As states loosen childhood vaccine requirements, health experts’ worries grow

An infant in Fayetteville, Ga., receives one of several routine vaccinations typically required for children entering K-12 schools. On the heels of the COVID-19 pandemic and with growing skepticism around vaccinations and government requirements, some state lawmakers want to end state vaccine mandates for children. Angie Wang/The Associated Press

Louisiana Republican state Rep. Kathy Edmonston believes no one ought to be required to vaccinate their children. So, she wants schools to proactively tell parents that it’s their right under Louisiana law to seek an exemption.

“It’s not the vaccine itself, it is the mandate,” Edmonston told Stateline. “The law is the law. And it already says you can opt out if you don’t want it. If you do want it, you can go anywhere and get it.”

Although Louisiana scores among the bottom states in most health indicators, nearly 90% of kindergarten children statewide have complete vaccination records, according to data from the Louisiana Department of Health from last school year. That’s even as Louisiana maintains some of the broadest exemptions for personal, religious and moral reasons. The state only requires a written notice from parents to schools.

Edmonston has sponsored legislation that would require schools to provide parents with information about the exemptions. The bill is intended to ensure parents aren’t denied medically necessary information, she said.

Vaccines protect not only the patient, but also those around them. Science has shown that a population can reach community immunity, also known as herd immunity, once a certain percentage of the group is vaccinated. That herd immunity can protect people who can’t get vaccinated, such as those with weakened immune systems or serious allergies, by reducing their chances of infection. In the past few years, however, COVID-19 vaccines have terrified some people who oppose requirements to get the shot, even though research shows the vaccines are far safer than getting the disease.

Some lawmakers across the country are working to sidestep vaccine mandates, not just for COVID-19, but also for measles, polio and meningitis. Public health experts worry the renewed opposition to childhood immunizations will reverse state gains in vaccination rates. Meanwhile, cases of some diseases, including measles, have increased across the country.

We’re against the government telling us what to do with our own bodies.

– Louisiana Republican state Rep. Kathy Edmonston

Edmonston’s bill is one of dozens this session that aim to relax vaccine requirements, according to a database maintained by the National Conference of State Legislatures, a nonpartisan research organization that serves lawmakers and their staffs. Most of the bills have either died in committee or failed to advance, but a few have become law.

Idaho enacted a law, effective in July, that allows students “of majority age” — 18 in Idaho — to submit their own immunization waivers to schools and universities, both public and private. And Tennessee passed a law, which took effect in April, that prohibits the state from requiring immunizations as a condition of either adoption or foster care if the family taking in a child has a religious or moral objection to vaccines.

“Conservatives have really moved towards that medical freedom position of where people need to be really educated about whatever vaccine that they are taking,” said Tennessee state Sen. Bo Watson, who sponsored his state’s legislation.

“I think the public health community has really lost credibility during the COVID-19 pandemic,” said Watson, a Republican. “And they’re going to have to work really hard to restore some of that credibility.”

Other bills that would have allowed some exemptions passed legislatures but were stopped short by governors.

In West Virginia, Republican Gov. Jim Justice vetoed legislation that would have allowed full-time virtual public school students, along with private and parochial schools, to avoid mandatory vaccine requirements. Justice said in his veto message that he “heard constant, strong opposition to this legislation from our State’s medical community.”

Similarly, Wisconsin Democratic Gov. Tony Evers vetoed legislation that would have required public colleges and universities to allow immunization waivers for health, religious or personal reasons.

Edmonston said she’s tried before with her legislation in Louisiana; it either died or got vetoed by former Democratic Gov. John Bel Edwards. But now, with Republican Gov. Jeff Landry in charge, Edmonston is confident the bill will get signed into law. It’s already passed the House and is being debated in the Senate.

Both she and Watson said the push to relax requirements or create broader exemptions for immunizations is not tied to vaccines themselves. The debate tends to be centered around what many conservatives call an overreach of government.

“We’re against the government telling us what to do with our own bodies,” Edmonston said.

