Officials in various states are taking steps to make it more difficult for parents to opt out of immunizing their children. All 50 states have laws detailing school vaccination requirements and all grant exemptions to children who are unable to receive vaccinations for medical reasons. However, some officials are concerned that non-medical exemptions are serving as mere loopholes for parents who object to vaccinations on unprotected grounds, or who simply don’t want to go through the trouble of immunizing their children. All states but Mississippi and West Virginia permit exemptions based on religious beliefs, and 20 states have provisions allowing exemptions based upon philosophical beliefs. Rather than simply eliminating exemptions to encourage immunizations, which would likely result in a backlash by vaccine opponents, some states are requiring additional proof of valid, exempt beliefs.
New Mexico, for example, allows religious, but not philosophical, exemptions to its vaccination requirements. However, the New Mexico Department of Health became concerned that the statute, which allows exemptions based upon a person’s “individual or jointly held” religious beliefs, was being interpreted as applying to persons with mere philosophical objections. In fact, the National Conference of State Legislatures, which created a list of states with religious and philosophical exemptions, clarified New Mexico’s statute with a footnote indicating that the Department of Health did not interpret the statute as a philosophical exemption. Rather than seek a change in the law, the Department of Health changed the exemption form, which simply asked parents to affirm that they held qualifying religious beliefs. The new form specifically states that philosophical exemptions are not granted and requires parents to state the religious beliefs that prevent them from immunizing their children.
In Washington, lawmakers grew concerned at the state’s growing number of unvaccinated children. State laws permit both religious and philosophical exemptions; during the 2008-2009 school year, 7.6 of kindergarteners had lawfully opted out of vaccinations. However, in 2011, the Legislature passed a law requiring parents seeking philosophical or religious exemptions to secure a health care professional’s written affirmation that he or she provided the parent with information about the benefits and risks of immunizations. Only parents who can demonstrate membership in a religious organization whose teachings prohibit any medical treatment by healthcare professionals are released from this requirement. Vaccine proponents monitoring the state’s exemption numbers note that non-medical kindergarten exemption rates dropped to 4.2% in the 2011-2012 school year. Other states are passing similar laws. California Governor Jerry Brown recently signed a bill into law that will also require a physician signature regarding informed consent. Vermont has passed a law requiring parents to annually submit exemption forms indicating that they have reviewed vaccination information provided by the Department of Health, understand that their actions increase the risk that others will contract illnesses, and understand that there are persons with special needs who are unable to be vaccinated and could be placed at increased risk.
Unlike states seeking to tighten exemption requirements, West Virginia, along with Mississippi, is one of only two states that does not allow any type of non-medical exemption. State law requires incoming students to receive vaccinations against five different illnesses. However, a state Department of Health and Human Resources rule that became effective in 2010 increased the vaccination requirements for seventh and twelfth-graders. “We the Parents,” a group of six families, challenged the DHHR’s authority to enact such a rule without legislative approval. A circuit court judge recently issued a ruling upholding the rule, but We the Parents plans to appeal. West Virginia judges in similar, pending cases, have required school boards to provide home-based instruction to unvaccinated students.
Why are states attempting to close loopholes and even increase regulation when vaccine opponents remain as vocal as ever? Outbreaks of illnesses previously controlled by immunizations are on the rise; in fact, a current national pertussis outbreak may be the largest in 50 years. Although the occurrence could be due, in part, to a less effective pertussis vaccine, the non-immunized population is contributing to the problem. Outbreaks can also stem from illnesses that are introduced by travelers from parts of the world where the diseases at issue are not controlled. People who are not vaccinated are susceptible to the diseases, as are infants too young to be vaccinated and others with medical contraindications to vaccinations. A study published in the New England Journal of Medicine revealed that non-medical exemptions from immunization laws have increased at an accelerated pace over the past twenty years. The study specifically tracked non-medical exemptions from 2005-2011 and noted that the rates of exemptions in states with philosophical exemptions were 2.54 times as high as those in states that allowed only religious exemptions. The rates of exemptions in states with less stringent exemption policies were 2.31 times as high than in states with tougher policies.
Neither side in the vaccine debate minces words. Parents opposing immunization regulations contend that the government is infringing upon their rights to raise their children. Proponents of immunization programs have little patience with those arguments. New Mexico nurse Shawna Bailey summed it up; “If you want to endanger the life of your child, that’s your decision. But there are little babies out there that can’t protect themselves.”