The Impact of Michigan’s Administrative Rule/Policy Change for Nonmedical Vaccine Exemptions

Date of Award


Degree Name

Doctor of Philosophy


Interdisciplinary Health Sciences

First Advisor

Dr. Kieran Fogarty

Second Advisor

Dr. Mary D. Lagerwey

Third Advisor

Rachel C. Potter


nonmedical vaccine exemptions, vaccine exemptions in Michigan, vaccine exemption policy, vaccine exemption clustering, immunizations, vaccine education


Currently, there are no federal laws mandating vaccination for school entry; the U.S. Supreme Court, however, still recognizes and supports the constitutionality of state-mandated vaccination laws, with its only requirement being that all states permit medical exemptions for school entry. However, these state-led vaccination mandates for school entry have invariably made for considerable heterogeneity among states in the types of exemptions allowed as well as in the enforcement of exemption criteria. While many states in the past have offered nonmedical vaccine exemptions, recent events, most notably the 2015 multistate Disneyland measles outbreak and the persistent increase in the number of people choosing to forego vaccination in the United States, has prompted some states, including Michigan, to revise their nonmedical vaccine exemption policies, with most opting for stricter vaccine exemption protocol (Lillvis, Kirkland, & Frick, 2014; Blank, Caplan, & Constable, 2013). However, the value and efficacy of instituting stricter policies has not been fully explored. Therefore, this dissertation uses a three-research study format to investigate the impact of Michigan’s attempt to strengthen its nonmedical vaccine exemption policy in an effort to decrease the state’s high nonmedical vaccine exemption rates.

The first research study assesses socio-demographic and socioeconomic school factors at the individual school level associated with high nonmedical, philosophical vaccine exemptions at the kindergarten level both before and after the administrative rule change. The second research study explores whether kindergarten vaccine exemptions cluster geographically in Michigan, and whether they cluster by type. The paper goes on to investigate whether the administrative rule change has had an impact on type-specific vaccine exemption clusters.

Whilst research studies one and two focus on the quantitative impact of the administrative rule change, research study three utilizes qualitative analysis to investigate the vaccine waiver educational sessions which, as stipulated by the administrative rule change, are mandatory for parents seeking to exempt their children from school-entry vaccines to attend. Chiefly, in an effort to help inform best practice, the paper examines which strategies, resources, and techniques some educators who conduct the vaccine waiver sessions believe are the most beneficial.

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