Just like other parents, Mahala Clivaz of Lexington has to shake off summer vacation and get her kids ready for school each September. But for years, Clivaz’s back-to-school routine involved more than buying notebooks and pencils for her 10-year-old son, Hugh, who was diagnosed with Leukemia when he was six. Cancer treatment decimated his immune system, making Hugh vulnerable to infection from other kids, including those who are not vaccinated.
“All I could do was ask the school nurse ... to make sure he was in a classroom with only vaccinated children,” she said. “When you have a child who is immuno-suppressed, taking them to a public place is very concerning. You don't want to take them to the supermarket with you, because you don't know who you're going to encounter.”
In Massachusetts, parents can seek two paths to avoid vaccinating their kids. One is a medical exemption for children who face health risks like allergic reactions, which requires documentation from a physician. The other is a religious exemption, which allows parents to refuse vaccines in line with religious beliefs. To get a religious exemption, all a parent or guardian has to do is state "in writing that vaccination or immunization conflicts with his sincere religious beliefs," according to state law.
More than 80 percent of the 920 Massachusetts kindergartners excused from vaccines last year received religious exemptions. The percentage of kindergartners taking religious exemptions reached an all-time high for the 2018-2019 school year, according to Massachusetts Department of Public Health data going back to 1987-1988.
The state's religious exemption faces a challenge in the legislature, where Rep. Andy Vargas of Haverhill has filed a bill to eliminate it.
“When you look at all the major world religions, none of them have denounced vaccines — in fact, even the Catholic Church has told people, 'Hey, vaccinate your kids, this is important,'" Vargas said. "It’s a public good.”
Jennifer Reich, a professor of sociology at the University of Colorado in Denver, said many parents who take religious exemptions for the children aren’t actually religious. According to her research, other factors are behind vaccine refusal.
“We've really set up a culture in the U.S. over the last 20 years of insisting that parents are solely responsible for their own children," Reich said. "We've treated vaccines as a kind of personal consumption product and not really part of public health systems that are really geared towards protecting everyone in the community — not just your own children.”
Reich has found that the parents who are most likely to reject vaccines are white, college-educated and wealthy. They’re also more likely to favor organic food.
"That same conversation about chemicals, about toxins, about artificial products, about pesticides ... also allows parents to question whether vaccines are part of that,” she said. "Lots of parents point to things like breastfeeding or high quality foods, including organic foods, or natural remedies, as superior to vaccines and superior to other kinds of pharmaceutical interventions, because they feel true to this larger conversation about, what does it mean to be healthy, and what does it mean to support health?"
Opponents to Vargas’ bill, like the advocacy group Health Choice Massachusetts, suggest that getting rid of the religious exemption might violate civil liberties.
"[Massachusetts] has achieved one of the highest rates of vaccination in the country without coercive means and exceeds the levels for herd immunity," Health Choice Massachusetts said in a written statement. "Every child deserves a public education without discrimiation [sic] on the basis of race, color, sex, gender identity, religion, national origin, sexual orientation or disabilty [sic]."
But Dorit Reiss, a professor of law at UC Hastings and an expert on vaccine policy, says Vargas' bill is legally sound. Maine recently banned religious and philosophical vaccine exemptions. California, Mississippi and West Virginia also only have the medical exemption.
“You don't have to exempt people from taxes if they have a religious objection to paying taxes, and you don't have to exempt them from school vaccine mandates if they have a religious objection," Reiss said. "If it's a general law, neutral on its face, you don't have to give a religious exemption. It's okay to enforce a general law across the board."
Reiss also said there's no good way for states to determine the sincerity of religious beliefs.
"What ends up happening is that [the exemption] benefits people who are either better liars or have access to legal counsel," she said. "Basically, we have a policy that lets people get out of vaccinating even if their reasons aren't religious. If they can make a convincing argument that isn't true, we have a policy that encourages people to buy in."
Parents who don’t vaccinate their kids tend to cluster. For example, the private Waldorf School of Lexington has the highest exemption rate in Massachusetts. More than 21 percent of kindergartners there got a medical or religious exemption last year. A spokesperson, Laura White, said the school is not anti-vaccine and parents make their own decisions.
The Waldorf philosophy emphasizes that children should learn at a speed that's comfortable, without rote memorization. Waldorf Schools introduce reading later than most public schools, when they feel students are more developmentally ready. The founder of the Waldorf philosophy, Rudolf Steiner, wrote that childhood diseases are a manifestation of the struggle between the hereditary and spiritual parts of the child.
Reich of the University of Colorado said the Waldorf School philosophy can coalesce with vaccine opposition.
"A lot of the understandings of how physiology and biology work within the Waldorf context encourage fewer medical interventions," she said.
For Clivaz, fewer medical interventions for other people has meant less security for Hugh, who is in public school in Lexington.
“Does your view of not wanting to vaccinate your child against a preventable communicable disease that's potentially fatal outweigh my right to have my child safe in the school?” she said. "If their child had a peanut allergy, and you were sitting next to them eating peanuts, they would be up in arms."
It looks like parents will still be able to get religious exemptions for the start of school this fall. Vargas’ bill has been referred to the Committee on Education and is unlikely to come to a vote before then.
Correction: Due to a typographical error in the immunization data from the Department of Public Health, an earlier version of this story incorrectly stated that the Great Barrington Rudolf Steiner School had the highest kindergarten medical/religious exemption rate in the state at 96.7 percent. In fact, the school’s kindergarten exemption rate is 9.7 percent, making it the 10th highest exemption rate in the state.
Our coverage of K through 12 education is made possible with support from the Nellie Mae Education Foundation.
