Talking Point #14 - State Exemption Laws

You have a right to refuse vaccinations and request an exemption for school or work.

October is Vaccine Injury Awareness Month, and with Alexis Lorenze’s story of vaccine injury going viral on social media, it’s time to update the VaxSafety.org website, this Substack, and my new Instagram! I’ll be posting 60 talking points that break this conversation into easily digestible parts, making it accessible for everyone, even kids. So, let’s put on our black ribbons for awareness and spread the word. Feel free to share widely, and check back anytime for updates, as I’ll be adding more information as needed.

Did You Know? Vaccination is a medical intervention performed on a healthy person that has the inherent ability to result in the injury or death of that healthy person. Because of this risk, you have choices. You have a right to refuse vaccinations and request an exemption for school or work.

To obtain a vaccine exemption for your child to attend school or for yourself as an adult, you must follow the regulations outlined in your state’s vaccine law. These laws vary from state to state. NVIC’s State Law & Vaccine Requirements webpages have the most up-to-date resource on each state’s vaccine requirements and exemption information. Below are the different types of vaccine exemptions used in various states throughout the U.S. The 4 types include philosophical exemption, religious exemption, medical exemption, or proof of immunity.

Visit NVIC’s website for a clickable map with each state’s vaccine requirements & exemptions: https://www.nvic.org/law-policy-state/vaccine-laws

Medical Exemptions: All 50 states allow medical exemption to vaccination. In most states, a medical exemption must be written by a medical doctor (M.D.) or doctor of osteopathy (D.O.). Some states also allow other state-designated health care workers to certify that the administration of one or more state mandated vaccines would be detrimental to the health of an individual. Most states do not allow a doctor of chiropractic to write medical vaccine exemptions.

*Medical Exemptions Difficult to Get - A medical exemption to vaccination is very difficult to obtain because almost all medical reasons for delaying or withholding vaccines have been eliminated by government and medical trade officials. Most doctors and health care workers follow federal vaccine recommendations published by the Centers for Disease Control (CDC) outlining what is and is not considered a medical contraindication to vaccination. Some states will accept a doctor’s written medical vaccine exemption without question. Other states allow state public health officials to review and reject the medical exemption written by a medical doctor or other state-designated health care worker if health department officials don't think the exemption is justified or because it does not conform to federal (CDC) vaccine contraindication guidelines.  **See bottom for California

Religious Exemption: The constitutional right to have and exercise personal religious beliefs, whether you are of the Christian, Jewish, Muslim, or other faith, can be defended. Constitutionally, Americans have an expectation that their religious beliefs will be respected and that government will not pass laws that obstruct the exercise of this most fundamental of freedoms.

If you exercise your right to religious exemption to vaccination, you must be prepared to defend it and explain your religious or spiritual beliefs in your own words. The religious exemption is intended for people who hold a sincere religious belief opposing vaccination to the extent that if the state forced vaccination, it would be an infringement on their constitutional right to exercise their religious beliefs. A state must have a "compelling State interest" before this right can be taken away. Limiting the spread of serious communicable diseases has been defined as a "compelling State interest" in court cases after the 1905 U.S. Supreme Court decision Jacobson v. Massachusetts affirmed the right of states to mandate smallpox vaccine.

In a number of state court cases setting precedent on the issue of vaccine mandates, the freedom to act according to one’s religious beliefs is subject to reasonable regulation, if exercise of personal religious beliefs substantially threatens the welfare of society as a whole. State requirements for religious exemption can vary widely state to state and below are examples of how religious exemption may be defined in your state and what may be required to obtain a religious exemption to vaccination:

1) The exemption’s definition may be broadly defined to include philosophical, personal or conscientiously held beliefs not necessarily tied to an organized religion.

2) Membership in an organized religion that has written tenets prohibiting invasive medical procedures such as vaccination. However, this kind of language has been ruled unconstitutional when it has been challenged in State Supreme Courts.

3) A signed affidavit from your pastor or spiritual advisor from the church you attend.

4) Notarization of your signature on a religious exemption statement attesting to your sincerely held religious beliefs about vaccination.

As of 2023, all U.S. states allow a religious exemption to vaccination except California,  Maine, New York, and West Virginia. Prior to registering your child for school, you should check your state law to verify what proof is needed if you intend to file an exemption for sincerely held religious or spiritual beliefs. 

If you belong to a church, consider educating the head of your local church about the sincerity of your personal religious beliefs regarding vaccination. You may be able to obtain a letter from your pastor, priest, rabbi, or other spiritual counselor affirming the sincerity of your religious beliefs and file it along with any statement you may be required to write explaining your religious or spiritually held beliefs about vaccination. 

Philosophical, Conscientious or Personal Belief Exemption: This type of exemption is for individuals who hold conscientious objections to one or more vaccines. Less than half of U.S. states allow for an exemption to vaccination based on philosophical, personal or conscientiously held beliefs. To learn if your state offers this type of exemption, please visit NVIC’s State Law & Vaccine Requirements webpage.

