Immunizations and Exemptions

You asked for information on state laws exempting children from immunization requirements for medical, religious, and philosophical reasons. You are interested in any available information concerning the number of individuals taking such exemptions, including any trends.

Although exemptions vary from state to state, all school immunization laws grant exemptions to children for medical reasons, according to the National Conference of State Legislatures (NCSL). Every state, except Mississippi and West Virginia, exempts individuals who have religious beliefs against immunization. Such exemptions are intended for those whose religious beliefs would be infringed if the state forced them to have their children vaccinated.

With the recent passage of laws in Texas and Arkansas, 20 states now allow exemption to vaccinations based on philosophical, personal, or conscientiously held beliefs. In many of these states, individuals must object to all vaccines, not just a particular vaccine in order to use the philosophical or personal belief exemption.

STATES WITH RELIGIOUS AND PHILOSOPHICAL EXEMPTIONS FROM CHILDHOOD IMMUNIZATION REQUIREMENTS

Every state, except Mississippi and West Virginia, grant religious exemptions to individuals for religious beliefs. A “religious exemption” generally means that a provision in state statute allows parents to exempt their children from immunization if it contradicts their sincere religious beliefs. Twenty states now provide a philosophical exemption in their law, with Texas and Arkansas the most recent additions to this list with passage of legislation in 2003. A “philosophical exemption” suggests that the statutory language does not restrict the exemption to purely religious or spiritual beliefs, but for example, allows it based on “moral, philosophical or other personal beliefs” (Maine) or in some cases, based simply on the individual’s (parents’) beliefs (California).

Table 1: States with Religious and Philosophical Exemptions from Childhood Immunization Requirements

Source: NCSL State Legislative Report, August 2002, updated 2004; chart taken from “School Vaccination Requirements, Legal and Social Perspectives,” James G. Hodge, Jr.

In California, a parent must submit a letter or affidavit to the governing authority stating that the immunization is contrary to his or her beliefs (Calif. Health and Safety Code, § 120365). “Governing authority” refers to the governing board of each school district or the authority of each public or private institution responsible for the operation and control of the institution. But under state law, whenever there is good cause to believe that the person has been exposed to a communicable disease, that person may be temporarily excluded from the institution until the local health officer is satisfied that the person is no longer at risk of developing the disease.

Under Maine law, in order to claim a religious or philosophical exemption the parent must “state in writing a sincere religious belief which is contrary to the immunization requirement… or an opposition to the immunization for philosophical reasons” (Maine Revised Statutes, § 6359).

A child is exempt from Michigan’s immunization requirements “if a parent, guardian, or person in loco parentis of the child presents a written statement to the administrator of the child’s school or operator of the group program to the effect that the requirements of this part cannot be met because of religious convictions or other objection to immunization” (Michigan Code, § 333.9215).

A child is exempt from vaccinations in Minnesota if a notarized statement signed by the minor child’s parent is submitted to the person supervising the school or child care facility stating “that the person has not been immunized as prescribed…because of the conscientiously held beliefs of the parent or guardian of the minor child ….(Minn. Stats. § 121A.15).

A new Texas law took effect September 1, 2003 that allows an exemption to immunization requirements for reasons of conscience, including religious beliefs (HB 2292). School officials may grant such exemptions provided the parent or guardian submits an official Texas Department of Health affidavit to the school.

A person can be exempt from Vermont’s immunization requirements “if the person, or in the case of a minor the person’s parent or guardian states in writing that the person, parent or guardian has religious beliefs or moral convictions opposed to immunization” (Vermont stats. § 1122).

Under Wisconsin law, the immunization requirement is waived “if the student, if an adult, or the student’s parent, guardian or legal custodian submits a written statement to the school, day care center, or nursery school objecting to the immunization for reasons of health, religion or personal conviction. At the time any school, day care center, or nursery school notifies a student, parent, guardian or legal custodian of the immunization requirements, it shall inform the person in writing of the person’s right to a waiver” (Wisc. Stat. § 252.94).

According to the federal Centers for Disease Control (CDC), almost 38,000 children were exempted from receiving the usual round of childhood immunizations in the most recently reported year (see Mitchell, “Parents Opting Out of Vaccines for Kids, UPI, November 13, 2003). Nearly half of that total was exempted for religious reasons. States experiencing a dramatic increase in exemptions include Colorado, Oregon, Washington, and Michigan (Oregon is the only one of these four without a philosophical exemption but it does have a religious exemption). Colorado, which has the lowest vaccination coverage rate in the country, has seen a significant increase in exemption rates, from 0.3% of kindergartners to 3% over a 10-year period. Michigan’s exemption rate is almost 6%, or more than 7,500 kindergarten-aged children. Washington’s exemption rate has increased from 3.4% of kindergarten-aged children five years ago to a current level of 4.1% (about 2,400 children).

Oregon’s number of exemptions has doubled since 1999, with the bulk of this due to an increase in religious exemptions. In particular, Ashland, a small city in Jackson County, Oregon, has a high rate of religious exemptions. In school year 2000-2001, 11% of school children in Ashland had a religious exemption to vaccination, compared to 3% for all of Jackson County and 2.7% for the state.

According to the article cited above, exemption rates range from 1% to 2.8% for several other states, including Arizona, California, Idaho, Indiana, Maine, Minnesota, Montana, Pennsylvania, Rhode Island, Utah, Vermont, and Wyoming.


February 25, 2004		2004-R-0263
EXEMPTIONS FROM CHILDHOOD IMMUNIZATION REQUIREMENTS

By: John Kasprak, Senior Attorney

*State*	*Religious* *Exemptions*	*Philosophical* *Exemptions*
Alabama	Yes	No
Alaska	Yes	No
Arizona	Yes	Yes
Arkansas	Yes	Yes
California	Yes	Yes
Colorado	Yes	Yes
Connecticut	Yes	No
Delaware	Yes	No
Florida	Yes	No
Georgia	Yes	No
Hawaii	Yes	No
Idaho	Yes	Yes
Illinois	Yes	No
Indiana	Yes	No
Iowa	Yes	No
Kansas	Yes	No
Kentucky	Yes	No
Louisiana	Yes	Yes
Maine	Yes	Yes
Maryland	Yes	No
Massachusetts	Yes	No
Michigan	Yes	Yes
Minnesota	Yes	Yes
Mississippi	No	No
Missouri	Yes	Yes
Montana	Yes	No
Nebraska	Yes	Yes
Nevada	Yes	No
New Hampshire	Yes	No
New Jersey	Yes	No
New Mexico	Yes	Yes
New York	Yes	No
North Carolina	Yes	No
North Dakota	Yes	Yes
Ohio	Yes	Yes
Oklahoma	Yes	Yes
Oregon	Yes	No
Pennsylvania	Yes	No
Rhode Island	Yes	No
South Carolina	Yes	No
South Dakota	Yes	No
Tennessee	Yes	No
Texas	Yes	Yes
Utah	Yes	Yes
Vermont	Yes	Yes
Virginia	Yes	No
Washington	Yes	Yes
West Virginia	No	No
Wisconsin	Yes	Yes
Wyoming	Yes	No
District of Columbia	Yes	No