By Matt Volz | KFF Health News
More than half of the children who attend Munchkin Land Daycare near Billings, Montana, have special needs or compromised immune systems. According to owner Sheryl Hutzenbiler, the children, ranging in age from 4 months to 9 years old, suffer from conditions such as fetal alcohol syndrome, cystic fibrosis and Down syndrome.
“These families came to me knowing that we could provide them with a safe and healthy environment,” Hutzenbiler said. Part of ensuring a healthy environment is a strict vaccination policy, she said, especially for those who are immunocompromised or too young to receive all childhood vaccinations.
When Montana Department of Health officials revived a proposal that would allow people to apply for religious exemptions from vaccination requirements at child care facilities, Hutzenbiler was both dismayed and relieved. Dismayed because allowing more children to take advantage of exemptions could jeopardize the community’s level of immunity needed to ward off highly contagious diseases such as measles and whooping cough. Relieved because as she pored over the proposed regulations, she discovered that her facility, which is licensed to care for up to 15 children, falls into a category of smaller providers that can decide whether to accept unvaccinated children.
“If it came down to where I had to, I had no choice, I would stop enrolling children today,” Hutzenbiler said. “In five years I would be closed.”
Montana, like 44 other statesallows religious exemptions from mandatory vaccinations for school-age children. If the state succeeds in expanding its policy to include child care facilities, it would be the second state this year to add a religious exemption to its vaccination requirements for younger children. Mississippi began to allow such exceptions for schools and day care centers in July after a court ruled that the state’s lack of a religious exemption violated the U.S. Constitution’s Free Exercise Clause.
Until recently, the trend has been in the opposite direction: four states—California, New York, Connecticut, and Maine—have eliminated religious exemptions over the last decade. West Virginia has never had a religious exemption.
But religious exemptions, fueled by the conservative backlash against COVID-19 vaccinations, have entered partisan politics, he said Maria Zieglera law professor at the University of California-Davis who specializes in the law, history and politics of reproduction, public health and conservatism.
“It tends to fall much more along the lines between red and blue states, with progressive states moving toward requiring vaccination in more situations and conservative states moving more toward expanding exemptions,” Ziegler said. “While religious exemptions to vaccinations are not a new issue, they have become polarized in new ways.”
The proposal in Montana is similar to one The state Department of Public Health and Human Services submitted a request last year that a legislative committee temporarily blocked after public health advocates and child care providers objected. Afterwards, in October 2022, Health Ministry officials said they would not enforce a ban on religious exemptions in daycare centers.
“We are committed to ensuring that these families have viable child care options consistent with state and federal law,” said department spokesman Jon Ebelt told the Montana Free Press by the time.
However, there are 45 pages in the state’s latest proposal a 97-page draft new version Due to the change in the licensing requirements for child care facilities, the Ministry of Health would like to extend this exemption to child care facilities where a family can only apply for a vaccination exemption for medical reasons. (There is a religious exemption for vaccination against Haemophilus influenzae type b.)
KFF Health News sent the Department of Health a list of questions about its decision to include a religious exemption in the proposed rule. Ebelt emailed a statement that did not directly address the exception at all.
“The rules package reduces red tape to improve access to child care for hard-working Montana families and ensures that related regulations are consistent with legislative changes mandated by the Legislature in 2021 and 2023,” it says his explanation.
A religious exemption under Montana’s proposed rules would require a child’s parent or guardian to submit a form certifying that the vaccination conflicts with his or her religious belief, custom or practice. Since there is no mechanism to verify the validity of such claims, health experts fear that the number of exemptions would increase and community immunity would decline.
“Exemptions result in fewer people getting vaccinated, which can lead to more outbreaks and more sick children,” said Marian Kummer, a retired pediatrician who practiced in Billings for 36 years.
A community is protected by herd immunity For example, according to the World Health Organization, 95% of the population can be vaccinated against measles. According to Montana, the vaccine exemption rate for kindergarten students was 3.5% in the 2020-21 school year the latest available datawhich makes it fall within this scope of protection.
The Health Department’s proposed changes would also eliminate the requirement that child care facilities keep away infected and unvaccinated children and staff if someone contracts a vaccine-preventable disease, said Kiely Lammers, director of the nonprofit advocacy group Montana Families for Vaccines.
Some have questioned the legitimacy of religious exemptions. A Review of Religions, published in 2013 in the journal Vaccine found “few canonical reasons for refusing vaccination.” And the US Supreme Court has ruled that there are limits on religious and parental rights: “The right to freely exercise religion does not include the freedom to expose the community or the child to communicable diseases or to expose the latter to illness or death,” is the prevailing word in 1944 Prince v. Massachusetts.
The American Academy of Pediatrics has called for the elimination of all non-medical exemptions, including both religious exemptions and exemptions based on personal beliefs, “as they are inappropriate on individual, public health and ethical grounds,” it says a 2016 policy statement.
In Connecticut, plaintiffs challenging the state’s decision to repeal religious exemptions said they objected to the use of fetal or animal cell lines in vaccine research and development. But a three-judge panel for the 2nd U.S. Circuit Court of Appeals wrote in August that religious exemptions do not serve “to protect the health and safety of Connecticut students and the general public” in upholding Connecticut’s decision.
But even in California, where In 2016, non-medical exemptions were abolishedThere are currently efforts to overturn the law. In one Lawsuit filed October 31stSeveral parents, with the support of a conservative law firm, are questioning the constitutionality of the law. One plaintiff, Sarah Clark, said she believes vaccines go against her interpretation of the Bible “because they are a foreign substance and are harmful to the body.” Attorney General Rob Bonta’s office said Nov. 1 that the case had not yet been served but would review the complaint and respond if necessary.
Montana’s proposed rule is scheduled for public hearing on November 13th. Some childcare providers like Hutzenbiler expect it to eventually come into force. She said she is already drafting language to submit to the state under the proposed rules, saying the Munchkin Land daycare will not accept unvaccinated children.
Lammers said state officials should be open to change and give daycare centers with 16 or more children the same opportunity as smaller facilities not to accept unvaccinated children.
“I hope at least we can do it the same across the board,” she said of the proposed rule.
Kummer, the retired pediatrician, said she hopes the proposal generates enough opposition for the state to scrap the religious exemption plans. But she doubts that will happen, given the anti-vaccine sentiment among Montana policymakers.
“It will take a tragedy in our state or elsewhere for people to realize we need vaccinations,” Kummer said.
California News Editor Judy Lin contributed to this report.