On April 9, 2019, New York City Mayor Bill de Blasio issued a health emergency declaration in parts of Brooklyn and Queens in response to an alarming measles outbreak. For perspective, there were 372 measles cases in the United States in 2018 (up from 120 in 2017 and 86 in 2016), but 555 in the first three months of 2019 alone. Mayor de Blasio strengthened the measles vaccination requirement in the neighborhoods hardest hit by the outbreak (via the declaration), shining a spotlight on the controversial matter of such mandates.
Children under the age of five are the most vulnerable to this potentially fatal disease, although it can effectively be controlled through vaccinations. But as more parents question the utility and safety of vaccines, sometimes ignoring legal mandates, measles has made a comeback in the developed world.
Few public mandates have created as much controversy as those requiring parents to vaccinate their children against certain diseases, pitting civil liberties against public safety. The following article explores U.S. vaccination laws, including exemptions to such mandates and key court cases.
Vaccinations: Support and Opposition
The Mumps, Measles, and Rubella (MMR) vaccine is 97 percent effective. Between 400 and 500 people (mostly children) died from the disease annually prior to the availability of the MMR vaccine in 1963, although many more suffered blindness, deafness, brain swelling, permanent brain damage, and lung problems. Reported cases of other diseases, such as polio and mumps, also have been greatly reduced through vaccines. Given the documented success of vaccinations in the fight against certain contagious diseases, why is there any opposition?
While the risks associated with measles is great, some parents believe that the risk from the vaccination is greater, such as potentially toxic additives and unanticipated side effects (such as the debunked theory that they cause autism). In addition to religious objections, some parents question their effectiveness, the motivation of pharmaceutical companies to sell vaccines, or whether these mandates violate individual rights. While these topics are beyond the scope of this article, they provide important context for the contention over vaccination laws.
U.S. Supreme Court and the Authority to Impose Vaccinations
Mandatory vaccination laws were first challenged in the U.S. Supreme Court during a smallpox outbreak in the early 1900s. The case, decided in 1905, stems from a Massachusetts law providing that local governments "shall require and enforce the vaccination" of residents if deemed necessary "for the public health or safety." The law carved out an exception for children determined by a physician to be "unfit subjects" for vaccinations.
The Supreme Court affirmed the constitutionality of the Massachusetts mandate, holding that the state may impose appropriate "restraints and burdens" on individual liberties "in order to secure the general comfort, health, and prosperity of the state." Therefore, states are within their authority to enforce reasonable vaccination mandates.
State Vaccination Laws
Vaccinations are regulated by the federal Food and Drug Administration (FDA), but vaccination laws are enforced at the state level. Children are required to provide proof of certain vaccinations prior to entering kindergarten, preschool, or daycare. These laws can apply to students in private as well as public institutions and throughout a child's schooling, including college. States also may require health care workers and other professionals to provide proof of immunization.
State laws vary, but typically include mandates for the following vaccinations:
- Poliovirus vaccine (IPV)
- Two doses of Measles, Mumps, Rubella vaccine (MMR)
- Three doses of Hepatitis vaccine (HBV)
- Two doses of Varicella (chicken pox) vaccine
- A booster dose of Diphtheria, Tetanus (lockjaw), Acellular, and Pertussis vaccine (DtaP)
- Meningitis vaccine (by age 11); and
- Tetanus Diphtheria Acellular Pertussis vaccine, or Tdap (by age 11).
Failure to comply with vaccination requirements by the given deadline, in the absence of a legal exemption, typically results in the child being prohibited from attending school or daycare.
Exemptions to Mandatory Vaccination Laws
All state vaccination laws provide limited exemptions from vaccination requirements, ranging from physician-verified medical reasons to philosophical or religious vaccine exemptions. Most state laws also reserve the right to prohibit children with such exemptions from attending school or daycare facilities in the event of an outbreak. Common exemptions to these requirements include:
- Medical - All states allow for exemptions to vaccinations if a doctor determines a child has an immune deficiency, serious allergies to the vaccine, or other health issues that would contraindicate vaccination.
- Religious or Personal Beliefs - Most states allow parents to exempt their child from vaccination requirements if it's contrary to their religious beliefs.
- Philosophical Reasons - This is a catch-all exemption for those who object to immunizations out of concern for safety, effectiveness, or otherwise contrary to their beliefs. Fewer than half of the states allow for this exemption.
Nearly a dozen states reserve the right to waive these exemptions in the event of an epidemic. Hawaii statute, for instance, doesn't recognize exemptions to vaccination mandates "if at any time there is, in the opinion of the department of health, danger of an epidemic from any of the communicable diseases for which immunization is required." The law offers quarantine as the only legal alternative in such an event.
Concerned About Vaccination Laws? Get Professional Legal Help Today
It's understandable to have questions and concerns about laws requiring certain vaccinations, although these laws are intended to balance public health concerns with respect for personal liberties. It's not an easy balance and there may be times when it makes sense to pursue your legal options. If you have concerns, contact an experienced health care attorney near you today.
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