Lawmakers debate religious exemptions

Mass. seeks to tighten vaccination requirements for children

Religion would no longer be an accepted reason to exempt a child from mandatory vaccinations in Massachusetts, under legislation seeking to tighten current law.

Such exemptions are rare, but the number of parents seeking waivers for religious reasons has grown over the past 20 years and accounts for the majority of unvaccinated children reported in the Commonwealth.

The legislative effort to tighten vaccination requirements arrives amid an anti-vaccination movement reinvigorated by the COVID-19 pandemic, a presidential bid by Robert F. Kennedy Jr., who shares false vaccine information, and a reappearance of preventable viruses in unvaccinated children that had virtually vanished from the United States. Massachusetts reported three measles cases in 2019 and one in 2020, according to the state Department of Public Health. Last year, New York state reported a polio case.

Parents like Jana Koretz, 38, are desperate for the bill to pass. Her daughter has to take immune suppressants due to an organ transplant in infancy, and the drugs make some vaccines dangerous to her. Being around unvaccinated children increases the toddler’s risk of contracting illnesses that could kill her.

“Until you have had an experience like that, where you have to face the reality that your child could die, you can’t appreciate how fearful it is to live in a world where every illness is a vulnerability,” said Koretz, a North Shore mother who asked that her daughter not be named for privacy reasons.

In addition to ending religious exemptions, the bill would require schools to report vaccination data to the state. Reporting is currently voluntary, and more than 200 of the state’s kindergarten classes, or about 15 percent, didn’t report any vaccine data this school year.

‘People using the religious exemption are really using it as an excuse.’

REPRESENTATIVE ANDRES VARGAS

Massachusetts has one of the best vaccination rates in the country, according to the US Centers for Disease Control and Prevention, but there are pockets of the state where immunization rates are dangerously low. In the 2022-23 school year, more than 150 Massachusetts kindergarten classes reported measles vaccination rates under 95 percent, below the level recommended by the CDC to guarantee herd immunity, according to the state health department.

“There are underserved communities at real risk,” said Dr. Jonathan Davis, Tufts Medical Center’s chief of newborn medicine.

Medical exemptions from vaccination are rare but necessary for children with some health problems, including neurological conditions, allergies to vaccines, or compromised immune systems, Davis said.

Religious exemptions, meanwhile, have become far more common over the past 30 years, according to health department data. In the 1987-88 school year, the oldest data available from the health department, 147 kindergartners received religious exemptions. This year, 813 claimed the exemption.

Several states, including Connecticut, Maine, and New York, no longer allow religious exemptions. Massachusetts should catch up with its neighbors, said state Representative Andres Vargas, a Haverhill Democrat, who sponsored the bill.

“People using the religious exemption are really using it as an excuse,” Vargas said. “I’m sure that for some people faith can be at the root of it, but ... the vast majority of skepticism is usually rooted in pseudo-science found online.”

Both Vargas and Davis said they were not aware of any major religion that prohibited vaccination.

The bill, which also would require schools to report immunization and exemption rates, is one of several recently introduced seeking to boost childhood immunizations, and all are expected to face strong opposition.

Members of Health Action Massachusetts, a nonprofit that has pushed to maintain vaccine exemptions for children, argue that the legislation would hinder religious freedom and block access to education. They plan to speak against the bill and others aiming to boost state child immunization rates at a Joint Committee on Public Health hearing scheduled for Wednesday.

Individuals’ religious practices may vary from mainstream teachings, but are still valid, Candice Edwards, a Health Action Massachusetts member, said in an emailed statement. Parents with strongly held religious beliefs will likely still refuse to vaccinate their children, she said, creating an obstacle to education for children whose parents cannot home-school.

“Eliminating the religious exemption won’t increase vaccine uptake in the Commonwealth,” she said, “but it will harm children of a small minority of religious families.”

Davis noted studies that showed eliminating religious exemptions in California boosted vaccination rates in highrisk counties and didn’t lead to a significant number of children leaving schools.

Vargas, who has proposed an end to the religious exemption before, said he is hopeful the bill will be voted out of committee, a crucial step that the vast majority of legislation on Beacon Hill never achieves. Whether it will become law is less certain, he said, because opposition will likely be vocal.

“It will take one-on-one conversations with colleagues,” he said.

Massachusetts requires children in kindergarten through 12th grade to be vaccinated against infectious diseases such as tetanus, polio, measles, mumps, and rubella, according to the health department. The state does not require children to receive a COVID-19 vaccine.

Just 0.6 percent of Massachusetts kindergartners overall have no records of immunization and either religious or medical exemptions to at least one vaccine, the department reported, but the rate of unvaccinated children varies widely by county. In Suffolk County, just 0.2 percent of kindergartners have an exemption and no documented vaccinations in the 2022-2023 school year. The state’s highest rate of exempted kindergartners without vaccinations was on Martha’s Vineyard and the Elizabeth Islands, with 2.3 percent.

The reappearance of viruses like measles is a warning sign, said Dr. Paul Offit, who advises the Food and Drug Administration on vaccination, and the COVID-19 pandemic only accelerated opposition to vaccination.

“What happened in this pandemic is the opposite of what I thought would happen,” said Offit, director of the vaccine education center at Children’s Hospital of Philadelphia. “Because we had mandates for vaccines and mandates for masks we leaned into a libertarian left hook.”

Another House bill under consideration would mandate HPV and hepatitis A vaccinations for children. HPV is a sexually transmitted disease but is the most common cause of cervical cancer, and vaccinating women before they become sexually active helps prevent the virus’s spread, Davis said.

A third proposal, with identical versions introduced in the House and Senate, would, among other measures, allow youth under 18 to be vaccinated without parents’ consent if a health care provider can confirm the child understands the risks of not being vaccinated. Circumventing parental consent could create risk if the child isn’t able to explain their own medical history, said Edwards, of Health Action Massachusetts.

For Koretz, the North Shore parent, arguments against the bills are overwhelmed by the science showing vaccines’ effectiveness and the importance of a well-vaccinated community to her daughter’s safety.

“I don’t feel like other people should be able to make that choice about whether my child will live or die,” she said.