As the vaccine debate continues, religious exemptions face scrutiny
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NEW YORK — In the latest episode of “South Park,” the incorrigible Eric Cartman faces expulsion from school because he doesn’t want to get stuck by the needle that delivers a required vaccine. To get around the rule, he claims a religious exemption.
The caustic cartoon lampoons the anti-vaccination movement as pitched battles are being waged in courtrooms and on courthouse steps. With schools back in session, students are finding themselves in Cartman’s position due to immunization requirements.
Hundreds of people in western New York recently showed up to what organizers called a religious freedom rally to oppose the state’s elimination of religious exemptions from school immunization requirements.
“On June 13, 2019, 20 million New Yorkers had a religious liberty stripped from them” by the state, declares a website by First Freedoms, a group dedicated to defending parents’ right to not vaccinate their children on the basis of religious beliefs.
Court battles are playing out across the state. An August hearing in Albany was attended by more than 1,000 protesters. Five days later, a federal judge denied a request by New York parents seeking a temporary stay of the law, ruling that their reasons were non-medical.
Attorney James Mermigis is representing parents in several counties in New York. A Christian, as his Twitter bio proclaims, he filed his first preliminary injunction against the law on behalf of his own family. He’s waiting for decisions on 10 motions statewide. He limited his arguments to state law rather than federal.
“Therefore it’s tougher for the state to beat these cases because there’s not a lot of New York precedent,” he said.
The debate has intensified during the country’s worst measles outbreak since 1992 and since the disease was declared eliminated in 2000, according to the Centers for Disease Control and Prevention. More than 1,200 new cases have been reported this year nationwide.
A 90% vaccination rate is required for herd immunity from measles. That’s higher than other diseases for which vaccinations exist because measles travels by air, making it highly contagious. Its symptoms escalate rapidly once it is contracted. Its most severe complications include blindness, brain swelling and respiratory infections. Complications can be fatal, especially in children.
New York has had more than 850 cases since last fall. Most of them have been in Hasidic Orthodox Jewish communities. The state has two of the largest in the U.S., one in Brooklyn and another in Rockland County, just north of New York City.
While the outbreak in New York triggered its repeal of religious exemptions, 45 states still have them. Fifteen states allow exemptions for personal beliefs, which can encompass religion or can be philosophical or moral. A lawmaker in Washington State pushed to limit exemptions after a measles outbreak there, but public backlash prevented the religious exemption from being removed.
Arguments for or against religion as a legitimate exemption are complicated. Direct references in sacred texts don’t exist because vaccines are a feature of the modern world. They first came into use in the late 18th century to fight smallpox. The conversation gets bogged down in interpretation, since religious texts address things like personal health and sovereignty.
Anti-vaccination sentiment is not unique to Orthodox Jews, who have vaccination rates that pretty much reflect those of the general population. Many Orthodox leaders have been vocal in support of vaccination. Agudath Israel of America, the largest Hasidic organization in the country, issued a statement in April reiterating its position.
For a better understanding of how religiosity relates to the anti-vaccine movement, the homeschool movement provides some insight. Of the estimated 1.7 million children being homeschooled in the U.S. as of 2016, only 16 percent had parents who said they were doing it for religious reasons. Anti-vaccine attitudes may be driving more parents to homeschool, making the vaccine and religion issue more of a chicken-or-egg question.
J. Allen Weston, executive director of the National Home School Association, said his organization is firmly opposed to mandatory vaccinations for moral reasons.
“The concept of forcibly injecting harmful and sometimes lethal substances into anyone, especially children, is barbaric,” he said. “We believe that there should be no need for exemptions and that vaccination should be strictly voluntary. This is not based on theology. It is based on common sense, real science and respect for human life.”
Brian D. Ray, president of the National Home Education Research Institute, also said there is no scriptural basis for opposition to vaccines. There are, however, broader definitions of religion that deserve sacrosanct status, he argued. That includes parental authority over what can be put into a minor’s body. Religion is more than the concept of a deity, he said. It encompasses institutionalized systems of attitudes, beliefs and practices.
“It is religious,” said Ray, who left the Catholic faith for what he called “Bible-believing” Christianity, or non-denominational Evangelical Protestantism. “Should the civil government have final authority over a child’s body or should the parents be able to make decisions unless there’s significant evidence of an imminent threat?”
He described his position as pro-choice rather than anti-vaccine because he isn’t opposed to vaccines generally. He compared it to the abortion debate. If a woman’s right to choose is widely accepted as a legitimate position on that issue, he asked, why isn’t a parent’s right to choose accepted on this one?
For Ray, the philosophical reasoning fits inside a religious freedom framework. Autonomy over one’s beliefs is then inseparable from what those beliefs lead a person to decide about vaccination. It isn’t about what religion dictates, but what religion allows.
Conversations within religious communities reflect overlapping attitudes that are often bound together. Ultra-conservative groups like fundamentalist Christians and Orthodox Jews tend to live more insularly in order to preserve their traditions and limit the unwelcome intrusion of lifestyles and behavior that represent a spiritual threat. Rejection of mainstream society goes hand-in-hand with mistrust of its authorities.
Research from the University of Pittsburgh Center for Research on Media, Technology, and Health suggests some ways that these and other perspectives are intertwined in the digital age.
A study published in March analyzed the Facebook profiles of a sample of commenters on a video posted by a Pittsburgh-area pediatric practice. It promoted the HPV vaccine as a cancer prevention measure. Several anti-vaccination groups drew attention to it and the video received thousands of disparaging comments over the next week.
While the office served patients local to it, the 197 commenters studied were located in 36 states and eight countries. Most were mothers. Their political affiliations spanned the political spectrum, with more than half expressing support for Donald Trump and a tenth being Bernie Sanders supporters.
The study identified four categories that its subjects fit into:
‘trust,’ which emphasized suspicion of the scientific community and concerns about personal liberty;
‘alternatives,’ which focused on chemicals in vaccines and the use of homeopathic remedies instead of vaccination;
‘safety,’ which focused on perceived risks and concerns about vaccination being immoral; and
‘conspiracy,’ which suggested that the government and other entities hide information that this subgroup believes to be facts, including that the polio virus does not exist.”
These characteristics were apparent in the messages from speakers at rallies in Brooklyn and Monsey, N.Y. earlier this year. Both events were hosted by Rabbi Hillel Handler and attended by several hundred ultra-Orthodox residents.
The messages at each, though, were delivered not by religious leaders but by well-known anti-vaccine personalities, including filmmaker Del Bigtree and Andrew Wakefield, whose 1998 study that suggested a link between the measles-mumps-rubella vaccine and autism prompted numerous researchers to demonstrate no such link. Wakefield lost his medical license for ethics violations, including not disclosing that his research was financed by attorneys who were suing vaccine manufacturers.
New York was the second state to remove its religious exemptions this year, after Maine. Its high concentration of measles cases spurred strong legislative action, which is likely protected by more than 100 years of precedent. The Supreme Court ruled in 1905 that states are not required to offer religious exemptions in matters where public health is at risk.
Janet Dolgin, a professor of health care law at Hofstra University, said she is troubled by the ability of vaccine skeptics to claim religious exemption without being religious. Beyond Christian Scientists, she said, no major religion includes opposition to immunization in its doctrine.
Dolgin expects exemptions to be tested wherever outbreaks occur. “To the extent that states experience epidemics, they’ll rethink their religious exemptions,” she said. “To the extent that they’re not particularly threatened, they may not.”