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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 was a primary contributing factor. 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 other medical attitudes and decisions and thus other possible effects or correlations with exemption selection.

Knight, A. (2004). Religious Exemptions to North Carolina's Childhood Immunization Requirements. School Law Bulletin (Fall): 12-9.

This researcher examines the problem of exemption from a legal angle, focusing on North Carolina as a specific test state. Religious exemptions are the only non-medical exemptions allowed in this state, which leads to an inflated number of religious exemption claims according to the research and the reasoning. This author provides an extensive historical background on the issue while also discussing the modern implications of solely allowing religious exemptions, with the fact that many religious exemptions might not actually be so providing a valuable piece of information to the research at hand.

Omer, S., Pan, W., Halsey, N., Stokley, S…. & Salmon, D. (2006). Nonmedical Exemptions to School Immunization Requirements. JAMA 296(14): 1757-63.

These authors found that states offering personal belief and other non-medical exemptions saw higher exemption rates from vaccines than states with religious-only exemptions, as did states with easier exemption processes. In both scenarios, incidence of pertussis was closely associated with the ease of obtaining exemptions and the availability of non-religious exemptions, and also correlated with actual exemption rates -- the higher the rate of exemption, the greater the incidence of pertussis. While these results are largely expected, they are also more detailed than many and serve as highly important affirmations of the empirical evidence for the effects of religious and non-religious exemptions to mandated vaccinations.

Ross, L. & Aspinwall, T. (1997). Religious Exemptions to the Immunization Statutes: Balancing Public Health and Religious Freedom. The Journal of Law, Medicine, & Ethics 25(2-3): 202-9.

Though studying the issue explicitly from a legal and ethical perspective, these authors discuss the medical impacts and the larger medical findings and guidelines regarding vaccinations and exemptions in their attempt to determine what is and should be legal. The idea that refusal to vaccinate or exemption from vaccination could be treated as neglect is discussed, any idea opposed by the American Academy of Pediatrics despite the fact that this organization has argued for the repeal of religious exemption statutes in vaccination mandates. Again, both medical and legal questions are raised that provide extensive context for the research.