Greater momentum after COVID-19

The federal Centers for Disease Control and Prevention recommends numerous vaccinations for infants as a standard regimen. And shots protecting against measles, mumps and rubella, chickenpox and hepatitis B, among others, are typically required to attend K-12 schools. States set their own requirements and exemptions, however, and there are variations.

Pushback against vaccine mandates goes back more than a century to the early 1900s, shortly after the U.S. Supreme Court in 1905 ruled that states could require parents to vaccinate their children, according to Simon Haeder, an associate professor of public health at Texas A&M University, who has been tracking vaccine hesitancy for several years.

Although the opposition tends to exist mostly along partisan lines, with Republicans more likely to support vaccine exemptions, Haeder noted that far-left groups — which may tend to be skeptical of medicines in general — also support the loosening of vaccination requirements.

“The scientific skepticism and opposition to state interference and the partisan nature of this issue has really escalated, starting during the COVID years,” Haeder told Stateline.

“It’s very hard for states right now wanting to increase vaccination requirements,” he said.

Among kindergartners, national coverage dropped from about 95% for all vaccines in the 2019-2020 school year to about 93% for all vaccines in both the 2021-2022 and 2022-2023 school years, according to the CDC.

Nonmedical exemptions account for more than 90% of all approved vaccination exemptions and are allowed in all but five states. Exemptions increased from 2.2% among kindergartners in the 2019-2020 school year to 3% in 2022-2023, and 10 states reported that more than 5% of kindergartners had an exemption from at least one vaccine.

Jennifer Herricks, a microbiologist and founder of Louisiana Families for Vaccines, an advocacy organization in support of vaccines, has been tracking efforts to relax vaccine mandates since 2015.

“I became a mom. And then it became even more personal for me, especially having those little infants who are too young to get a lot of the vaccines,” Herricks said. “And then you realize that they are vulnerable to these diseases and that they are depending on the people around them to be vaccinated so that they don’t get sick.”

But Jill Hines, co-director of Health Freedom Louisiana, a group that opposes vaccine mandates, said some parents just want the chance to opt out.

“Believe it or not, my children are fully vaccinated. We were never informed of the state’s exemption law,” Hines told Stateline. She added that some in her group feel that vaccine reporting requirements are an invasion of privacy.

“We should not be denied access to society, access to a job, access to an education, simply because we’ve refused medical intervention,” she said.

Growing concern among health professionals

Mississippi, which sits near the bottom of state rankings on most health indicators such as obesity and heart disease, hasn’t had a measles case since 1992.

“We have pushed back all the potentially fatal childhood infections from being commonplace in Mississippi to being extremely rare,” Dr. Daniel Edney, the state health officer, said in an interview.

Immunizations against childhood diseases have been required by state law since 1979 for entry into K-12 schools and day care centers. The mandate has helped Mississippi lead the nation with some of the highest rates of childhood vaccinations, including a vaccination rate of nearly 99% among kindergarteners.

But last year, a federal judge ordered Mississippi to begin accepting religious exemptions after an interest group, Texas-based Informed Consent Action Network, sued the state in federal court. Since then, thousands of exemption requests have poured in.

Mississippi is approaching the approval of more than 2,800 religious exemptions, Edney said. He expects other states also will see more exemptions as lawmakers elsewhere find success with legislation to relax vaccine mandates or increase requirements on opt-out information.

“If you’re going to be against good, sound childhood vaccine policy — the vaccinations that have been proven safe and effective for decades — you need to be against clean water and against proper sewage and food protection,” Edney said.

Dr. John Gaudet, a Mississippi pediatrician for about three decades, said he worried the COVID-19 vaccine controversy would spill into the nation’s ongoing childhood vaccine debate.

“I think there was a point where you would go to the doctor, and you would just kind of take it almost as, ‘Well, this is what the doctor recommended,’” he said. “And so there’s now more of a consumer mentality: ‘Well, the doctor may say this, but maybe that doctor is not trustworthy.’”

Across the country, meanwhile, measles has surged, with at least 132 measles cases reported so far this year, according to the CDC. Two-thirds of those cases are among people under the age of 19, and over half of them have resulted in hospitalizations. The cases have spread to 20 states.

But not, so far, to Mississippi.

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