It’s not the time for exemptions
Alex Lupi, Jennifer Connell, Jan Niec and Malin Adams
Several bills in the Tennessee House and Senate seek to loosen regulations on vaccines.
Increasing availability of COVID-19 vaccines has sparked both excitement and hesitation. Vaccination of an entire country over a one-year period is unprecedented, and a sweeping mandate for all people to be vaccinated would not be appropriate.
However, vaccines are crucial in groups with already-established norms for immunization to protect vulnerable people. The Tennessee Legislature has proposed several bills that expand exemptions from receiving the COVID-19 vaccine. As rates of cases and deaths remain high, now is not the time for legislation expanding exemptions from receiving vaccines.
What is the current law around vaccines and exemptions?
Tennessee requires routine immunization for children attending child-care facilities, preschool, K-12 schooling and college students. These long-standing requirements are based on a 1905 Supreme Court case, Jacobson v Massachusetts that decided smallpox vaccines could be required in certain populations. This case contributed to smallpox eradication in 1980. Still, medical and religious exemptions to immunization remain available in Tennessee.
Current Tennessee law expressly states these exemptions apply only “In the absence of an epidemic or immediate threat thereof.” A recently proposed bill, HB 0010/SB 0007, sought to remove this language and offer additional religious exemptions to vaccines. This bill was defeated in a House subcommittee on March 2.
In the workplace, employers may require certain vaccines. For example, many health-care employers require influenza vaccination. For some circumstances, the U.S. Equal Employment Opportunity Commission has stated it would be lawful for an employer to exclude an employee from the workplace if they refuse a COVID-19 vaccine.
New vaccine legislation
Several new bills have been proposed in the Tennessee legislature that seek to oppose required vaccines or expand exemptions for vaccines.
Some bills target exemptions to schools (HB 1421/ SB 1313), and others to the workplace (HB 1147/SB 1308). Other relevant bills include HB 0013/SB 0187,
HB 1269/SB 0564, and HB 1494. (Editor’s note: You can learn more about these bills at the Tennessee General Assembly website: capitol.tn.gov).
Recommendations in response to the proposed bills
Certain groups should be vaccinated as the law currently directs. We offer the following groups as examples for whom exemptions should not be extended: Health-care providers, schools and essential businesses.
Hospitals, nursing homes, home health agencies and pharmacies have all been stretched to capacity to provide care for patients during the past year. Patients most at risk of severe illness rely on these services to stay alive. An outbreak as a result of unvaccinated employees could cause avoidable harm, as seen early in the pandemic before vaccines were available.
Both students and staff in schools rely on vaccination to ensure a safe reentry to in-person education. Teachers face risk by interacting with children who, despite having lesser disease severity, are significant sources of transmission. Also, children with immunodeficiencies or chronic conditions face risk of severe infection and rely on classmates and teachers to provide a safe learning environment.
Outbreaks in meat and poultry packing facilities in 2020 exposed how vulnerable essential workers are. Especially concerning is the fact that the majority of affected workers are racial or ethnic minorities. Essential workers must be protected while they keep our country running.
Herd immunity first
The COVID-19 pandemic is not over. New bills proposing expansion of vaccine exemptions should be at least delayed until herd immunity is achieved. While one bill (HB 0010/SB 0007) seeking to expand religious exemptions to vaccines has been defeated in a Tennessee House committee, many are still proposed. Contact your legislators to express your support for life-saving vaccines and disapproval of antivaccine rhetoric.
Alex Lupi, Jennifer Connell and Jan Niec are second-year medical students at Vanderbilt University School of Medicine.
Malin Adams is an adult-gerontology primary care nurse practitioner student at Vanderbilt School of Nursing with a special interest in geriatrics and community health.
The views expressed by the authors are personal in nature and are not intended to represent the views of Vanderbilt University.