Religious Exemptions from Vaccine Requirements: A Danger to Public Health

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Religious Exemptions Vaccine Requirements

Oregon is the 12th least religious of the 50 US states. Its largest city, Portland, boasts the most unreligious metropolitan area of any major US city, with 42 percent of city and suburban residents identifying as religiously unaffiliated. But Oregon is in 7th place for exempting schoolchildren from state vaccination requirements on the grounds of religious and philosophical objections of the parents. This is in sharp contrast with Mississippi, which is tied with Alabama as the most religious state, but is in last place for religions and philosophical vaccine exemptions, with a rate of zero.

Along with West Virginia, and as of last year California, Mississippi doesn’t allow religious exemptions. What’s more, the lack of religious/philosophical exemptions has given these three states the lowest rates of total exemptions (exemption for any reason, including medical) whereas Oregon leads the country in that category. And the difference between the two ends of the spectrum is striking. Whereas Oregon had a total exemption rate of 7.1 percent for the 2013-14 school year, the rates in Mississippi and West Virginia were 0.1 and 0.2 percent, respectively.

The reason for the differences is twofold. First, religious and philosophical objections –again, I emphasize of the parents– account for an overwhelming proportion of the total vaccine exemptions given to schoolchildren. And second, the motivation for opting for non-medical exemption –which in many states can be either for religion or philosophy and in other states only for religion– is not usually religion. It’s simply that the parents don’t want to do it, and this is their loophole.

Really there’s not much difference between a religious and a philosophical objection, except in one aspect. In states with a philosophical exemption on the books, it means that the parents only need to sign a form, whereas in states with just a religious exemption option, usually it means there’s a second step; the form also needs to be signed by somebody purporting to be the family’s religious leader. So, for all intents and purposes, religious and philosophical exemption is the same thing. Your child has no medical issue contraindicating one or more of the required vaccines, but you oppose vaccination, so you sign a form, and voilà, you’re exempt.

And this loophole underlies the dropping vaccination rates in the United States, a dropping rate that has been implicated in recent breakouts of certain communicable diseases, a notorious one being the Disneyland outbreak of measles in Southern California (2014-2015). Because of that outbreak and the dropping school vaccination rates in the state, California joined West Virginia and Mississippi in 2016 in being the only US states not to allow exemption for school children, unless there is a medical reason. The state did this by passing Senate Bill (SB) 277, which eliminated what they called personal belief exemptions (PBEs), a term that encompasses both religious and philosophical beliefs.

Along with protecting otherwise healthy children from diseases that can have a fatal outcome, or that can produce long-term effects in those that survive, another motivation for making vaccination required is to enable herd immunity –which protects everybody, including those few children that have a medical reason for avoiding a vaccine. For herd immunity to work, vaccination rates at a school must be in the mid nineties percentage wise, or higher. Unfortunately, though, the rates have dropped into the eighties or lower in many well-to-do, snooty neighborhoods, where alternative medicine is popular. This accounts for disease outbreaks not just in Southern California, but elsewhere too.

But not in Mississippi or West Virginia. For their health ills, these poor states at least can boast the lowest rates of diseases like measles and diphtheria that we have known how to prevent for almost a century. On top of this, the good news is that the rate of preventable diseases in California is expected to drop in the months to come, because of that enormous state’s termination of the religious loophole option for vaccination exemption. However, based on kindergarten enrollment data for the new school year, a research letter published on September 5 in the Journal of the American Medical Association JAMA warns that the number of medical exemptions (MEs) from mandatory vaccination has increased as the PBEs have gone down. This means that anti-vaccine parents are asking pediatricians and family doctors for MEs, and that some doctors are agreeing to do it for children who have no medical reason for avoiding a vaccine.

Of course, we should still expect the overall number of exemptions to go down in California, as they are very low in those other two states, so the elimination of PBEs can only be a good thing.  But there are 47 other US states, and given the stats cited earlier on the rates of religious identification versus religious exemptions, something is rotten in the state of Oregon, and in other states too. But a hint of what’s happening is that apparently anti-vaccine bloggers are giving people advice on how to obtain a religious exemption. Here is an excerpt from an article on a site called “Living Whole”, where the writer begins by assuring the readers that, “We’re not stupid and the queen of common sense is back in the ring to tell you guys how to get the religious exemption you’re entitled to…like a boss.” From there, she moves on to fear mongering that includes claims that vaccines are full of hazardous materials and also that many contain genetic material from “aborted babies”, and quotes a string of biblical passages for the readers to use to support their case. Along the way, she advises the readers to be tough and tenacious, never to yield an argument to anyone, whether a state official or a pastor or other religious leader, even suggesting that Roman Catholics should resist Catholic school authorities when they insist that a child should get a vaccine.

Religious or not, people who reject immunization are making use of whatever religious or philosophical objection they can dream up, and it really has no correlation with their religious beliefs, or lack thereof. This raises the question of whether the religious argument is appropriate for anybody, and if so, who? To that end, there is a wonderful article that explains the rules and traditions, religion by religion, the main points of which I’ll sum up here.

To begin, if you have a real religious motivation for rejecting vaccines for your children, chances are that you belong to the Dutch Reformed Church (DRC). Rejection of vaccine by members of this church dates back to the early 19th century, so it’s a long-standing tradition. Something to keep in mind, though, is that four years ago a DRC community in Holland suffered a major outbreak of measles –1,226  cases, 14 percent of which included severe complications, such as pneumonia (90 cases), middle ear infection (66 cases), and 1 case of encephalitis (inflammation of the brain). 82 of the patients required hospital admission, which should bring home the point that the biggest risk connected with vaccines is not getting vaccinated.

Apart from the DRC, the article mentions a few other sects of Christianity that either have been wishy washy about vaccination in the past, but now accepts vaccination, or that don’t currently take a position. As for the main branches of Christianity, including Catholicism  (in all forms, not just Roman), mainstream Protestants, and Later Day Saints (Mormon), they are fine with vaccines.

Hinduism has no prohibition against vaccines, and this includes when they contain components from cows and other animals. Buddhist countries tends to be fairly pro-vaccination, and actually an early type of smallpox inoculation –that maybe inspired Edward Jenner to invent the first true vaccine for smallpox may have originated among Buddhists. Speaking of Jenner, for his contribution to humanity, he was lauded around the year 1850 by Rabbi Yisroel Lipshutz. Lipshutz was a distinguished rabbi of the 19th century, which should be a hint that Judaism also is positive on vaccination, and that’s true no matter what type of animal, if any, contributes components to a vaccine, even a pig. Saving lives –including though the prevention of disease– takes precedent above religious rules in Judaism, and Moslems have a similar tradition.

So where does this take us? Hopefully, it will lead to the end religious, philosophical, and other personal exemptions from vaccine requirements. It also would be nice it triggers a crackdown on physicians who fall into the gutter of helping anti-vax parents endanger their children and communities.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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