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By Barbara Loe Fisher, National Vaccine Information Center

It is important for you to know the legal requirements of the vaccination laws in your state and to understand the difference between a legal requirement and a recommendation. While vaccine policymakers in the American Academy of Pediatrics (AAP) and the Centers for Disease Control (CDC) recommend that the MMR shot be given to all children, your state may legally require only measles and rubella vaccines. In this case, you have the legal option to vaccinate with only measles and rubella vaccines and not with mumps vaccine.

You also have the option in most states to be exempted from vaccination or re-vaccination if you can show proof of existing immunity. You can go to a private laboratory for a blood test to determine if there are enough antibodies to prove existing immunity to a disease such as measles or whooping cough. A blood test that measures antibody levels can cost $55 or more, depending on the disease.

When making an informed vaccination decision, it is important to consider whether one or more of the following factors will affect the safety and effectiveness of a particular vaccine or combination of vaccines your child will receive:

  • Child's age
  • State of health at the time of vaccination
  • Number and types of vaccines to be given simultaneously
  • Past history of acute vaccine reactions or serious health problems following vaccination
  • Family history of vaccine reactions, severe allergies or autoimmune or neurological disorders

Legal Exemptions to Vaccination
Medical, philosophical or personal belief exemptions are worded differently in each state. To use an exemption for your child, you must know specifically what the law says in your state.

Philosophical Exemption
The following 18 states allow exemption to vaccination based on philosophical, personal or conscientiously held beliefs: Arizona, Arkansas, California, Colorado, Idaho, Louisiana, Maine, Michigan, Minnesota, New Mexico, North Dakota, Ohio, Oklahoma, Texas, Utah, Vermont, Washington and Wisconsin.

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. Many state legislators are being urged by federal health officials and medical organizations to revoke this exemption to vaccination. If you are objecting to vaccination based on philosophical or personal conviction, keep an eye on your state legislature as public health officials may seek to amend state laws to eliminate this exemption.

Religious Exemption
All states allow a religious exemption to vaccination except Mississippi and West Virginia. The religious exemption is intended for people who hold a sincere religious belief opposing vaccination to the extent that if the state forced vaccination, it would be an infringement on their right to exercise their religious beliefs. Some state laws define religious exemptions broadly to include personal religious beliefs, similar to personal philosophical beliefs. Other states require an individual who claims a religious exemption to be a member of The First Church of Christ, Scientist (Christian Science) or another bonafide religion whose written tenets include prohibition of invasive medical procedures such as vaccination. (This kind of language has been ruled unconstitutional when it has been challenged in state Supreme Courts.) Some laws require 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 waiver. Prior to registering your child for school, you must check your state law to verify what proof may be needed.

Due to differences in state laws, the National Vaccine Information Center does not recommend or provide a prewritten waiver for religious exemption because it may not conform with what is required in your state, and may actually draw attention to your child, and you may be singled out and challenged.

If you are challenged, you could end up in litigation brought by your state or county health department to prove your religious beliefs. The religious exemption is granted based on the First Amendment of the Constitution, which is the right to freely exercise your religion. Because citizens are protected under the First Amendment of the United States, a state must have a "compelling State interest" before this right can be taken away. One "compelling State interest" is the spread of communicable diseases. In state court cases which have set precedent on this issue, the freedom to act according to your own religious belief is subject to reasonable regulation with the justification that it must not threaten the welfare of society as a whole.

However, parents have successfully obtained religious exemptions to vaccination. 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, you must be prepared to defend it. It is always best to define your personal religious beliefs opposing vaccination in your own words when you write a letter defending them. If you do belong to a church and take the time to educate the head of your local church about the sincerity of your personal religious beliefs regarding vaccination, obtaining a letter from your pastor, priest, rabbi or other spiritual counselor affirming the sincerity of your religious beliefs may also be advisable.

Medical Exemptions
All 50 states allow medical exemption to vaccination. Proof of medical exemption must take the form of a signed statement by a Medical Doctor (M.D.) or Doctor of Osteopathy (D.O.) that the administering of one or more vaccines would be detrimental to the health of an individual. Most doctors follow the AAP and CDC guidelines. Most states do not allow Doctors of Chiropractic (D.C.) to write medical exemptions to vaccination.

Some states will accept a private physician's written exemption without question. Other states allow the state health department to review the doctor's exemption and revoke it if health department officials don't think the exemption is justified.

Proof of Immunity
Some states will allow exemptions to vaccination for certain diseases if proof of immunity can be shown to exist. Immunity can be proven if you or your child have had the natural disease or have been vaccinated. You have to check your state laws to determine which vaccines in your state can be exempted if proof of immunity is demonstrated.

Private medical laboratories can take blood (a titer test) and analyze it to measure the level of antibodies, for example, to measles or pertussis that are present in the blood. If the antibody level is high enough, according to accepted standards, you have obtained proof of immunity and may be able to use this for an exemption to vaccination. BLF

Copyright 2009 National Vaccine Information Center. All Rights Reserved.
407-H Church Street, Vienna, Virginia 22180



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