What State Legislatures Did About Vaccine Exemptions in 2015

March 21, 2016|1:27 p.m.| Scott Briscoe

ASTHO recently completed a summary of bills considered by statehouses in 2015 that dealt with immunization. Not surprisingly after last year’s measles outbreak that started in Disneyland but became national in scope, many of the bills dealt with personal or religious vaccination exemptions.

As a little background, all states have vaccination requirements for children who attend schools, and every state has an exemption if there is a medical reason why a child should not take a vaccine. Many states also created nonmedical exemptions for the rare cases when a person holds religious or personal beliefs against vaccinations. The religious or personal exemptions became a problem when the antivaccine movement gained momentum and pockets of unvaccinated children created significant and unnecessary infectious disease vulnerabilities in some areas. The result: one case of a foreign tourist carrying a highly infectious disease to a crowded area sparks dozens of cases from many different states. For most children who catch it, measles is gross and annoying, but manageable. To others, however, it can be deadly.

Back to 2015 state legislation—at least 35 bills dealing with exemptions were considered in at least 20 states. Rather incredibly, some of them tried to make exemptions easier to obtain, such as Montana House Bill No. 158, which, among other changes to the state’s immunization laws, tried to add a personal exemption to religious and medical exemptions. Fortunately, no bill broadening exemptions made it into law last year.

Most bills were consistent with ASTHO’s Immunization Policy Statement, which says “The adoption of easy-to-attain exemptions for vaccine requirements is inconsistent with good public health policy and contrary to efforts to improve vaccine coverage.”

Of the 35 bills ASTHO tracked, only six became law:

  • California—eliminated personal exemption for school-aged children, but allowed exemption for children who do not attend classrooms, such as children in home schooling or independent study programs.
  • Connecticut—required those seeking religious exemption to get judicial or government official acknowledgement.
  • Delaware—required health department review of medical exemption and required parents of children seeking religious exemption to acknowledge that in the event of an outbreak their children may be barred from attending school.
  • Illinois—required health department to create a standard form to be used for exemptions throughout the state and that the form be signed and notarized; required documentation signed by healthcare provider for all medical exemptions; and required the state to publish exemption rates from schools.
  • Vermont—eliminated the philosophical exemption.
  • West Virginia—granted health commissioner the ability to approve or deny medical exemption requests.

“In addition to eliminating philosophical and religious belief exemptions, there are additional strategies that states often use to improve immunization rates,” notes ASTHO Director, Immunization Kimberly Martin. “For example, working with partners to improve access to immunizations by expanding the number of immunization providers, such as pharmacies, faith-based providers, workplace providers, or community providers; working to communicate effectively about vaccines to the community; or working to improve immunization registries and other systems that can help providers access complete immunization records for their patients or help remind patients when it is time to get their next vaccine.”

Overall, 23 of the 35 bills sought to eliminate or make the exemption process more rigorous (although some only marginally so, such as an attempt in Illinois to change the wording from objecting on religious grounds to objections because the immunization conflicts with the tenets and practices of their religion). Seven bills sought to add or broaden exemptions, and five did neither (most of these were about public reporting of exemption rates by school).

The 2015 State Immunization State Legislative Summary also includes bills related to vaccine information systems, scope of practice for vaccine administration, addition of vaccines to a state’s vaccine regimen, and other vaccine-related legislation.

It is not uncommon for legislation that is not approved in a year to be considered again the following year. You can see what is happening so far in 2016 by accessing ASTHO’s State Health Policy Tracker, powered by CQ Roll Call. Also check out ASTHO's Immunization Resource Guide, designed to help health agencies and organizations increase access to vaccines and vaccination rates.

Scott Briscoe is senior director of communications and marketing for ASTHO.