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A Public Health and Personal Freedom Balancing Act

posted on Wed, Jan 11 2012 8:47 am by Andy Baker-White

Philosophical Vaccination Exemptions

A number of states now permit philosophical or personal belief exemptions for childhood vaccinations. While medical and religious exceptions are common practice across the country, philosophical belief exemptions have only recently begun gaining legal traction. All states allow medical exemptions for individuals who, with documentation from a physician, can show they are immune-compromised or may be harmed by the vaccine, while every state except Mississippi and West Virginia permit religious exemptions. 

In 2002, James Hodge, Jr., director for the Network—Western Region, and Lawrence Gostin, director for the O’Neill Institute for National and Global Health Law, examined the historical, social and legal perspectives of school vaccination requirements. At that time fifteen states allowed philosophical exemptions. Currently 20 states provide personal belief exemptions and that number may grow. With House Bill 2094 Kansas may soon become the 21st state to expand vaccines exemptions beyond medical and religious grounds. 

The growth of philosophical exemptions has created controversy within and outside of the field of public health. In their June 2011 newsletter, Kansans for Vaccine Rights argued for the proposed personal belief exemption stating that “disease prevention . . . is an individual responsibility” and that vaccinations “are neither 100% safe nor 100% effective.” In a testimony presented to the Kansas Health and Human Services Committee, Nancy Tausz, Communicable Disease Division Director for the Johnson County Health Department, countered that “enforcement of vaccine mandates results in a decreased number of hospitalizations and deaths” and pointed out that “states allowing personal belief exemption have a higher rate of vaccine preventable disease compared with states without such exemptions.” 

A 2006 review of Arkansas’ philosophical exemption in the American Journal of Preventive Medicine found that the number of granted exemptions increased from 529 to 1145 over a four-year period.  During that same period the percentage of exemptions that were nonmedical exemptions (i.e., religious and philosophical) rose from 79% to 95%. Another 2006 study in the Journal of the American Medical Association concluded that personal belief exemptions and easily granted exemptions are associated with an increased incidence of pertussis (i.e., whooping cough).

How easy are we willing to make it for an individual to obtain a vaccine exemption thereby risking the spread of preventable disease? Those seeking religious exemption must show they are part of a recognized religion and that the vaccination is against religious belief and practice. Under the proposed Kansas legislation a written statement signed by a parent or guardian declining the vaccination for reasons of conscience or personal beliefs is all that is required to obtain the exemption. The tension between mandating and exempting vaccinations is characteristic of public health law in the United States. How do we balance the prevention of disease with the preservation of personal freedom? Unfortunately this question is not easily answered and something public health practitioners, policy-makers and their attorneys deal with everyday.

This information was developed by Andy Baker-White, associate director for the Network for Public Health Law – Mid-States Region at the University of Michigan School of Public Health.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state

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