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FEDERAL VACCINE RECOMMENDATIONS VS. STATE VACCINE LAWS
There is a difference between federal vaccine policies and state vaccine laws. Federal public health officials at the Centers for Disease Control (CDC) make national vaccine policy recommendations for children and adults. With the approval of state legislatures, public health officials in state health departments make and enforce vaccine mandates. That is why vaccine laws and legal exemptions to vaccination vary from state to state.
The first vaccine mandated in the U.S. was smallpox vaccine. By 1922, some states had passed laws requiring that children show proof they were vaccinated for smallpox in order to attend school. By the early 1980’s, the CDC recommended and most states mandated that children get 23 doses of seven vaccines (polio, diphtheria, tetanus, pertussis, measles, mumps, rubella) to attend kindergarten.
By 2014, the CDC recommended that children get 69 doses of 16 vaccines between day of birth and age 18. Most states mandate that children get 29 doses of nine vaccines to attend kindergarten with children enrolled in daycare in many states required to get multiple doses of 13 vaccines.
LEGAL EXEMPTIONS TO VACCINATION
Medical, religious, philosophical, conscientious or personal belief exemptions are worded differently in each state. To file and receive a vaccine exemption for your child to attend school, you must follow the regulations outlined in your state’s vaccine law. In 2014, all 50 states allowed a medical vaccine exemption; 48 states allowed a religious vaccine exemption and 17 states allowed a philosophical, conscientious or personal belief exemption.
All 50 states allow medical exemption to vaccination. In most states, a medical exemption must be written by a medical doctor (M.D.) or doctor of osteopathy (D.O.) but some states allow other state-designated health care workers to certify that the administration of one or more state mandated vaccines would be detrimental to the health of an individual. [Most states do not allow a doctor of chiropractic to write medical vaccine exemptions.]
Medical Exemptions Difficult to Get
- A medical exemption to vaccination is very difficult to obtain because almost all medical reasons for delaying or withholding vaccines have been eliminated by government and medical trade officials. Most doctors and health care workers follow federal guidelines published by the Centers for Disease Control (CDC) outlining what is and is not considered a medical contraindication to vaccination. Some states will accept a doctor’s written medical vaccine exemption without question. Other states allow state public health officials to review the medical exemption written by a medical doctor or other state designated health care worker and revoke it if health department officials don't think the exemption is justified because it does not conform to federal (CDC) vaccine contraindication guidelines.
All states allow a religious exemption to vaccination except Mississippi and West Virginia.
The religious exemption is granted based on the U.S. Constitution First Amendment right to freely hold and exercise religious beliefs. A state must have a "compelling State interest" before this right can be taken away. Limiting the spread of serious communicable diseases has been defined as a "compelling State interest" in court cases after the 1905 U.S. Supreme Court decision Jacobsen v. Massachusetts affirmed the right of states to mandate smallpox vaccine. In a number of state court cases setting precedent on the issue of vaccine mandates, the freedom to act according to one’s religious beliefs is subject to reasonable regulation if exercise of personal religious beliefs substantially threatens the welfare of society as a whole.
Religious Beliefs Must Be Sincerely Held
- The religious vaccine exemption is intended for people who hold a sincere religious or spiritual beliefs opposing vaccination to the extent that if the state forced vaccination, it would be an infringement on their right to exercise their beliefs. Some state laws define religious exemptions broadly to include personal religious or spiritual beliefs. Other states require an individual, who claims a religious exemption to be a member of a church with a written tenet prohibiting vaccination or other invasive medical procedures.
Whenever there has been a legal challenge to state vaccine laws with very restrictive language requiring an individual to belong to an organized religion or state recognized church with tenets opposing vaccination, the state’s vaccine law has been ruled unconstitutional. Americans have the right to hold sincere spiritual beliefs that are not part of an organized religion or state recognized church.
Some state vaccine laws have required a signed affidavit from the pastor or spiritual advisor of the parent exercising religious exemption that affirms the parents' sincere religious belief about vaccination, while others allow the parent to sign a notarized statement attesting to sincere religious beliefs about vaccination. Prior to registering your child for school, you should check your state law to verify what proof is needed if you intend to file an exemption for sincerely held religious or spiritual beliefs.
