With COVID-19 vaccine mandates proliferating across the country in the public and private sectors as well as some school districts, the pushback from those unwilling or hesitant to get their shots is heating up.
The vaccination effort has raised new questions about exemptions because mandates for adults are generally rare outside of settings like healthcare facilities and the military, and the inoculations are relatively new.
While there is no overall data yet on exemptions for COVID-19 vaccines, a number of companies and state governments have seen interest in religious exemptions — a protection stemming from the Civil Rights Act of 1964.
This leaves employers in the difficult and legally precarious position of determining whether the requests are valid. As such, some states have tried to do away with non-medical exemptions overall for their employees.
In school settings, where vaccines have long been recognized as crucial to preventing communicable diseases, state-level mandates are common and have been tested in the courts.
“One of the most important public health practices we have to alleviate outbreaks and things like measles and whooping cough are vaccines required for school or for daycare entry,” Dr. Joshua Williams, an assistant professor of pediatrics at the University of Colorado School of Medicine, told ABC News.
In addition to California announcing that it is adopting a state-wide mandate, individual education boards in cities like Los Angeles have started adding the Pfizer vaccine, which was granted full FDA approval in September and is currently the only vaccine approved for children older than 12, to their list of immunization requirements.
Experts say other school districts are likely to follow suit and have strong legal ground to enforce the requirement set forth in the 1944 Supreme Court case Prince v. Massachusetts.
Here’s what to know about the debate over non-medical exemptions:
On the rise in schools
Data from the Centers for Disease Control and Prevention (CDC) shows that while requests for medical exemptions in schools remain low and fairly constant (around 0.3%), non-medical exemptions (including religious and personal belief exemptions) have risen from 1.4% in the 2011-’12 school year to 2.2% in the 2019-’20 school year (a 57% increase).
In Idaho, for instance, in the 2019-’20 school year, 7.2% of kindergarteners had non-medical exemptions, according to the CDC data. That contrasts with around 1% for states like Massachusetts, Louisiana and Alabama.
Ellen Wright Clayton, a professor of pediatrics, law and health policy at the Vanderbilt University Law School, believes that schools should take a stand against religious exemptions in the interest of protecting public health.
“The fact of the matter is, parents are not entitled, for any reason, to expose other people’s children or other people to [COVID-19] for religious reasons,” Clayton said.
Forty-four states and the District of Columbia currently offer religious exemptions to vaccines, of which 15 offer broader personal belief exemptions for personal, moral or spiritual ideologies. The remaining six states — California, Connecticut, Maine, Mississippi, New York and West Virginia — only offer medical exemptions.
Williams, from the University of Colorado, noted that despite a decrease in religiosity among Americans, there has been an increase in religious exemption requests for vaccination, implying that these exemptions are “no longer serving their original purpose.”
It has increased even as some religious leaders, including Pope Francis and Rabbi Chaim Kanievsky, a leading authority in Israel’s ultra-Orthodox Jewish community, have made clear that vaccines are necessary for the common good and take precedence over religious beliefs.
In his research, Williams also investigated the influence of the availability of personal belief exemptions in states on the rate of religious exemptions for childhood vaccinations. In 2016, Vermont eliminated its personal belief exemption policy which was followed by an increase in religious exemption applications from 0.5% to 3.7%.
This suggests that “perhaps people were increasingly using that religious exemption category, even though they might not necessarily have a religious objection to vaccines,” Williams said.
“One thing that people have done previously has shown that the harder it is to obtain an exemption, the lower the rate of exemptions becomes,” he added.
Unlike personal belief exemptions, which are relatively broad, religious exemptions have to be integrated into a holistic belief system, said Dorit Reiss, a professor of law at UC Hastings College of the Law.
“You can’t just grab onto a biblical verse when it’s convenient,” Reiss, who has written about the legality of vaccine mandates in law journals, said.
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