Medical and religious freedom lobbying – bouyed by successes in overturning coronavirus vaccine mandates in some areas – has led to an increasing number of children not receiving childhood vaccinations, threatening a return of deadly diseases, writes MedicalBrief.
For more than 40 years, Mississippi had one of the strictest school vaccination requirements in the US, its high childhood immunisation rates being a source of pride, but in July, it began excusing children from vaccination if their parents cited religious objections, after a federal judge sided with a “medical freedom” group.
Today, 2 100 Mississippi schoolchildren are officially exempt from vaccination on religious grounds, while another 500 are exempt because their health precludes vaccination.
Dr Daniel Edney, the state health officer, warns that if the total number of exemptions climbs above 3 000, Mississippi will once again face the risk of deadly diseases that are now just a memory.
“For 40 years, our main goal has been to protect those children at highest risk of measles, mumps, rubella, polio,” he said, calling the ruling “a very bitter pill to swallow”.
Mississippi is not an isolated case, reports The New York Times. Buoyed by their success at overturning coronavirus mandates, medical and religious freedom groups are taking aim at a new target: childhood school vaccine mandates, long considered the foundation of the nation’s defence against infectious disease.
Until the Mississippi ruling, the state was one of only six that refused to excuse students from vaccination for religious or philosophical reasons. Similar legal challenges have been filed in the five remaining states: California, Connecticut, Maine, New York and West Virginia.
The ultimate goal, say advocates behind the lawsuits, is to undo vaccine mandates entirely, by getting the issue before a Supreme Court that is increasingly sympathetic to religious freedom arguments.
No major religions, including Roman Catholicism, which strongly opposes abortion, have objected to vaccination. But the plaintiffs in these cases say their religious objections stem in part from the use of foetal tissue in vaccine development.
A few childhood vaccines, including those that protect against chickenpox and rubella, were developed with cells obtained from aborted foetuses in the early 1960s. Those cells continue to grow in laboratories today.
The legal push comes as childhood vaccine exemptions have reached a new high in the United States, shows a report from the Centres for Disease Control and Prevention: 3% of children who entered kindergarten last year received an exemption, the CDC said, up from 1.6% in the 2011-12 school year.
A broad majority of Americans continue to believe in the value of childhood vaccines. But in a survey earlier this year, 28% of respondents said that parents should be able to choose not to vaccinate their children, up 12 percentage points from four years ago.
In California, a group of parents backed by Advocates for Faith & Freedom, a non-profit group devoted to religious liberty, filed suit in federal court in October seeking to restore the state’s “philosophical” exemption, which was eliminated after a measles outbreak in 2015.
A federal judge recently allowed a similar case to go forward in Maine, which ended its religious exemption in 2021.
Connecticut, which also did away with its religious exemption in 2021, has faced legal challenges backed by We the Patriots USA, a group based in Idaho.
In August, a divided federal appeals court rejected a constitutional challenge to the state law, and last Friday, a federal judge dismissed a second lawsuit.
Preventing deaths
Public health experts regard vaccination as a singular triumph. The WHO says up to 5m deaths worldwide are prevented annually by vaccines for diseases like diphtheria, tetanus, pertussis, influenza and measles.
In the US, measles alone once killed 400 to 500 people each year and whooping cough deaths numbered in the thousands, while polio left more than 15 000 paralysed, according to the CDC.
If vaccination rates dip much below 95%, public health experts warn, those diseases will become more than just a memory.
“It’s a dangerous game we’re playing,” said Dr Paul Offit, the director of the Vaccine Education Centre at Children’s Hospital of Philadelphia.
“If we eliminate school vaccine mandates, measles will be the first vaccine-preventable disease to come back, and it will come roaring back. Why would we want to put children in harm’s way again?”
The Mississippi case offers a window into the political forces shaping these trends. The plaintiffs in the case included members of Mississippi Parents for Vaccine Rights, a group founded in 2012 by MaryJo Perry, who said her path into advocacy began after her youngest son, now 20, experienced seizures after routine vaccination.