Each state's requirements for this exemption vary greatly from state to state. In some states parents or children old enough to give consent (usually age 12 or older) must object to all vaccines and not just one vaccine. In Washington and Oregon, parents seeking a personal belief exemption must first obtain a signature from a medical doctor or other state-designated health care worker in order to file the exemption or may be required to complete a state vaccine education program (Oregon). 

While the term "conscientious objector" is generally associated with someone who refuses to serve in the military due to matters of conscience, according to the College of Physicians of Philidelphia it was The British Vaccination Act of 1898 that created a vaccine exemption based on conscienctious objections that gave rise to this popular term. 

To learn more about the history and ethics for this exemption, please visit NVIC's fully referenced Informed Consent webpage.

Proof of Immunity: Some state laws allow individuals to be exempted from vaccination or re-vaccination if proof of existing immunity for certain diseases can be shown. If a person has recovered from the natural disease or has been vaccinated, a blood titer test may indicate that there are enough naturally acquired or vaccine-acquired antibodies to “prove” immunity to a particular disease. Private medical laboratories can perform the blood titer test and measure the level of antibodies and provide you with a report that you can submit with the request for an exemption if the antibody titers are high enough according to accepted standards. A blood titer test that measures antibody levels can cost $55 or more, depending on the disease.

**CALIFORNIA RESIDENTS:

Students will need to provide immunization records to their schools before entry, and schools will still need to report to the California Department of Public Health (CDPH) the immunization status of all students at the existing checkpoints of child care, kindergarten, and 7th-grade.

In 2011 AB-499 Minors: medical care: consent was passed

AB-499 allows minors 12 years old and older to consent to vaccines for sexually transmitted diseases without the knowledge or consent of their parents.  This includes HPV vaccine.

In 2015, Governor Jerry Brown signed SB 277 (Pan)

which removed philosophical and religious exemptions, leaving only medical exemption and proof of immunity through blood titer testing. “Effective one year from now, in July 2016, SB 277 will eliminate personal and religious exemptions from immunization requirements for children in childcare and public and private schools.”

The following exempt categories will not have to meet existing immunization requirements for entry:

1) Home-based private schools

2) Students enrolled in an independent study program who do not receive classroom-based instruction

3) Special education services specified in an individualized education program.

SB 277 does allow philosophical and religious exemptions from any new immunization requirement initiated by CDPH for school and childcare attendance. In other words, if the CDPH introduces a new vaccination requirement to attend school, families can then use the philosophical or religious exemption. For instance, since the Covid vaccine was added to the CDC schedule after 2016, families can use any exemption.

In 2019, Governor Gavin Newsom signed SB 276 & SB 714 (Pan)

Beginning January 1, 2021, all new medical exemptions for school and child care entry must be issued through the California Immunization Registry - Medical Exemption website (CAIR-ME)​. Medical exemptions can only be issued by MDs or DOs licensed in California and must meet applicable Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), and American Academy of Pediatrics (AAP) criteria.

Parents can create an account in CAIR-ME and apply for an exemption. They will receive an exemption application number to give to their child’s physician. The physician can register for an account in CAIR-ME and log in to issue the medical exemption.  Once the medical exemption is issued, the physician prints the form and provides a copy to the parents to give to their child’s school or childcare facility.

Resources:

National Vaccine Information Center - State Law & Vaccine Requirements: https://www.nvic.org/vaccine-laws/state-vaccine-requirements.aspx

The Moral Right to Conscientious, Personal Belief or Philosophical Exemption to Mandatory Vaccination Laws. https://www.nvic.org/vaccination-decisions/informed-consent/the-moral-right-to-exemptions-to-mandatory-vaccination-laws

What Do I Need To Know About Vaccine Exemption? Updated December 28, 2023 https://www.nvic.org/resources/frequently-asked-questions/vaccine-exemptions

Facts and Resources for California Residents: https://www.nvic.org/Vaccine-Laws/state-vaccine-requirements/california.aspx

Shots for School: Medical Exemption FAQ’s: https://www.shotsforschool.org/laws/exemptions/

AB-499 Minors: medical care: consent.(2011-2012) https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201120120AB499

Immunization Update from CDPH. https://eziz.org/assets/docs/IZUpdate_2015_07.pdf

CDPH - Exemption FAQs. Medical Exemptions (MEs)​ Updated : September 9, 2024 https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/School/laws-exemptions.aspx

SB-276 Immunizations: medical exemptions.(2019-2020) https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB276

SB-714 Immunizations.(2019-2020) https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB714

Pre-2020 Medical Exemptions Written by Disciplined Physicians are Revoked 2021 https://drive.google.com/file/d/1WxHhNDtsJGwQ9_YXTCkDkhTT03_Lrdtf/view?fbclid=IwAR1AGpImF1nSWtOBzw6iZbJU4gAbMGBM4MGJrc_itYpTgK6HY3ooaJbRn90

Update on Pre-2020 Medical Exemptions to Required Immunizations, April 7, 2023 https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Immunization/Pre2020MEs_Letter.pdf