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, [
Jacobson] 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.” [
Jacobson at p. 37.]
In the later case of Prince v. Massachusetts, [
Prince v. Massachusetts, 321 U.S.
158 (1943)] 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.