Seizures are a rare occurrence after vaccination. A large-scale study of more than 265 000 children identified 383 who had vaccine-related seizures, or less than two-tenths of 1%. Nearly all children who have post-vaccination seizures recover completely.
Years of activism
Mississippi had a religious exemption until the state’s Supreme Court struck it down in 1979, reasoning that protecting Mississippi schoolchildren “against the horrors of crippling and death” from polio and other infectious diseases superseded religious claims. The state has had high childhood vaccination rates as a result.
“For many years, it was one of the few things Mississippi has done well,” said Dr Anita Henderson, a paediatrician in Hattiesburg and a past president of the state’s chapter of the American Academy of Paediatrics.
“About 99% of our kindergartners have been fully vaccinated, and Mississippi has not seen a case of measles in more than 30 years.”
But Perry and her group tried for years to change the law, holding lobbying days to push Mississippi’s legislature to add a “personal belief” exemption to state law. However, the legislation never passed.
In 2016, Perry met Del Bigtree, a former TV producer who had partnered on a documentary with Andrew Wakefield, the British doctor behind the discredited theory that vaccines are linked to autism. Their film, Vaxxed, took aim at the drug industry and was a hit with Perry’s group.
Bigtree later travelled to Mississippi to testify on behalf of legislation that the organisation was supporting to expand vaccine exemptions.
He said the success of the film prompted him to found the Informed Consent Action Network aimed at giving people “the authority over your health choices and those of your children” and to end “medical coercion”.
It funded the Mississippi lawsuit, and spends millions of dollars on legal work.
Bigtree says his work is non-partisan. But on 6 January 2021, he addressed a “medical freedom” rally close to the pro-Trump crowd that stormed the US Capitol.
Public health experts say the purpose of vaccination is to protect entire communities. and that making immunisation a personal choice puts vulnerable people, including those who cannot get vaccinated for medical reasons, at risk.
Last year, a measles outbreak in Ohio infected 85 children, nearly all of them unvaccinated. No one died, but 36 children were hospitalised.
States have long had the legal authority to require vaccination as a condition of school enrolment. As far back as 1905, the Supreme Court ruled in Jacobson v. Massachusetts that a state had the right to “protect itself against an epidemic” by requiring citizens to be vaccinated against smallpox or pay a fine.
But the coronavirus pandemic has seen a “dramatic shift” in public health jurisprudence – especially in cases involving religious liberty, said Wendy Parmet, an expert in public health law at Northeastern University.
A legal victory
The Mississippi case was filed last year, and Edney, the state health officer, was one of the defendants.
During a hearing in April in Federal District Court in Gulfport, Paul Perkins, a Baptist pastor, testified that the state’s vaccination requirement prevented him from enrolling his own daughter in the Christian academy that he runs.
The case put Edney and the Mississippi State Board of Health at odds with the state Attorney-General, Lynn Fitch, who argued that an existing religious freedom law required the state to offer religious exemptions.
At the hearing in April, the judge, Halil Suleyman Ozerden, ordered the state to begin accepting requests for religious exemptions, setting a mid-July deadline for Edney to set up a process for offering them.
The judge made his ruling final in August, finding that Mississippi’s vaccination requirement had violated the constitutional rights of the plaintiffs, who, he said had “sincerely held religious beliefs about vaccination”.
Edney said he decided not to appeal, fearing that the case would go to the Supreme Court and that the state’s vaccination requirement would be struck down entirely.
Instead, he said, the state was working to ensure that parents seeking exemptions have “deeply held” beliefs, including by requiring them to watch an educational video about “the millions of lives that have been saved and continue to be saved” by vaccination.
Bigtree hailed the suit as a “landmark, historic case.” In the wake of its victory, his group trumpeted its support for similar legal challenges in other states.
See more from MedicalBrief archives:
Vaccine hesitancy sees drop in childhood jabs post pandemic – Unicef
WHO, Unicef flag worst decline in childhood immunisations in 30 years
Comprehensive study debunks, again, the MMR/autism link