JUDY WOODRUFF: For some parents in the U.S., it’s a question in the fall: Should they vaccinate their children to send them to school?

The American Academy of Pediatrics believes so and says that a measles outbreak that started at Disneyland a few years ago shows how fast childhood diseases can resurface if not enough children are protected.

California and several states have since tightened their immunization requirements. But some parents are still pushing back.

PBS special correspondent Lisa Stark of our partner Education Week reports from Vermont about the vaccine fight there.

It’s part of our weekly series Making the Grade.

LISA STARK: Seven-year-old Merin Blake is a second grader at Champlain Elementary in Burlington, Vermont, a school her parents picked for her back in kindergarten, not because of class size or test scores, but based on how many students had all their vaccines.

MIA HOCKETT, Merin’s Mom: When I took a look at the immunization rates for schools in Burlington, and also, though, at the kind of private schools in the area, I was really aghast about how low they were. And that made me really, really anxious.

LISA STARK: Mom Mia Hockett was anxious because Merin was in the midst of treatment for childhood leukemia, diagnosed just before her 4th birthday. The intensive chemotherapy compromised her immune system, making her vulnerable to diseases.

School nurse Nancy Pruitt worked to keep Merin safe.

NANCY PRUITT, Certified School Nurse, Champlain Elementary: In her classroom, we made sure that the kids were vaccinated. We don’t have the — we can’t always do that, but we made sure that she had a classroom with kids that had been vaccinated.

LISA STARK: Vaccinated against preventable illnesses, such as mumps, measles, whooping cough, chicken pox, and polio, which would have been especially dangerous for Merin.

MIA HOCKETT: I know that kind of a lot of people think that we don’t really have these diseases, so we don’t need to be afraid of them. But in that situation, when we’re kind of thinking about, you know, our child…

LISA STARK: Hockett isn’t just a mom. She’s also a doctor. And she wanted a school with vaccination rates of at least 90 to 95 percent, which public health officials say is required to protect those who are vulnerable or can’t be vaccinated.

Christine Finley runs the immunization program for the state of Vermont.

CHRISTINE FINLEY, Vermont Department of Health: When children are in school, they’re in a setting where they are interacting broadly with one another.

If you don’t have a large percentage of the children vaccinated, then, basically, your shield isn’t going to work, because you have got places where a disease can begin to spread within a school.

LISA STARK: Finley says, by 2014, vaccine rates had dropped to alarming levels, at some public schools, as many as 20 percent of students without all the required shots, and at a dozen private school, 50 percent not fully vaccinated.

Vermont, like every state, requires vaccines to attend school, but, like all states, allows exemptions.

In every state, children can get waivers for medical reasons. Forty-seven states permit families to skip vaccines for religious beliefs; 18 also allow for personal or philosophical exemptions.

Some states are moving to tighten their laws, chief among them California, which, in 2015, did away with all waivers, except for medical exemptions.

Kindergarten vaccination rates have jumped to the highest levels in more than 15 years, nearly 96 percent.

DANIEL SALMON, Johns Hopkins University: The problem is, in many states, it’s easier to get an exemption than it is to vaccinate your child.

LISA STARK: Easier, says Daniel Salmon with the Institute for Vaccine Safety at Johns Hopkins University, because parents simply sign a waiver request, much less effort than getting children vaccinated.

WOMAN: So, this one is for you, and this one is for the school.

DANIEL SALMON: While, nationally, most people vaccinate their children, and that’s clearly the norm, we’re starting to see communities where more and more parents are refusing vaccines.

LISA STARK: Low vaccine rates in some communities are blamed for three large measles outbreaks in the past four years, one in Ohio, one that began in Disneyland and spread to seven states, and another this year in Minnesota.

Are your children vaccinated?

ARIEL BREWER LOUIS, Vermont Parent: No, they are not.

LISA STARK: Ariel Brewer Louis is a Vermont mom of three. We caught up with her during an event for those who question the safety and efficacy of vaccines.

She told her story on board a bus that’s traveling the nation to promote an anti-vaccine documentary and record vaccine testimonials.

ARIEL BREWER LOUIS: I have three girls.

LISA STARK: Brewer Louis recalled that decades ago her brother may have had a serious reaction to a vaccine, according to their mother.

ARIEL BREWER LOUIS: It must have planted a seed, because when my first was born, I just said no. I just opted out.

LISA STARK: Parents say they forgo some or all vaccines for their children for a variety of reasons. They’re worried about the number of doses, the crowded vaccine schedule, and past claims of a link to autism, which have been discredited.

Jennifer Stella runs the Vermont Coalition for Vaccine Choice.

Are you anti-vaccine?

JENNIFER STELLA, Co-Director, Vermont Coalition for Vaccine Choice: I think I have been called anti-vaccine a lot, haven’t I? You know, I’m pro-choice. I think that everybody should have a choice.

LISA STARK: Stella says her two children reacted badly after receiving several immunizations. Her son cried incessantly, stopped nursing and seized in her arms, and her daughter had head-to-toe rashes.

JENNIFER STELLA: I don’t think that vaccines are safe enough for my children.

LISA STARK: Pediatrician Jill Rinehart says vaccines are extremely safe and effective.

DR. JILL RINEHART, Pediatrician: I mean, there’s not much that I do every day for children that saves lives. Immunizations are something that I do every day that I know makes a huge difference.

LISA STARK: Rinehart and other doctors helped push the state to tighten Vermont’s vaccine laws. So did Hockett, with Mia in tow.

In 2015, lawmakers eliminated the state’s philosophical exemption. Parents can still opt out for religious or medical reasons.

Partly because of the change in law, Brewer Louis is homeschooling her 8-year-old. But she is relying on the religious exemption to send another daughter to preschool.

What is your religious objections to vaccines?

ARIEL BREWER LOUIS: I don’t have a religious objection to vaccines, but that’s my only option. And the way I see it, I have done my research, and there’s no way I am going to vaccinate my children to send them to school.

LISA STARK: What do you say to people who say to you, I should have the right not to vaccinate my child?

MIA HOCKETT: I absolutely agree with that, but none of this legislation actually forces someone to get immunized. What is says is that, if you’re opting out of your right and responsibility to vaccine, then you also have to bear the burden of opting out of the benefits of organized education.

LISA STARK: Here in Vermont, parents have at most six months from the start of school to either make sure their child has all the required vaccinations or to claim an exemption. If they don’t, that child is no longer welcome at school.

School nurse Pruitt says no student has been excluded from her school yet, but some have come close. She believes the new law has had an impact.

NANCY PRUITT: So we had a 2.3 percent increase on our student body being fully vaccinated.

LISA STARK: And do you think that’s because of the change in the law?

NANCY PRUITT: I do.

LISA STARK: As for Hockett, she’s focused on a return to normalcy. Merin is considered cured of leukemia, and, in August, was deemed healthy enough to resume her vaccines.

So, this school year, Merin’s parents hope she can count on her own immunity, not just others, to stay healthy.

For the PBS NewsHour and Education Week, I’m Lisa Stark in Burlington, Vermont.

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