As measles spread across the nation earlier this year, 71 residents of Vancouver, Washington, fell ill, most of them unvaccinated children.
So state Rep. Paul Harris, a Republican representing the district, sponsored a measure to limit exemptions from immunization.
Activists protesting the bill converged on his legislative office; the resulting chaos led security officers to close the entire floor to the public. A death threat was posted on Facebook.
Only a handful of Harris’ Republican colleagues supported the measure because, they said, it infringed on individual liberties.
“I think there’s a lot of misinformation out there, and people don’t believe in science or think there are more vaccine injuries than are being reported,” he said.
The nation is struggling with the worst measles outbreak in 25 years, with more than 1,000 confirmed cases in 28 states. Medical experts agree that vaccines prevent epidemics, save lives and are very safe, though complications occur in rare cases.
Yet curbing religious and philosophical exemptions to vaccination has proved extraordinarily difficult, pitting neighbors against neighbors and sometimes paralyzing statehouses. So far this year, only two states — Maine and New York — have successfully outlawed all exemptions except those granted for medical reasons.
But even in New York, where 80% of the nation’s measles cases are concentrated, angry parents shouted and heckled from the Assembly gallery after the vote was called. The chairman of the health committee, Richard N. Gottfried, voted against the bill, which barely passed the Assembly, but Gov. Andrew Cuomo, who had expressed reservations, signed it immediately.
The wide majority of Americans support routine childhood immunizations. But a small and impassioned group of parents rejects vaccines for religious reasons or fears about their safety, often drawing support from conservatives wary of what they see as government intrusion into personal life decisions.
Opponents describe tighter laws as an assault on their parental rights and religious freedom. In Washington state, opposition was so fierce that legislators managed only to eliminate exemptions based on personal beliefs, not those based on religion — and only for the measles, mumps and rubella vaccine.
Parents may continue to use religious exemptions to avoid the MMR vaccine and can cite other personal or moral beliefs to avoid other childhood vaccines.
“We would have preferred removing the personal exemption for all vaccines, but we weren’t able to — there was so much political pushback,” said state Rep. Monica Stonier, a Democrat who also represents Vancouver. “We just wanted to get something done.”
All 50 states require certain vaccinations for students attending school, with exceptions made for children who cannot tolerate them because of underlying medical conditions, according to the National Conference of State Legislatures, a bipartisan organization that tracks vaccine legislation in the 50 states.
Most states grant exemptions for people who oppose vaccination for religious reasons, and until recently 16 states allowed exemptions based on personal, moral, philosophical or other beliefs, as well, according to the organization.
But the norm is to vaccinate.
Over 80% of adults agree with experts that childhood vaccines are safe for healthy children, although most parents of young children worry about vaccines’ effects, another survey found. Still, the vast majority vaccinate, and only 2.2% of school-age children had a vaccine exemption in 2017, according to a national survey by the Centers for Disease Control and Prevention, a slight increase from the year before.
Nearly a dozen states have recently proposed getting rid of personal-belief exceptions, but efforts to pass bills have stalled or been derailed in several states. Take Oregon, which has one of the highest rates of vaccine exemptions: 6% of kindergartners were exempt in the 2014-2015 school year. By contrast, fewer than 1% of kindergartners in New York have an exemption. But a legislative push in Oregon for limiting nonmedical exemptions provoked a furious backlash.
“It was pretty bloody,” said state Rep. Mitch Greenlick, a Democrat representing Portland. “I must have gotten a couple thousand emails and phone calls. We stopped answering the phone, basically.”
Protesters “called us Nazis and wore yellow stars of David to show they were being persecuted by Nazis,” he added.
Ultimately, the bill was scuttled when Republicans in the state Senate walked out of the session and could not be coaxed back until both the vaccine bill and a gun control bill were dropped.
A ‘very personal’ decision
California eliminated nonmedical exemptions to vaccines in 2015, after 159 visitors to Disneyland were infected with measles. Now, with 51 residents infected this year, state lawmakers are considering a bill to rein in what critics have called bogus medical exemptions authorized by unscrupulous physicians, although most of those sickened with measles were adults.
If the California bill passes, parents will have a harder time obtaining a medical exemption for their children. Applications for medical exemptions would require approval by the state health department, which must conform to guidelines drawn up by the CDC and the Advisory Committee on Immunization Practices.
The guidelines lay out fairly narrow medical reasons to justify foregoing vaccinations: A child who went into a coma after a pertussis vaccine would be exempt from another pertussis shot, for example. But a child who had seizures for three days would not qualify for an exemption.
California Gov. Gavin Newsom has expressed concern about government officials making decisions traditionally left to parents and physicians, although he did not say he would veto the bill. “I believe in immunizations,” he said. But “I do legitimately have concerns about a bureaucrat making a decision that is very personal.”
Maine successfully passed legislation barring all nonmedical exemptions for vaccines this year.