Michigan's vaccine waiver education requirement reduced exemptions, then eroded as enforcement became contentious

Michigan had the fourth-highest vaccine waiver rate in the country in 2014, prompting state health officials to create an administrative rule requiring parents to attend an in-person education session at their local health department before obtaining a nonmedical school vaccine exemption. The rule was crafted as an administrative workaround while Republicans controlled the state legislature and governor's office, bypassing the need for legislation. Suzanne Waltman, president of Michigan for Vaccine Choice, later described it to PBS News as "a stealth move."

The policy produced an early success: kindergarten waiver rates dropped 32% in 2015, according to Norm Hess, executive director of the Michigan Association for Local Public Health. But rates began rising again after that first year, and when the pandemic hit, immunization rates dropped sharply and the in-person sessions became fraught. Dr. Juan Marquez, medical director for Washtenaw and Livingston counties, said the sessions became "an unsafe setting" for nurses, with parents yelling at staff for hours. He noted that over ten years and 10,000 waivers issued across his two counties, the sessions changed the minds of "maybe one or two people."

In response, the state worked with Livingston County to pilot a hybrid model in which parents complete a 20- to 30-minute online course before going to their local health department in person to sign the waiver. State immunizations director Ryan Malosh said officials initially worried the more convenient process would function as "a sinkhole," drawing waiver-seekers from across the state. Waiver rates in Livingston County did increase, but at the same rate as the rest of the state. The state subsequently commissioned the University of Michigan to develop a standardized online course, and about a third of Michigan's 83 counties have adopted the hybrid approach.