JACKSON, Miss. — The Mississippi state epidemiologist, Dr. Thomas E. Dobbs III, stood in a crowded room at the State Capitol this week and waited for a legislative verdict on the law that fostered what he regards as a public health triumph in a place that has few of them: the country's highest immunization rate among kindergarten students.
But in recent weeks, the nearly unbending nature of Mississippi's law requiring students to be vaccinated has been in jeopardy, with two dozen lawmakers publicly supporting an exemption for "conscientious beliefs."
The debate, coming as other states grappled with a measles outbreak, turned Mississippi into one more battleground between medical experts who champion vaccinations and parents who fear the government's role in medical decision-making.
"We have been a victim of our success, and people don't realize how bad these diseases are," Dr. Dobbs said in an interview before lawmakers met on Tuesday to consider a bill that would have expanded exceptions to the vaccine requirement. "But by and large, I think there's an increasing understanding of how important it is to maintain our invaluable defense against unnecessary illnesses."
Members of the education committee for the House of Representatives, in effect, endorsed the state's current approach on Tuesday. By a voice vote, they advanced a heavily amended version of the bill that now calls for only technical changes to Mississippi's law, which has been largely untouched since the late 1970s. The law requires all children in public and private schools to have certain immunizations, including for chickenpox, hepatitis B and measles. Generally, children must have the vaccines by the time they are in kindergarten.
Mississippi — one of the states with the worst rates of smoking, obesity and physical inactivity — is seldom viewed as a leader on health issues. But it is one of two states that permit neither religious nor philosophical exemptions to its vaccination program. West Virginia is the other. Only children with medical conditions that would be exacerbated by vaccines may enroll in Mississippi schools without completing the immunization schedule, which calls for five vaccines.
For the 2013-14 academic year, Mississippi reported that nearly all of its 45,719 kindergarten students had been adequately immunized, and the state's measles, mumps and rubella vaccination rate was about five percentage points higher than the national median of 94.7 percent.
For kindergartners that year, Mississippi approved just 17 medical exemptions, the Centers for Disease Control and Prevention said. Neighboring Arkansas, which had about 3,100 fewer kindergarten students than Mississippi that year, recorded 24 medical exemptions, along with 468 religious or philosophical exemptions.
Amid the measles outbreak, policy makers across the United States are considering whether to modify state vaccine policies. A group of California legislators said Wednesday that they would offer a proposal to eliminate their state's personal belief exemption.
"As a mother, I know the decisions we make about our children's health care are deeply personal," Assemblywoman Lorena Gonzalez, a supporter of the planned measure, said in a statement. "And, while I respect that fundamental right to make medical decisions for your own family, a parent's decision to ignore science and medical facts puts other children at risk. We as a state can't condone that."
In Mississippi, where officials like Dr. Dobbs applauded the outcomes associated with the state's vaccination program, the inflexibility bred discontent among some legislators, as well as people beyond Jackson.
The original version of the bill that went before lawmakers Tuesday would have required parents who cited conscientious beliefs as the basis for an exemption to indicate an understanding of "the benefits and risks of vaccinations and the benefits and risks of not being vaccinated."
The proposal's supporters, many of whom do not fully agree with parents who consider vaccines harmful, sought to portray the bill as grounded in personal freedoms.
"It is a medical treatment," said Amy Martin, a nurse from the Jackson area who, dressed in a white coat, walked the Capitol's hallways on Tuesday. "All medical treatments — medication, procedures — they all come with risk. And because of that, I believe that parents ought to have the freedom and the liberty to decide what is best for their children."
Lindey Magee, a co-director of Mississippi Parents for Vaccine Rights, said the immunization standards were so overbearing that she opted to home-school her son and daughter so that they could avoid certain inoculations.
"I don't like being coerced into something," said Ms. Magee, of McComb, a city of about 13,000 people near the Louisiana border. "My husband and I prayerfully and carefully made that decision, and there's no room for prayerful, careful decisions in Mississippi concerning our vaccine schedule."
Ms. Magee said that she did not wish for Mississippi's vaccine program to be abolished. She said she wanted a more relaxed schedule and the right to choose which shots her children would receive and when.
She also said the extraordinary vaccination rate that Mississippi officials cherish was shameful.
"I'm not proud of it," Ms. Magee said. "I don't think it's something to be proud of. I think all it shows is that we are being extorted for our reputation of ignorance in Mississippi. We bring up the national rear in everything that matters. I think it's silly to look at that vaccine rate and think that's something to be proud of."
But Dr. Dobbs said the concerns of "a small group of loud constituents" were often based on misinformation, and he said Mississippi officials feared that changing the immunization rules would lead to increases in measles and pertussis.
The Mississippi Supreme Court ruled in 1979 that the state had the authority to order widespread vaccinations as a condition of school enrollment. In its ruling, which described much of Mississippi's vaccine law as "a reasonable exercise of the police power of the state," the court even struck down a religious exemption.
"The protection of the great body of schoolchildren attending the public schools in Mississippi 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 said.
The subsequent immunization campaign has led many public health experts to hail Mississippi as a model for the nation, at least in this case.
"That kind of strong approach is helpful for the health of children in America," said Dr. David W. Kimberlin, the president of the Pediatric Infectious Diseases Society and a professor at the University of Alabama at Birmingham. "I believe that that should be something we all work toward, that we all hold in the highest of value in terms of our prioritization."
State health officials emphasized Mississippi's performance in discussions before the education committee's meeting.
"We've tried to use that as an example of us doing something right and really being a national leader," Dr. Dobbs said.
After the vote, some parents left in tears.
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