COMMENTARY

'Vaccine Exemptions'? Call Them What They Really Are

Paul A. Offit, MD

Disclosures

August 10, 2012

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Hi. My name is Paul Offit. I am talking to you from the Vaccine Education Center at The Children's Hospital of Philadelphia.

Today I want to talk about an article that recently came out in the journal Pediatrics, titled "Frequency of Alternative Immunization Schedule Use in a Metropolitan Area," by Steve Robison and colleagues in Portland, Oregon.[1]These authors looked at the choice by parents to separate, delay, withhold, or space out vaccinations in the Portland metropolitan area from 2003-2009. They found a 4-fold increase, from about 2.5% to 10% of parents, who made this choice during those years. The parents were making this choice because they could. With this article as background, I thought we would talk about vaccine exemptions.

There are 3 ways to exempt yourself from vaccines. The first way is a medical exemption. For example, a person may have a contraindication to getting a vaccine. Some people are allergic to gelatin. Gelatin is used as a stabilizer in the chickenpox vaccine and in the nasal spray influenza vaccine. That would be a reasonable reason not to get a vaccine.

A second way people can exempt themselves from vaccines are the so-called philosophical or personal belief exemptions. Twenty states allow that kind of exemption. I would argue that these exemptions are misnamed.

First of all, the notion that vaccines are a "philosophy" is inaccurate. Philo means love, sophos means wisdom. Exactly where is the wisdom in saying that it is better not to get vaccines than to get them?

The term "personal belief" is also incorrect in that vaccines are not a belief system. Religion is a belief system. Religion is a faith-based system. Science and medicine are evidence-based systems. They are data-based systems, not beliefs. If you want to feel better about vaccine use, I think one needs only to look at the roughly 20,000 studies that have evaluated the safety or efficacy of vaccines, or the hundreds of studies that have looked at what happens when you combine vaccines and give them at the same time to feel confident that, in fact, there are data to support that choice.

The third way one can exempt oneself from vaccines are so-called religious exemptions. Forty-eight states have them. I would argue this also does not make a lot of sense.

The first vaccine was Edward Jenner's vaccine in 1796. The New Testament was written around 100 AD, the Old Testament between 1400 and 400 BC, and the Qur'an around 600 AD. All those texts were written well before vaccines existed, so not surprisingly, they never mention or predict them.

I also would argue that it does not make sense to say, "It is my religious belief that a child not get a vaccine," and therefore a child should be left with less protection under the law. The 14th Amendment of the Constitution, the so-called Equal Protection Clause, states that a child or anyone should be equally protected and implies that this is independent of a parent's belief system. If the child is exposed to harm, that child should have equal protection. For example, if a Jehovah's Witness parent says, "I do not want my child to get a lifesaving blood transfusion," the parent does not have the freedom of religion to practice that because of the 14th Amendment.

What is interesting -- and I do not think most people know this -- is that the 2 states that do not have religious exemptions are Mississippi and West Virginia, states you would not necessarily pick. The reason these states do not have a religious exemption is because both states' Supreme Courts said that it was a violation of the Equal Protection Clause of the 14th Amendment.

I think we should call these exemptions what they really are. Let's not sugarcoat this choice. We should call them the "I do not want to get vaccines because I have read a lot of scary things about vaccines and I am afraid that they might hurt my child, and I am not so sure I believe in pharmaceutical companies or the medical establishment or the government, so I do not want my child to get them" vaccine exemption. That would be, I think, more honest.

Thanks for your attention.

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