The more difficult problem is religious or cultural groups that oppose
immunizations. These groups tend to cluster, reducing the effective
immunization level in their neighborhoods, schools, and churches. In addition
to endangering their own children, such groups pose a substantial risk to the
larger community. By providing a reservoir of infection, a cluster of
unimmunized persons can defeat the general herd immunity of a community. As
these infected persons mix with members of the larger community, they will
expose those who are susceptible to contagion.
Many physicians, lawyers, and judges believe that the constitutional protection
for freedom of religion includes freedom from immunizations. This is not the
law today, nor has it ever been the law in the United States. The U.S. Supreme
Court, in Jacobson v. Massachusetts,207 held that an
individual could not refuse smallpox vaccination: "We are not prepared to hold
that a minority, residing or remaining in any city or town where smallpox is
prevalent, and enjoying the general protection afforded by an organized local
government, may thus defy the will of its constituted authorities, acting in
good faith for all, under the legislative sanction of the State" (p.
In the later case of Prince v. Massachusetts,208 the U.S.
Supreme Court spoke directly to the issue of religious objections to
- But the family itself is not beyond regulation in the public interest,
as against a claim of religious liberty. And neither rights of religion nor
rights of parenthood are beyond limitation. Acting to guard the general
interest in youth's well being, the state as parens patriae may restrict the
parent's control by requiring school attendance, regulating or prohibiting the
child's labor and in many other ways. Its authority is not nullified merely
because the parent grounds his claim to control the child's course of conduct
on religion or conscience. Thus, he cannot claim freedom from compulsory
vaccination for the child more than for himself on religious grounds. The right
to practice religion freely does not include liberty to expose the community or
the child to communicable disease or the latter to ill health or death.
Despite the clear language of the U.S. Supreme Court, nearly all state
immunization laws provide an exemption for persons with religious objections to
immunization. This creates a large loophole because the Constitution will not
allow laws that favor one religion over another. Christian Scientists are
exempt if they choose to be, but so are individuals who have their own unique
religious beliefs. If a state provides a religious exemption, the state may not
question the validity of the religious beliefs of those who invoke the
State compulsory immunization laws contain these exemptions because few
legislators understand the public health and safety implications of
immunization. No states exempt religious groups from child abuse laws or other
criminal laws intended to protect either children or the general public.
Physicians should make a concerted effort to educate their legislators to the
risks of allowing children to remain unimmunized.