March 14, 2011

Testimony for Senate Health, Human Services and Senior Citizens Committee on S2625, A bill that “Clarifies statutory exemptions from mandatory immunizations for students.”

Monday, March 14, 2011. Submitted by Dr. Drew Harris, NJPHI Chairma 

Committee Members:

Thank you for the opportunity to speak to you today. My name is Dr. Drew Harris, Chairman of the New Jersey Public Health Institute. I am here to urge the passage of S2625.


We believe that the recently promulgated regulations allowing parents to claim an exemption from mandatory vaccination requirements by a simple statement of religious objection is inconsistent with state statutes, undermines public health and enacts a de facto philosophical exemption contrary to current law.


WHAT IS AT STAKE? A parent’s decision not to vaccinate impacts not just their children, but also everyone they come in contact with. Vaccines protect communities, not just individuals. Unvaccinated children can become the vector through which serious infectious diseases reach those who are too young, immune-deficient or medically compromised to be immunized. Vaccines are not 100% effective, so even properly vaccinated children may still be susceptible to serious infections. High vaccination-compliance rates provide the herd immunity necessary to protect everyone.


Medical research has given us vaccines against a whole host of highly contagious diseases, including: measles, mumps, rubella, diphtheria, bacterial meningitis, chicken pox, polio, hepatitis B, influenza and pertussis. These are serious diseases that not too long ago caused serious injury, long-term disability and sometimes death. In California, a recent whooping cough (pertussis) outbreak killed 10 infants too young to be immunized and sickened 8,383 people in total. Similar outbreaks occurred in Michigan and Ohio. Recent outbreaks of Haemophilus influenza type B and measles, both vaccine-preventable, have occurred in Minnesota and Oregon, respectively. An outbreak of mumps in the New York/New Jersey region this past year sickened 1,521 mostly young people, including 19 who were hospitalized. Universal vaccination is the one public health measure that stands between us and a return to a time when parents lived in dread that one of these killers would strike their child.


LEGISLATIVE INTENT: In the original 1947 statute mandating vaccinations for school children, the Legislature provides for religious exemptions, subject to limits when necessary to ensure public health. In later laws mandating Hepatitis B and meningococcal meningitis vaccinations, the Legislature specifically prohibits philosophical/moral exemptions [...except that a general philosophical or moral objection to the vaccination shall not be sufficient for an exemption on religious grounds. (18A:61D-10.)] while also stating that the reason for granting an exemption must be a "...bona fide religious tenet or practice." Clearly, legislative intent is not to allow broad or specious religious exemptions when vaccines are mandated.


DE FACTO PHILOSOPHIC OBJECTION: As written, the current regulations create a de facto philosophical/conscientious exemption. Parents can claim a religious exemption for their children without having to provide any evidence that the belief is sincere or bona fide. There is no attempt to differentiate the basis of the objection from philosophic, moral or even medical concerns. In fact, the assertion does not need to be internally consistent. Parents can claim a religious exemption while choosing to accept some vaccines or delaying their usage—both of which suggest that the objection is a health-related concern rather than a closely held religious belief.


IMPACT OF REGULATORY CHANGES: Since the weakening of the requirements, the number of children who have been granted religious exemptions has almost tripled between 2005 and 2010, increasing from 2,232 to 5,723 pre-school and school-aged children. While these numbers appear relatively small, our experience tells us that these children are likely clustered in certain school districts, putting their classmates and communities at higher risk for vaccine-preventable diseases.


The significant rise in religious exemptions is not the result of changes in religious practices by families with pre-school and school-aged children. Parents are using the weakened regulations as a loophole to avoid vaccinating their children. Anecdotally, health care providers and public health officials are reporting an increase in the number of parents being granted religious exemptions after they were denied their requests for medical or philosophical ones. A simple Internet search reveals that some are sharing advice on how to assert a religious objection when clearly their concerns are medical or philosophical. For instance, “Carma” wrote on the forum:

“... I came to the conclusion that we need the freedom to decide which vaccine and when we want to vaccinate because we need time to research and we may end up doing selective vaxing[sic]. Our child is at daycare in NJ, so we submitted a religious exemption (with a lot of great help from LI [forum moderator]) to the daycare and it went all right.” 


In the name of good public health, the Legislature should enact religious exemption requirements that are fully consistent with legislative intent and good public health practice. 


Thank you for the opportunity to comment on this important public health policy. Respectfully submitted, Drew A. Harris, DPM, MPH, Chair, NJPHI