The Pediatric Infectious Diseases Society (PIDS), whose membership constitutes individuals dedicated to the treatment, control, and eradication of infectious diseases in children, opposes legislation or regulations that would allow children to be exempted from school and childcare immunization requirements based on their parents’ personal or religious beliefs (non-medical exemptions). Exemptions from school and childcare requirements can lead to outbreaks of disease.

All states allow children who have medical contraindications to vaccination to be exempted from state requirements. Most states also allow for exemption based on religious beliefs, and some states allow for exemption based on the secular personal beliefs of the parents. Expansion of these non-medical exemptions in many states has led to declining vaccination rates, with consequent increases in the incidence of vaccine-preventable diseases. This has been seen with recent outbreaks of measles, which is highly transmissible, can be associated with extreme disability and death, and is effectively prevented through vaccination. While claims of associations of these vaccines with neurologic disease or autism are false, many parents cite these fears as reasons to avoid vaccinating their children. In states with non-medical exemptions, these parents make the choice to leave their children susceptible to disease, and the data unequivocally show that, as a result, children are harmed. Importantly, it is not just their own children—it is the children of the entire community, who are harmed by a breakdown in the herd immunity that heretofore had protected them.

For these reasons, PIDS opposes non-medical exemptions.

For states that do not presently allow such non-medical exemptions, we strongly encourage them to maintain this stance. States are also encouraged to develop and maintain immunization registries and to publicly report vaccination rates. In states that do allow non-medical-exemptions, we encourage development of legislation to oppose them.

When non-medical exemptions exist or are under consideration, any proposals for non-medical exemptions should require the following:

  • States that adopt provisions for non-medical exemptions must track exemption rates and periodically reassess the impact that exemptions may have on disease rates, in order facilitate public health responses to outbreak situations
  • Children should be barred from school attendance and other group activities as recommended by local and state health departments if there is an outbreak of a disease that is preventable by vaccination from which they have been exempted. Parents who claim exemptions for their children should acknowledge in writing their understanding that this will occur.
  • Parents requesting exemption should receive state-approved educational counseling that delineates the personal and public health benefits of immunization, the scientific basis for safety of vaccines, and the consequences of exemption for their child as well as other children in the community who are vulnerable and cannot otherwise be protected. Parents should sign a statement that delineates the basis, strength, and duration of their belief; their understanding of the risks that refusal to immunize has on their child’s health and the health of others; and their acknowledgement that they are making the decision not to vaccinate on behalf of their child. Parents who claim exemptions should be required to revisit the decision annually with a state-approved counselor and should be required to sign a statement each year to renew the exemption.

Immunizations are one of the most important public health interventions in history. Millions of deaths have been prevented through routine immunizations and tens of billions of dollars have been saved, making childhood immunizations one of the most cost-effective components of our health care system. High levels of immunization are necessary to make sure that vaccine preventable diseases do not return to plague our citizens and communities.