Opinion | Public schools should only permit vaccine exemptions for medical reasons

New York City Mayor Bill De Blasio declared a public health emergency on April 8 in relation to the recent measles outbreak in certain areas of the city. Residents of certain Brooklyn neighborhoods are required to be vaccinated against measles immediately. Failure to follow the mandated orders could result in a $1,000 fine.

New York confirmed an additional 60 cases this past week, making the city responsible for about 285 cases of measles since October 2018. Nationally, there have been 465 cases reported as of April 4. Measles often causes ear infections that can result in permanent hearing loss, as well as diarrhea that causes the infected person to become severely dehydrated. About 5% of people who contract measles develop pneumonia, which can be deadly, particularly for young children. In the most severe cases, the brain swells, resulting in intellectual disability, convulsions and even death.

Since measles is one of the most contagious diseases, the current outbreak makes public schools especially dangerous for children who cannot be vaccinated due to other medical reasons. For the safety of all children, public schools should limit their vaccine exemptions to medical conditions only.

The measles vaccine was licensed for medical use in 1971 and in most states became mandatory by the 1980s for children entering public school. But the law hasn’t stopped parents from finding ways around vaccinations. Typically public schools will consider exemption for two main reasons — medical recommendation or religious beliefs. Seventeen states offer the option of exemption due to philosophical or personal belief, too.  

Children with certain medical conditions cannot be vaccinated, even if they have parents who believe in vaccination. For instance, the measles, mumps and rubella (MMR) vaccine cannot be administered to children who test HIV positive. Children who are going through medical treatments that severely inhibit the function of the immune system, such as chemotherapy, cannot be vaccinated either. Additionally, children who have medical conditions that cause them to bruise or bleed easily, or have siblings with a history of immune system problems, are strongly encouraged to forgo vaccination, according to the Center for Disease Control.

These children must depend on those around them to obtain vaccination in order to prevent the disease from spreading. This is called herd immunity, and though it isn’t an ideal alternative to vaccination, for families who have children who are too sick to get a vaccine, it’s the best and only way to keep their child from developing another illness.

For those who are too sick to be protected against diseases like the measles, almost every other community member has to be vaccinated. According to the Vaccine Knowledge Project, every 19 in 20 people must be vaccinated for Herd Immunity to be effective. But in the United States, only 91.1% of the population is vaccinated against measles — not enough for herd immunity.

It isn’t difficult to find a way around the vaccination requirements, even in states that do not accept philosophical or personal exemption requests. Only a few states vigorously examine religious exemption requests before granting them, meaning some parents abuse the religious exemption to bypass the vaccination requirements.

While most states don’t allow philosophical arguments to be cited in a request for religious exemption, it is impossible to know what exactly people cite, and if they actually believe it, when they apply. According to the Pew Research Center, most states, like Connecticut, do not require detailed reasoning or documentation for requesting religious exemption.

Following the Disneyland measles outbreak in late 2014, California passed legislation that would only allow medical vaccine exemptions in public schools in order to curb the rate of unvaccinated children. It became the third state, behind Mississippi and West Virginia, to no longer consider religious exemptions for vaccine laws.

Laws are never perfect, but the California Department of Public Health found that the law’s efforts were effective in raising the vaccination rate. In the 2016-17 school year, vaccination rates for children entering kindergarten rose from 92.8% to 95.6%. In theory, the rate is now high enough to protect children who cannot be vaccinated.

That same year, Mississippi’s rate of the MMR vaccine was 99.4% — the highest in the country, according to the Center for Disease Control. West Virginia, another state that only accepts medical exemption, had an MMR vaccination rate of 95.9%, another one of the highest rates in the country.

New York state is currently in the process of attempting to eliminate religious exemption. Legislators introduced the bill on April 4.

“The goal here is to push legislation to remove all non-medical exemptions for vaccination for children to go to school in New York state,” state Senator David Carlucci said about the proposed legislation. “We’ve seen the spread of measles really spread like wildfire in communities where the vaccination rates are not high.”

This legislation is a much needed step forward, considering that very few religions even condemn vaccination outright. Though vaccines can sometimes contain pork-derived products, people of the Muslim faith who don’t consume pork products have not opposed vaccination for the most part, seeing it as necessary. Islamic leaders signed the Dakar Declaration on Vaccination in 2017, explaining the necessity of vaccination. The Catholic Church has also expressed support for vaccination, despite controversy surrounding the use of descendent cells from aborted fetuses.

“The reason [for supporting vaccination] is that the risk to public health, if one chooses not to vaccinate, outweighs the legitimate concern about the origins of the vaccine,” the National Catholic Bioethics Center writes on their website. “This is especially important for parents, who have a moral obligation to protect the life and health of their children and those around them.”

States need to protect children who are too sick to be vaccinated and those who complied with the laws and obtained vaccines. The best way to do this is by eliminating religious exemptions.

If parents truly are against vaccines due to their religious beliefs, they have the option to homeschool or send their child to a private school that is equipped to review and cooperate with religious exemptions. They have the right to refuse vaccinations, but they do not have the right to put others’ children in danger of life-threatening diseases.

Leah primarily writes about social issues and sustainability for The Pitt News. Write to Leah at LEM140@pitt.edu.