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Compulsory Immunization

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. 37).

In the later case of Prince v. Massachusetts,208 the U.S. Supreme Court spoke directly to the issue of religious objections to vaccination:

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 exception.

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.

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