According to the National Conference on State Legislatures, all 50 states mandate that students get certain vaccinations against infectious diseases, many aligning their requirements with the CDC’s Advisory Committee on Immunization Practices (ACIP), and all allow exemptions for medical reasons. Currently, 45 states and Washington D.C. grant religious exemptions, which, because there are constitutional issues with a state’s inquiring into the bona fides of religious exemption claims, have become de facto “philosophical” exemptions. Fifteen states allow “philosophical” exemptions outright.
Each year, there are competing bills introduced in the state legislatures attempting to either constrict or expand school immunization requirements, including exemptions. This year is no exception. As well, public health initiatives aimed at the COVID-19 pandemic, and the appearance of vaccines to abate it, have energized the anti-vaccine and “health freedom” crowd. They’ve managed to woo sympathetic legislators into introducing bills targeting COVID-19 mitigation measures like testing, vaccination, and mask-wearing.
This week we’ll take a look at legislation affecting school vaccination requirements. In my next post, we’ll review COVID-related bills. (There is some overlap.)
First, some housekeeping. Different states have different abbreviations for legislation: House Bill 123 could be H123, HB123 or, in a state that calls one of its chambers the Assembly, A123, and all of these could be with or without a space between the letters and numbers. There’s also LD (Legislative Document) 123, LB (Legislative Bill) 123, and HF (House File) 123, among others. Some states give pre-filed bills one designation and the filed bills another. To simply things (for me), I’m going to use whatever combination of letters and numbers the particular state uses with a link to the legislature’s website, where you can find all the details.
We’ll start in Arizona. While most anti-vaccine legislation tries to put lipstick on the proverbial pig by creating exemptions so broad that they swallow the rule, an Arizona bill dispenses with the cosmetics. HB 2065 makes all school vaccinations merely recommended for attendance, not required. An unvaccinated child could not be excluded from class unless there is an active case of a disease at his or her school and the health department has declared an outbreak in the school’s area.
Oklahoma SB 350 also prohibits public and private schools from requiring any immunizations for minor children attending school. SB 477 would prevent public and private universities and other institutions of higher education from requiring student immunization against meningococcal disease, hepatitis B, measles, mumps, and rubella. Apparently, current law allowing anyone to opt out of the meningococcal disease vaccine for any reason and medical, religious and “moral” opt-outs for hepatitis B and MMR were not sufficiently subservient to “health freedom”.
To ensure that Oklahoma health officials’ hands are completely tied in all situations, higher ed school students cannot be required to undergo any vaccination, use any medical device, or undergo any medical procedure, surgical procedure, or physical examination, all of which I suspect is aimed at the COVID-19 pandemic and future public health emergencies. Not only that, but in a provision that almost certainly violates the First Amendment’s free speech guarantees and is void for vagueness to boot, the bill allows criminal misdemeanor prosecution of any employee of a higher ed institution who coerces or in any way influences a student to get vaccinated.
Likewise, Maine’s LD 156 makes vaccination completely voluntary for students, but only those attending a virtual public school or a private school.
Other state legislators are using the more traditional approach of expanding exemptions, or making them easier to get, including one bill allowing an exemption for any reason, which essentially makes immunization optional. Some bills also narrow the diseases for which vaccination may be required.
The Missouri legislature has several of these bills pending. HB 37 would add a conscientious belief exemption to the existing religious exemption at all levels of education, pre-school to post-high school. HB 566 would go even further, allowing exemptions for any reason. (HB 566 would also require the mother’s consent to inoculation of her newborn with the hepatitis B vaccine and hepatitis B immune globulin (HBIG) per ACIP guidelines when the mother tests positive for hepatitis or her status is unknown. Immunization of newborns under those circumstances are automatic under current law.)
The state would be prevented from enacting any requirement for obtaining a non-medical exemption beyond signing a form, such as watching a video or visiting the health department, and it would be required to develop an informational brochure on obtaining exemptions and make sure it is widely distributed, as well as to make exemption forms easily available.