Religious or Spiritual Beliefs Are Personal
- Due to differences in state laws and the personal nature of a religious or spiritual belief, the National Vaccine Information Center does not recommend or provide a prewritten statement to use an example for filing a religious exemption. Each person filing an exemption for religious or spiritually held beliefs should be able to articulate in writing and verbally the reasons for why the belief is religious or spiritual, rather than secular, in nature and be able to defend those beliefs in a court of law if challenged by government officials.
The constitutional right to have and exercise personal religious beliefs, whether you are of the Christian, Jewish, Muslim or other faith, can be defended. If you exercise your right to religious exemption to vaccination on behalf of your child, you must be prepared to defend it, which is why you should explain your religious or spiritual beliefs in your own words.
If you do belong to a church, you may want to take the time to educate the head of your local church about the sincerity of your personal religious beliefs regarding vaccination. You may be able to obtain a letter from your pastor, priest, rabbi or other spiritual counselor affirming the sincerity of your religious beliefs and file it along with the statement you write outlining your religious or spiritual beliefs about vaccination.
PHILOSOPHICAL, CONSCIENTIOUS OR PERSONAL BELIEF EXEMPTION
The following 17 states allow an exemption to vaccination based on philosophical, personal or conscientiously held beliefs:
- North Dakota
In order to be allowed to exercise the philosophical, conscientious or personal belief exemption in some states, parents or children old enough to give consent (usually age 12 or older) must object to all vaccines and not just one vaccine. In Washington, Oregon and California, parents seeking a personal belief exemption must first obtain a signature from a medical doctor or other state-designated health care worker in order to file the exemption or may be required to complete a state vaccine education program (Oregon).
Since 2011, there have been efforts by lobbyists associated with the pharmaceutical, medical trade and public health industries to eliminate or severely restrict non-medical exemptions in state vaccine laws. If you want to have the legal right to file and receive a non-medical exemption to vaccination, be sure to sign up for the free online NVIC Advocacy Portal
so you can keep an eye on vaccine legislation moving in your state that may eliminate (or add) exemptions.
PROOF OF IMMUNITY
You also have the option in some states to be exempted from vaccination or re-vaccination if you can show proof of existing immunity for certain diseases. If a person has recovered from the natural disease or has been vaccinated, a blood titer test may indicate there are enough naturally acquired or vaccine acquired antibodies to “prove” immunity to a particular disease.
Check vaccine laws in your state to find out if a blood titer test can be used to prove immunity so one or more vaccines may be exempted. Private medical laboratories can perform the blood titer test and measure the level of antibodies and provide you with a report that you can submit with the request for an exemption if the antibody titers are high enough according to accepted standards. A blood titer test that measures antibody levels can cost $55 or more, depending on the disease.
MAKING A WELL INFORMED VACCINE DECISION
Before making a vaccination decision, it is important to first ask yourself eight questions. NVIC’s “If You Vaccinate, Ask Eight” brochure will help you think about how to evaluate factors that may place you or your child at risk for suffering a vaccine reaction. Several factors to consider are:
It is important to review the risks and complications of infectious diseases and vaccines, including reading the vaccine manufacturer product insert before making a vaccine decision. See NVIC’s Diseases and Vaccines pages to learn more.
- State of health at the time of vaccination
- Number and types of vaccines that will be given simultaneously
- Past history of acute vaccine reactions or serious health problems following vaccination
- Family history of vaccine reactions, severe allergies, autoimmune or neurological disorders
Reforming Vaccine Policy & Law: A Guide is an illustrated 55-page guide published in 2014 by NVIC that gives an overview of why vaccine safety and informed consent protections should be secured in all U.S. vaccine policies and laws. This unique information and vaccine choice advocacy resource helps you educate your friends, family, legislators and community leaders about vaccine science, policy, law and the importance of protecting informed consent rights in America. Download your copy today!