Religious exemptions to vaccination rise amid stricter state policies

States that allow exemptions to vaccinations for children based upon personal or religious beliefs of the parents report a significant rise in kindergartners with religious exemptions during the 2017-2018 school year compared with the 2011-2012 school year, and a new study has determined that the elimination of personal belief exemptions may be responsible for the increase.

The study, published recently in Pediatrics, analyzed data on exemptions for children starting kindergarten from 2011 to 2018 from the Centers for Disease Control and Prevention. Researchers performed a cross-sectional, retrospective, state-level analysis of state estimates of the proportion of children with medical and religious/personal belief exemptions as well as the proportion of kindergartners who were up-to-date on recommended vaccines (measles/mumps/rubella, diphtheria/ tetanus/ acellular pertussis, and varicella) and calculated the proportion of kindergartners with religious vaccine exemptions for each state year, adjusting for the strength of each state’s exemption policies.

In unadjusted analyses, states with religious and personal belief exemptions had a significantly lower mean proportion of kindergartners with religious exemptions (0.41%; 95% confidence interval [CI], 0.28%-0.53%) compared with states with religious exemptions only (1.63%; 95% CI, 1.30%-1.97%). In adjusted analyses, states with religious and personal belief exemptions were one-fourth as likely to have kindergartners with religious exemptions compared with states with religious exemptions only (risk ratio 0.25%; 95% CI, 0.16-0.38).

Using the 2011-2012 reference year, states were more likely to have kindergartners with religious exemptions during the 2017-2018 school year (P=.04). This finding held for states with easy, medium, or difficult exemption policies.

The researchers say their study demonstrates how vaccine exemption policies influence state-reported vaccine exemption data. “State-level religious exemption rates appear to be a function of personal belief exemption availability, decreasing significantly when states offer a personal belief exemption alternative,” they write.

However, the study authors note that the increase in exemptions based on religious beliefs is curious because it is accompanied by a simultaneous decrease in Americans’ declarations of religious affiliations. All major religions support vaccination, they write, and fewer Americans say they are religious, yet exemptions based on religious belief have increased as of the 2017-2018 school year.

They suggest that researchers and policymakers work together to reconsider the nature and purpose of religious exemption laws “to determine how best to balance a respect for religious liberty with the need to protect public health.”