Missouri HB 37 also freezes the diseases against which vaccination can be required to poliomyelitis, rubella, rubeola, mumps, tetanus, pertussis, diphtheria, and hepatitis B, for elementary and secondary schools, and for day care centers, preschools and nursery schools. (Required vaccinations for the latter group now use the ACIP guidelines.) It limits required immunizations to public schools, day care centers, etc., only, making vaccination requirements for private and parochial schools optional. Higher education students living in on-campus housing would no longer be required to get the meningococcal vaccine unless the housing is publicly owned, thereby eliminating the mandate for private schools and privately-owned housing at public schools. HB 35, introduced by the same sponsor as HB37, prohibits any school, city, or county from requiring additional immunizations.
Finally, failing to vaccinate your child could no longer be considered in neglect and abuse cases in Missouri. To protect the Dr. Bob Sears-type physician, providing medical exemptions, apparently no matter the circumstances, could not be considered by the medical board for any purposes, such as in disciplinary proceedings,
Minnesota already has a “conscientiously held beliefs” exemption to school vaccinations. SF 292 and HF 452 add a “genuinely and sincerely held religious belief” exemption as well, which seems superfluous. Utah HB 233, which passed the House and is now before the Senate, requires medical and “personal or religious belief” exemptions to vaccinations required by universities and other higher ed institutions, except for students “studying in a medical setting”. The bill prohibits all schools from barring any unvaccinated student, at any level of education, from in-person classes, although “nothing restricts a state or local health department from acting . . . to contain the spread of infectious disease.”
Mississippi is one of the few states allowing only medical exemptions to school vaccinations. HB 475, which died in committee, added a religious exemption. South Dakota HB 1097 amends the law allowing an exemption when “the child is an adherent to a religious doctrine whose teachings are opposed to immunization” to refocus the exemption on the parent’s opposition “because of a sincerely held religious or philosophical belief”. Connecticut HB 5578, which has 15 Republican sponsors (almost a third of the Republican House membership), would add moral and philosophical objections to the already-allowed medical and religious exemptions. Indiana HB 1279 creates a religious exemption to required vaccinations for foster home licensure. (It also creates a medical exemption.)
Current law in Massachusetts permits a medical exemption if the physician has personally examined the child and is of the opinion that “the physical condition of the child is such that his health would be endangered by such vaccination or by any of such immunizations”. Massachusetts HD2973 amends that law so that the physician can take into account “concerns regarding an increased risk of adverse events, family history, or exacerbation of pre-existing medical conditions”, whether those are recognized by experts as valid criteria or not.
In what appears to be another attempt to protect the Dr. Sears-type physician, the proposed legislation would prohibit disciplinary action against a physician providing a medical exemption in the “absence of manifest bad faith”, nor could the exemption be used “to change or negatively affect a physician’s rating or standing with any employer, insurer, hospital affiliation or academic affiliation”, thereby making it harder for the medical board and other organizations to discipline a doctor.
In New Jersey, A4659 and S2995 would prohibit any school or government entity from requiring flu vaccinations for anyone age 18 or younger. New York A3250 would prohibit flu vaccine mandates for children (age 6 months – 59 months) in childcare and preschool.
In the pro-vaccination column, state bills seek to eliminate, or put restrictions on, exemptions. Others allow minors to consent to vaccination without parental approval. Some bills try to protect children by having their caregivers vaccinated.
Connecticut SB 568 and HB 6423, as well as Vermont H148, would eliminate religious belief exemptions (the only non-medical exemption allowed) to school vaccination. Nebraska currently allows parents to opt out of childhood vaccinations for children in childcare facilities for any reason. LB 447 would limit exemptions to medical reasons.
New Jersey currently permits medical and religious exemptions, but S903 would beef up the requirements. Medical exemptions must be for a specified time period and based on “valid medical reasons” as determined by the Commissioner of Health’s regulations. Those wanting a religious exemption must sign a notarized statement explaining the nature of the religious tenet implicated by the vaccine and how vaccination would violate it, and provide information showing the religious tenet is consistently held. A “general philosophical or moral objection” is not sufficient. The parent (or student, if old enough) must state that he or she “understands the risks and benefits of vaccination” and that the student may be excluded from school in the event of an outbreak.
