by Anne Zimmerman, JD, MS
Vaccination hesitancy calls for a social sciences approach, not merely a public health data driven solution, nor necessarily a legal one. Nonmedical costs of eliminating religious exemptions should be considered. Ending religious exemptions risks increasing rights extremism and suffering its societal effect on all other public policies. By bringing those who are fighting to preserve the religious exemption into the discussion, a unified approach or compromise may be possible. Alienating them may cause more harm than good.
When rights-based activists protest, as they did in Connecticut this week and in New York last year, they empower a movement that effects issues well beyond vaccination. The timing in Connecticut and New York was terrible—and could lead to decreased acceptance of COVID-19 vaccines. The 2018 and 2019 measles cases were essentially contained to areas well below the herd immunity threshold and the cases primarily affected those who made the choice to take the risks associated with being unvaccinated, risks increased by the failure to surround oneself with vaccinated people. In Brooklyn in 2019, during the measles outbreak, public health officials increased vaccination rates through awareness and collaboration with religious and community leaders. The public health outreach raised the vaccination rate from under 80 percent to over 91 percent quickly. Approaches must continuously focus on local communities where herd immunity is not met. Public health officials and the media spotlight vaccination protests giving them more heft. The protests began in the 1800s and are unlikely to stop now.
Is eliminating religious refusals for all required vaccines a fight we want to fight? I am uncertain.
Middle ground could be eliminating the religious exemption for the measles vaccine only or for the MMR. It also could be county-based rather than statewide. (There could be legal issues if an exemption were pulled only in a religious community, but public health has a local tradition.) Then, as COVID-19 vaccines are approved and possibly required, there would be precedent that outbreaks might call for the narrow elimination of religious refusals, and depending on herd immunity, exemptions could be dialed back. There are many ways to address localities not reaching herd immunity through campaigns designed to appeal to the reasons they have chosen to avoid a particular vaccine.
Eliminating religious and philosophical exemptions risks fueling “Trumpism” and its rights absolutism. Alienating and angering those opposed to vaccination will allow them to frame remaining unvaccinated as a moral good, an exercise of religious freedom. The goal of widespread vaccination leading to herd immunity may be reached with improvements in transparency, public trust, and communication. Measles and COVID-19 are fact patterns that call for taking vaccination seriously. Encouraging the vaccine hesitant to unite and organize during the pandemic represents a lost opportunity to look to reason and middle ground.
Public health is important. It would come from policies that support wellbeing, prevention, education, and access to care. Public health is not the only body of public policy that affects health. Extreme views of rights threaten gun control, a government role in access to healthcare, and funding for social programs that encourage good health. If freedom were to mean no minimum wages, no public spaces free of guns, and corporate free speech drowning out that of individuals, to many of us that would not feel like freedom. If people are aggravated by losing the religious exemption, something that absent an emergency and in areas with herd immunity arguably should enjoy First Amendment protection, they will ensure the future of Trumpism. In the end, that may be a pyrrhic victory.