, said that when proposals to create a philosophical exemption arose in recent years, he received calls mostly from one side — those wanting the change. With the measles outbreak this year, Kirby said he's hearing from parents who want to keep the law as it is.
"They don't want their children going to school with people who have not had the shots," Kirby said.
West Virginia's school vaccination law has its roots in the 1880s and has been repeatedly changed. But the trend toward expanding exemptions never gained traction.
Last week, a proposed religious exemption was removed from consideration without debate in the legislature.
Dr. Ron Stollings, a state senator, said lawmakers may tweak which state officials can grant medical exemptions, but public safety demands exemptions be kept to a minimum.
"Without this mandate, we'd be in the 60 to 70 percent vaccinate rate and not 90 percent," he said.
Emily Wagster Pettus reported from Jackson, Mississippi. Associated Press writer Jonathan Mattise contributed from Charleston.