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Religious Exemption
Annotated Bibliography: The Effects of Religious Exemptions on Pertussis and Other Diseases
Abrevaya, J. & Mulligan, K. (2011). Effectiveness of state-level vaccination mandates: Evidence from the varicella vaccine. Journal of Health Economics 30(5): 966-76.
Longitudinal data on the use of varicella immunizations was used to determine the real effects o immunization requirements mandated by various governmental entities within the United States. Significant increases in vaccination rates are found to be the result of such mandates within the first year of adoption, peaking within two years of adoption, and with minimal effects on the rate thereafter. Approximately twenty percent of short run increases in immunization adoption is attributed to mandates, and no differences were found in different socioeconomic groups when it comes to adoption rates. Though this research does not deal with exemptions specifically, it provides context and some direct implications for a discussion and examination of such exemptions.
Aspinwall, T. (1997-8). Religious Exemption to Childhood Immunization Statutes: Reaching for a More Optimal Balance between Religious Freedom and Public Health. Loyola University of Chicago Law Journal 109.
Examining the legal and ethical implications of immunization mandates and religious exemptions, this author examines the effects of both on other elements and institutions of society aside from simple healthcare provision. Evidence of the public health risk that religious exemptions constitute is provided, as is evidence of the erosion of certain principles of liberty if the mandates are not fitted with exemptions. This provides much more detailed and nuanced context for further discussion of empirical evidence.
Etkind, P., Lett, S., Macdonald, P., Silva, E. & Peppe, J. (1992). Pertussis Outbreaks in Groups Claiming Religious Exemptions to Vaccinations. American Journal of Diseases of Children 146(2): 173-6.
After examining four outbreaks of pertussis in Massachusetts that were in close temporal proximity, these authors concluded that religious and philosophical exemptions among the populations of children involved in the outbreak...
The religious and/or philosophical beliefs of many parents and children in these populations extended to a resistance towards the use of antibiotic prophylaxis or therapy as well, which also contributed to the growth and severity of the outbreak. Direct implications of religious exemption and other possibly coinciding issues are discussed here, making it an excellent article for inclusion in this particular research.
Felkin, D., Lezotte, D., Hamman, R., Salmon, D., Chen, R. & Hoffman, R. (2000). Individual and Community Risks of Measles and Pertussis Associated With Personal Exemptions to Immunization. JAMA 284(24): 3145-50.
This population-based retrospective cohort study that examined all reported cases of measles and pertussis among children ages three to eighteen years of age in the state of Colorado found a 22.2 times greater likelihood of measles acquisition and a 5.9 times greater likelihood of pertussis acquisition amongst children exempted from vaccination due to religious or philosophical reasons. Schools with outbreaks of these diseases also had higher numbers of religious/philosophical exempted students, and at least eleven percent of vaccinated children who acquired measles became infected through contact with an exempted child. This research provides clear and concrete data for use in discussing the effects of religious exemption.
Guadino, J. & Robison, S. (2012). Risk factors associated with parents claiming personal-belief exemptions to school immunization requirements. Vaccine 30(6): 1132-42.
These authors note that the record low numbers of vaccine-preventable diseases -- evidence that vaccination programs are working -- has led to a dearth of research regarding parent-claimed exemptions for religious and other reasons. They investigated parental attitudes in identified "exemptor pockets" in Oregon and found that a general distrust of local doctors and heightened concerns about vaccines regardless of their religious or philosophical reasons for selecting exemption. No correlation is suggested by the researchers, however this provides interesting context for the larger discussion of religious exemptions and their relation to…
A seven-year population-based retrospective cohort study of individuals aged five to nineteen years old was used to create a mathematical model of risk associated with measles vaccination, exemption, and infection, and to determine if other patterns could be observed. Exemptors were determined to be thirty-five times more likely to contract measles than those that had been vaccinated, and populations of exemptors tended to be found within certain geographic pockets of close proximity which contributed to outbreak behavior. The model also suggests that a large-scale outbreak was experienced in exemptor populations one year earlier than in the broader population, which has direct implications on the effects of religious exemptions on overall public health and safety.
Siegel, A. & Salmon, D. (2001). Religious and philosophical exemptions from vaccination requirements and lessons learned from conscientious objectors from conscription. Public Health Report 116(4): 289-95.
In addressing both the legal and the practical implications of vaccination mandates and exemptions, the authors assert that states are not actually required to allow religious exemptions for public school entrances. Their findings also suggest that individual educational counseling for parents that object and stringent belief ascertainment by the state can limit the number of exemptions significantly in states that allow them. These recommendations are grounded in commentary on the effects of exemption that is of direct and contextual use to the research at hand.
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