Mississippi has the nation’s highest kindergarten vaccination rate. Idaho’s rate is among the nation’s lowest.

What separates these two states — so often neighbors in national demographic rankings?

The answer can be found in the states’ laws. Mississippi essentially requires all parents to immunize their children before kindergarten. In Idaho, parents can use three different types of waivers to get out of immunizing their children. And Idaho schools have no recourse but to accept the paperwork and enroll these students.

A tale of two states, by the numbers

On Oct. 17 — before a measles outbreak linked to Disneyland sparked a renewed national debate over vaccinations — the Centers for Disease Control issued a report on state vaccination rates. The numbers tell a stark tale:

• In 2013-14, 88.2 percent of Idaho’s 23,934 kindergartners had current vaccinations for measles, mumps and rubella — one of the immunizations required by the state. This 88.2 percent rate ranked fifth-lowest in the nation. It’s also below the 90 percent threshold that is widely believed to curb the spread of contagious diseases.
• Meanwhile, 1,540 Idaho kindergartners were given immunization waivers — 89 for medical issues; 147 on religious grounds; and 1,304 over philosophical concerns. That adds up to 6.4 percent of Idaho’s student population; only Oregon had a higher waiver rate.
• In Mississippi, 99.7 percent of the state’s 45,719 kindergartners were current on “MMR” vaccinations.
• Mississippi’s vaccination rates were higher, in large part, because parents cannot seek a waiver based on religious or philosophical grounds. Medical waivers are allowed, but only 17 of these were granted.

How waivers work

Parents can claim — and receive — a vaccination waiver by filling out a two-page form available on the Department of Health and Welfare’s website.

A medical waiver does require a doctor’s signature. A religious or philosophical waiver only requires a brief explanation. And when parents turn in the forms at kindergarten registration, schools have no recourse but to accept the paperwork and enroll the student.

“We just give them the forms, and that’s all we can do,” said Rob Winslow, executive director of the Idaho Association of School Administrators.

The form is so easy to fill out that it might even be a “path of least resistance” for parents, said Niki Forbing-Orr, a spokeswoman for the state Department of Health and Welfare. It’s sometimes easier to simply claim a philosophical exemption than it is to schedule a round of vaccinations or booster shots.

The waiver forms provide schools with a paper trail. If a disease breaks out, a school can exclude an unvaccinated child from attending class — for the student’s protection, and to limit the spread of disease to classmates, teachers and staff.

The waiver debate

Idaho’s vaccination waivers date back to 1978 — the same year the state passed its mandatory vaccination law. The two chapters were added to state code at the same time.

Forty-eight states allow religious waivers (Mississippi and West Virginia are the lone exemptions). Nineteen states allow waivers based on philosophical grounds, according to the National Conference of State Legislatures.

Nationally, the trend appears to be moving in the direction of additional waivers. Five state legislatures are considering expanded waivers, according to the NCSL — and that includes a proposed religious waiver in West Virginia and, in Mississippi, a waiver that would cover medical and conscientious beliefs.

It’s unlikely that Idaho would buck this momentum.

Asked about vaccination waivers, Sherri Ybarra spokesman Kelly Everitt said the newly elected state schools superintendent “supports parental rights.”

The issue puts Health and Welfare in a bind. The agency strongly supports immunizations but also respects parental rights.

“It is a tough situation,” Forbing-Orr said.

More reading: For more about immunization programs in Mississippi and West Virginia, here’s a story from the Associated Press.