Assessing factors and gaps in the implementation of philosophical exemptions to school immunization requirements

Several states exempt students from school immunization requirements based on a parent's philosophical or personal belief against vaccinations. The availability of philosophical exemption has ebbed and flowed over the years. In 1990, 22 states allowed philosophical exemptions; by 2000, the number fell to 14 with many states abolishing the exemption. Currently, 20 states have laws authorizing philosophical or personal belief exemptions. A number of other states, including Kansas and South Dakota, are now considering legislation to add this type of exemption. A 2006 review of Arkansas' philosophical exemption in the American Journal of Preventive Medicine found that the number of granted exemptions increased from 529 to 1145 over a four-year period. During that same period the percentage of exemptions that were non-medical exemptions (e.g., philosophical exemptions) rose from 79% to 95%. Another 2006 study in the Journal of the American Medical Association concluded that philosophical and easily granted exemptions are associated with an increased incidence of pertussis. Public health law researchers have also investigated the restrictiveness of state law (i.e., the extent to which state law discourages or prevents an exemption) for non-medical exemptions. This presentation will examine how philosophical exemption laws in different states (e.g., Michigan and Wyoming) have been interpreted and implemented, explore the various state and local actors that manage philosophical exemption requests, and recommend changes to philosophical exemptions laws to better protect students and public health.