Vaccines and Personal Belief Exemptions

If you want to board the family pet at your local kennel, you better have proof of an up-to-date rabies vaccination. It’s the law in every state: You must vaccinate your dog, cat, or ferret against rabies according to the recommended schedule. There are no exemptions for pet owners who might have religious or philosophical beliefs that conflict with immunization.

The rabies vaccine protects the pet who receives it—and other pets and people—from acquiring rabies. When you take your beloved pet to the kennel, you can rest assured that there is very little chance it will acquire rabies from another animal during the stay.

Believe it or not, there is an anti-vaccine movement for pets. There are people (on the Internet, of course) who believe the rabies vaccine is harmful and unnecessary. Fortunately, the law is very clear, and it provides no accommodation for those who ascribe to an unscientific world view. The law does a very good job of protecting pets and people from irresponsible pet owners.

Unfortunately, the law is failing to protect our children.

Although all 50 states and the District of Columbia require schoolchildren to be vaccinated, all but two (Mississippi and West Virginia) allow exemptions based on parental religious beliefs. At least 18 states also allow non-religion-based “personal belief exemptions.”

Over the past few years, the proponents of expanding religious and personal belief exemptions have gained ground. During a recent three-year period, 31 bills were introduced in state houses across the nation seeking to expand the rights of parents to exempt their children from vaccination laws. None of these bills passed, but the movement rolls on.

The most conclusive evidence of the movement’s momentum is the resurgence of vaccine-preventable diseases. Endemic measles was eradicated from the United States in 2000. Yet in 2014, New York City is battling a measles outbreak. In 2010, the largest epidemic of pertussis since 1947 occurred in California. Although there are many factors that contribute to these outbreaks, the growing number of unvaccinated children is a significant contributing factor.

South Carolina does not have a personal belief exemption, but parents are free to claim a religious exemption without needing to prove they are “members of a recognized religious denomination in which the tenets and practices of the religious denomination conflict with immunization.” All that is required is a signed and notarized “Certificate of Religious Exemption” stating that the parent has “religious objections”—a one-time signature that condemns a child to unvaccinated status until the age of majority.

The controversy over mandatory vaccination is a classic case of conflicting rights and interests. In fact there are two basic conflicts: (1) The parental right to make medical decisions for the child versus the best interest of the child; and (2) the right of unvaccinated individuals to attend schools and daycare centers versus the right of everyone else to use those facilities without acquiring an infectious disease.

The first conflict is the most difficult to resolve. A statute that is too restrictive could create a backlash against vaccination. We also risk marginalizing communities who hold sincere but non-scientific beliefs about medical care. A softer touch is needed when dealing with parents who hold sincere but irrational beliefs (and this approach should include not dismissing unvaccinated children from our medical practices). After all, a certain level of nonconformity can be tolerated, as long as vaccination rates do not fall below those needed to maintain herd immunity.

The second conflict must be addressed in a more straightforward manner. The law does not force parents to vaccinate their children. It simply requires certain vaccinations before children are allowed to enter school and daycare. Vaccine refusers are free-riders, and the public’s interest in controlling infectious disease trumps their right to serve as a vector of disease.

In a perfect world, school-based vaccine mandates would be as air-tight as those for rabies vaccine. There would be no personal belief exemptions, and unvaccinated children would not be allowed to attend daycare or school. The burden would fall on the parents and their religious institutions to provide alternative child care and educational opportunities.

A number of legislative strategies have been proposed to deal with the growth of personal belief exemptions. These strategies warrant our support:

  • Requiring mandatory education and counseling regarding the benefits of immunizations before granting an exemption to parents. 
  • Requiring a statement from a physician documenting that vaccinations have been recommended but refused. 
  • Requiring that exemptions be renewed on an annual basis. 
  • Requiring schools and daycare centers to regularly publish their immunization and exemption rates. 

The conquest of vaccine-preventable diseases ranks among the greatest achievements of the scientific age. The push for broader exemptions based on personal beliefs threatens to undermine these achievements. It’s time we pushed back.

This article was published in South Carolina Family Physician.