School vaccine exemptions must be for medical conditions only

No, vaccines do not cause autism.

No, vaccines do not cause cancer.

No, vaccines are not toxic.

No, getting the disease is not safer than vaccination.

Yes, they are safe. Yes, they are effective. As a pediatrician, I spend countless hours each week talking about vaccines and counseling parents about the importance of immunization. While parents may not know anyone with rubella, polio or tetanus — almost every parent knows someone who knows someone who might have had a problem with childhood vaccines.

Parental refusal of vaccines is now so prevalent the World Health Organization declared it a “top threat to global health.” There are now approximately 850 measles cases nationwide, spanning 25 states. More than 600 of these cases have originated in New York. The number of children infected keeps rising.

Some parents and legislators — fed a steady diet of false information — are contributing to the epidemic by allowing unimmunized children to attend school. Today in New York state, 285 schools are at risk for measles because the student body is under-immunized.

Measles isn’t the only vaccine-preventable disease surging back. There have been 426 cases of mumps this year, approximately 300 in March alone. Pertussis outbreaks occur so often they are now considered medically “routine.”

It is time to stop endangering all kids and allow only medical exemptions from school vaccination requirements. With the mountains of scientific data, legal scholarship and policy evidence support this measure, we should have no hesitation in blaming future cases on the inaction of state legislatures.

While vaccines are safe and effective — roughly 1 in 100 vaccinated children will remain vulnerable to diseases like measles should they encounter an unprotected but exposed child. This neglects the children in school who’ve had transplants or kids with cancer or immune diseases that render them unable to benefit from vaccination.

Measles is especially contagious, the virus persists up to one hour after an infected person leaves the room and an exposed child infects up to 95 percent of those at-risk children around them. Prior to the creation of measles vaccine over a half-century ago, approximately three to four million U.S. cases occurred annually.

Pediatricians predicted the return of vaccine-preventable disease years ago, as we noticed we were spending more time in our practices (with less and less success) encouraging and reassuring parents to get their children immunized. When vaccination rates decrease, diseases return.

Pediatricians support eliminating non-medical vaccination exemptions for school attendance because this policy is a proven way to increase vaccination rates and protect all children from vaccine-preventable diseases. Most importantly, those with cancer and immune diseases who rely on high population immunization rates to indirectly protect them.

Of all states which still allow either philosophical or religious exemptions to vaccination, New York is among the worst offenders. Seventy-five percent of national measles cases originated in New York. California eliminated non-medical exemptions in 2015 after roughly 210 measles cases. Washington state also amended its immunization laws after 78 cases there. Maine eliminated non-medical exemptions this year, despite not having a case since 2017. Exposure to an infected Massachusetts resident was enough to motivate legislators there.

Yet in New York state, over 600 cases and five pediatric intensive care hospitalizations have not motivated lawmakers to act.

Opponents of immunization contend First Amendment freedoms protect their right to increase the risk of disease in their children based on religious belief. This is sleight-of-hand reasoning. No prohibition on philosophical or medical exemptions forces vaccination. Parents who do not wish to immunize their child are still free to do so but must home school their kids — thus preventing the public health issue of introducing large numbers of unimmunized children to the high-risk school population.

There are no major religions which prevent vaccination and courts have ruled in over 115 years of cases that the need to protect children outweighs and religious objections, should they even exist. There are no rights that are limitless. As Oliver Wendell Holmes noted, “My right to swing my fist ends where your nose begins.” Pages of legal scholarship have demonstrated these laws are constitutional.

In addressing whether religious pretext exempts parents from state regulations, Supreme Court Justice Rutledge writing in the 1940s stated, “Parents may be free to become martyrs themselves. But it does not follow they are free, in identical circumstances, to make martyrs of their children.”

A small group of parents, however, are unable to see these proposals as anything other than a proven public health strategy. Sadly, they have turned a policy debate into a systematic attempt to harass and intimate legislators, pediatricians, parents, and vaccine advocates who are pushing for these proposals.

Their tactics not only are reprehensible and in some cases, dangerous. These groups have overtaken town halls and disrupted public events. Protestors surrounded the car of New York State Senator Kevin Thomas, who supports a bill removing religious exemptions — and refused to leave, requiring the senator to call the police. assemblyman Jeffrey Dinowitz, a lead author of the bill, has been told by anti-vaccine activists, according to a report, that they hope his “grandchildren get autism.”

As a vaccine advocate, I have been shouted down at town halls and once needed an escort to my car. Colleagues have been attacked on social media, and have endured coordinated internet attacks, aimed at their physician reviews on websites such as,, Google, and Yelp. In many cases, these physicians have spent hundreds of hours and thousands of dollars trying to restore their online reputations, which for private practice physicians are integral to maintaining a financially-viable practice. Parents of children who die from vaccine-preventable disease and post on social media encouraging other parents to vaccinate their child have also been attacked. Anti-vaccine protestors have claimed they falsified their child’s cause of death, or in some cases, say their child never existed.

The intimidation sadly works. Several lawmakers have said while they support the bill, they will not publicly say so until the last possible minute—out of fear of these attacks, which prevent them from promoting other achievements for their districts. Of course, when all legislators remain quiet, the bill refuses to gain traction, creating a catch-22 which allows immunization rates to stay low and vaccine-preventable diseases to remain.

These epidemics should motivate legislators to understand the importance of strengthening our public health infrastructure.

If we don’t recognize all the evidence regarding vaccination safety and policy, then we are allowing government officials to make decisions out of fear, intimidation, and falsehoods.

And another outbreak is certain.

Shetal I. Shah is a pediatrician.

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