A969 and S902 similarly strengthen the standards for medical exemptions, requiring that they be consistent with the ACIP guidelines and subjecting exemptions to review by the local board of health. Interestingly, a medical exemption can be granted based on a sibling’s “vaccine injury” but only if there is “a final determination of vaccine injury” by the federal Vaccine Injury Compensation Program or “a court of competent jurisdiction”. Among other strengthened record-keeping requirements, schools are required to post information on their student immunization rates.
Oregon SB 254 would eliminate religious and philosophical exemptions to school vaccination requirements. Only exemptions based on “an indicated medical diagnosis” would be allowed, subject to review by the boards regulating health care practitioners whose scope of practice includes granting these exemptions, this to ensure they are granted “in compliance with a reasonable interpretation of” ACIP recommendations. Unfortunately, because Oregon licenses naturopaths and gives them a broad scope of practice, “naturopathic physicians” are allowed to write exemptions; thus, the state naturopathic board will be reviewing those exemptions. This could mean a different “reasonable interpretation” than the medical or nursing boards, given naturopathic antipathy to vaccination and fabrication of “alternative” schedules. Fortunately, a legislative committee would review the regulatory boards’ work, perhaps shining some disinfecting light on naturopathic vaccination practices, or at least instilling a fear of getting caught.
New Jersey A5144 allows minors 14 years and older to get school-required vaccinations without parental consent. In New York A3192 and S3041 also allow children 14 and older to get immunizations recommended by the ACIP or approved by the state without parental consent, while A822 and S937 allow minors to get any STD vaccine and be treated for STDs without parental consent. Vermont, as well, has a bill pending (H43) permitting minors 16 and older to consent to immunizations recommended by the CDC. Late last year, the District of Columbia passed a regulation allowing minors 11 years and older to consent to ACIP-recommended vaccinations without parental approval. Several members of Congress, which has the power to reject D.C. legislation, are sponsoring a joint resolution to kill it. All bills allowing minors to get immunized without parental approval require informed consent.
New Jersey A1603 requires an HPV vaccination for all students in grades 6-12. Medical exemptions and exemptions for “bona fide religious tenets or practices of the student or the parent or guardian” are allowed, but the bill makes clear that “a general philosophical or moral objection to the vaccination shall not be sufficient”.
In Texas, companion bills HB591 and SB138 add vaccination against bacterial meningitis to required immunizations for public school students. Current exemptions for medical reasons or “reasons of conscience, including a religious belief” would still apply.
New Jersey A4576 and S2907 require all students (day care to post-high school) to get the flu vaccination, with narrowed medical and religious exemptions similar to those in the New Jersey bills cited above. New York S45 mandates the flu vaccine for children in daycare, citing the high rate of infection in this age group and their well-known lack of attention to good hygiene practices. New York A2240 adds vaccination against the flu to the required list for all children in day care and school as well.
Finally, Mississippi’s HB 433, which died in committee, would have required all school employees to have an annual flu vaccination, with only medical exemptions allowed. The State of Washington has something called “outdoor nature-based child care”, teaching a “nature-based curriculum”, in its educational armamentarium. (This sounds both lovely and a bit like an episode of Portlandia.) SB 5151 would require employees and volunteers working in “outdoor nature-based child care” to have an MMR vaccination.
The anti-vaccination forces are already out there opposing bills to increase immunizations and narrow exemptions, as well as promoting those weakening or eliminating vaccination requirements. The Alliance for Natural Health, an organization protecting your right to be bamboozled by fringe practitioners and their nostrums, has set up (via Convio) a system to contact legislators directly regarding every bill mentioned in this post, complete with canned vaccine misinformation talking points about mercury, VAERS, “overloading” the young immune system, the CDC “whistleblower“, and the like. To wit:
Other experts believe the overloading of a young immune system with so many vaccines at once can cause genetic changes.
Anyone who believes this is certainly no “expert”.
To counteract this disinformation campaign and support immunization in states with legislation pending, contact legislators via your state’s legislative website. Pro-vaccine (that is, accurate) information is available here on SBM. The CDC has a list of reliable vaccination sources you can cite as well.