By Melinda Carstensen
Should unvaccinated students be barred from public schools?
In New York, three families challenged the state's decision to keep unvaccinated children from attending school when other students had a vaccine-preventable illness. Despite their argument, a federal judge in New York City upheld the city's policy, The New York Times reported.
Judge William F. Kuntz II wrote that the Supreme Court has “strongly suggested that religious objectors are not constitutionally exempt from vaccinations.” The families said their religious freedoms were violated when children were forced to stay home.
All U.S. states require proof of certain vaccinations before children attend daycare, grade school and college, but most states allow parents to opt out of immunizing their kids if they can provide religious, medical or philosophical reasoning.
According to the Centers for Disease Control and Prevention, in the 2012-2013 school year a median of 1.8 percent of kindergarten parents had exempted their children from a vaccine. Of those, .3 percent were for medical reasons and 1.5 percent were not, CDC spokesman Jason McDonald said.
In New York, parents can submit exemption requests if they offer a written explanation of a “genuine and sincere” religious objection, or if a doctor says a vaccine is medically harmful to a child. Schools can decide whether to accept or deny religion-based requests.
Exemption requests have generated concerns among health officials, who point out recent increases in preventable diseases. According to the CDC, immunization exemption requests have contributed to this year’s record measles outbreak. Of the first 288 reported cases in 2014, 89 percent were unimmunized and the majority was exempted for personal belief reasons.
As of Monday that number had climbed to 514, McDonald said. Seventy percent of the total reported cases come from an Amish community in Ohio.
According to the Times article, Ohio granted more than three times as many religious and personal belief exemptions to kindergarteners last year as it did in 2000.
A theory called “herd immunity” suggests that outbreaks can be contained if a certain percentage of people are immunized.
But that protection is limited based on the disease, McDonald said.
For that theory to kick in for whooping cough and measles, immunization rates are estimated to be in the 94 to 96 percent range.
Proponents of exemptions argue it's parents' constitutional right to refuse vaccinating their kids.
Barbara Loe Fisher, cofounder and president of the pro-vaccination exemption nonprofit National Vaccine Information Center, argued for more “informed consent” in vaccination practices.
“Every vaccine has a side effect, and some can be greater than others,” she said. “We’re not all the same biologically, and we don’t live in the same environments.”
The NVIC has historically advocated for more flexible medical and religious exemptions, and supports “voluntary and informed risk-taking,” Fisher said.
One of the plaintiffs in the New York lawsuit, Dina Check, said the state unrightfully denied her religious exemption after it rejected her medical exemption. A school nurse submitted the medical exemption request without her consent, she claims in her suit.
The other two families challenging New York’s immunization policy believe their First Amendment right to freedom of religion and their 14th Amendment right to equal protection under the law were violated. The Times reports their kids were told to stay home when their classmates had chickenpox.
Philosophical exemptions aren’t allowed in New York, but they are in several states, including the Patch areas of Maine, Michigan and Washington. Some parents file those types of exemptions because they fear vaccinations are linked to autism, a suspicion that no study has proven.
Every state except for Mississippi and West Virginia permit a religious exemption, according to the National Conference of State Legislatures.
Kathryn Edwards, a professor of pediatrics at Vanderbilt University and a member of the American Association of Pediatrics’ committee on infectious diseases, said the correlation between immunization exemptions and infection rates is simple.
“In those states where there is greater flexibility in exemptions, there are higher rates of children exempting, and there are lower immunization rates and more disease.”