It Is Time to Roll Back Religious and Philosophical Exemptions to Childhood Vaccination Mandates

For the first time in 35 years, two unvaccinated people have died from measles in Lancaster County, Pennsylvania, amidst the largest outbreak in decades. Add those deaths to the two unvaccinated children who died in Texas from measles in 2025. Then add the death of the infant too young to be vaccinated in Mississippi who died from whooping cough last year, where public officials pointed to unvaccinated adults potentially endangering the unvaccinated. As herd immunity declines, it’s not just the deaths, but also the dozens of hospitalizations, which put a strain on already strapped healthcare systems. Herd immunity is being compromised by politicians and bad actors. This suffering and death are preventable. And do you know who is responsible? Obviously, the White House and RFK, Jr. bear responsibility for encouraging vaccine ignorance and avoidance. RFK, Jr. has called himself a “measles survivor,” and said five years ago in Lancaster County that the “cure for measles is chicken soup and vitamin A,” where he praised their low vaccination rate. With two deaths there now, though, there are calls for his removal. They are also the reason this extremely important public health issue has been politicized to the point of killing children. The anti-vaxx movement has no conscience when it comes to the facts of outbreaks, with RFK, Jr. asserting falsely that only one person died in Pennsylvania from measles, and never taking responsibility for the 83 deaths from measles in Samoa that he fomented. It Is Up to the States to Protect Children from Measles, RFK, Jr., and Trump There is also blame to be apportioned at the state level: Lawmakers in each state with religious and/or philosophical exemptions are the ones creating a glide path for parents to endanger their children by failing to vaccinate them. Pennsylvania has the most lax vaccine exemption law possible as it permits religious and philosophical exemptions, which is undoubtedly fueling the largest measles outbreak since 1992. It is widely known that the Mennonites and Amish avoid vaccinating their children, and a major center for the Pennsylvania outbreak is in the county where they are prevalent, Lancaster, but it is also affecting 27 other counties. There is further evidence that parents in the Philadelphia area are not vaccinating their children at the rates that preceded this outbreak. Historically, states with high vaccination rates and no religious exemptions have had fewer illnesses and deaths than those with exemptions. West Virginia and Mississippi have been leaders in child vaccination rates with no vaccine exemptions except for medical reasons, which translates into better health for all citizens in those states. Following the rise of the MAHA and conservative Christian anti-vaxx initiatives, these states’ excellent records on child health have been threatened in the courts. Lawsuits in each state have gone different directions, with the West Virginia Supreme Court staying a lower-court ruling for the religious claimants pending appeal, and protecting public health for now. Conversely, a Mississippi federal court ordered religious exemptions, which has contributed to the downturn in vaccination rates in that state, and the infant who died from whooping cough. Mississippi provides an excellent example of the toxicity of extreme religious liberty reasoning. In 1979, in Brown v. Stone, the state’s highest court held that religious exemptions are unconstitutional because they endanger other children. That court’s reasoning is well worth repeating in this era of self-referential religious liberty claims. Here is a court considering religious liberty and the public good at the same time: The protection of the great body of school children attending the public schools in Mississippi against the horrors of crippling and death resulting from poliomyelitis or smallpox or from one of the other diseases against which means of immunization are known and have long been practiced successfully, demand that children who have not been immunized should be excluded from the school community until immunization has been accomplished. That is the obvious overriding and compelling public purpose of [the childhood vaccine mandate]. To the extent that it may conflict with the religious beliefs of a parent, however sincerely entertained, the interests of the school children must prevail. [The vaccine mandate] is a reasonable and constitutional exercise of the police power of the state insofar as it provides for the immunization of children before they are to be permitted to enter school. Thus, only medical exemptions were permitted, which kept the number of non-vaccinated children low and within the boundaries needed to maintain herd immunity. That is a rational decision that guaranteed the greatest protection against deadly disease for the greatest number, so we should all support it. In this topsy-turvy era, though, when religious exemptions are out of control and the religious right has weaponized religious liberty to their own ends, a federal court reasoned that because Mississippi has a medical exemption, it was illegal to deny a religious exemption. That is literally comparing apples to oranges. Medical exemptions are subject to the hard cap that the child has to be immunocompromised or allergic to the vaccine, and luckily, that is truly rare, less than 1% of all children. Religious exemptions have no such natural limit. Let’s face it, herd immunity is all in the numbers, so an open door for religious exemptions in a society with so many believers and conspiracy theorists is likely to undermine it. The contemporary religious liberty calculus has weighted religion way too heavily while trivializing the harm, including the deaths, that religion causes. This has to stop. When religious/philosophical exemptions are added to the latest parental rights push, children are victimized, and as a society we owe them more protection than that. Children should have a right to an open future, that is, their parents owe them protection from death at a minimum. What States Need to Do Now That means that the states need to roll back religious and philosophical exemptions, which will require state lawmakers and governors to take up the cause of children, the elderly, and the pregnant despite the religious and anti-vaxx lobby. The trend was moving in that direction before Covid hit. Before 2015, California was a hotbed of anti-vaxxers led by the likes of actress Jenny McCarthy. Then, over the 2014–15 holidays, there was the public spectacle of a measles outbreak at Disneyland. That public health disaster led California lawmakers to eliminate the state’s religious and philosophical exemptions in 2015 so that only medical exemptions remained. The wind was at the back of science and children for a while. Then Covid hit, and the anti-vaxxers and others in social media rabbit holes concocted theories that the Covid mRNA vaccine either didn’t work, was just political, or made people sick. Viruses don’t care about politics, though. Many anti-Covid vaccine advocates died from embracing the politics rather than the facts, as you can see here, here, here, and here. As the Disneyland outbreak faded from public memory, Covid misinformation and disinformation sowed doubts that contributed to a rise in the RFK, Jr./MAHA theory of “vaccine choice.” Then Trump weaponized RFK, Jr. against the American public by appointing him of all things the head of HHS. In turn, good people are falling for this theory of choice that is leading to dangerous conditions for children, the elderly, pregnant women, and the immunocompromised. As vaccine expert Dr. Paul Offit emphasizes, the “choice” is between life and death. Time for state lawmakers to step up. This country knows how to eliminate the measles menace because mass vaccination and public cooperation led to success in 2000. This time around it will take a three-part approach: (1) lawmakers need to eliminate these misguided religious and philosophical exemptions, (2) courts need to reject the wildly unscientific theory that medical exemptions are comparable to religious exemptions, and (3) parents need to get their unvaccinated children to the pediatrician’s office or a public health clinic that will provide them for children without insurance. Lawmakers nationwide often cower in fear of the religious lobbies, valuing their re-election over the welfare of their constituents. The Catholic bishops, though, have given them some nice cover with their recent statement to Florida that no religious exemption is required for childhood vaccines in their view. With the bishops supporting vaccination, those Evangelicals objecting to childhood vaccines might consider the children’s side as well, because the objection from them has been that some were generated by an aborted fetus decades ago, which they believe creates moral complicity in abortion. The Evangelicals did not even oppose abortion until Catholic activist Paul Weyrich persuaded them with promises of more political power in the late 1970s, meaning that if the Catholics are not opposing these vaccines from an anti-abortion stance then neither should they. Setting aside that particular concern, though, the complicity in the preventable deaths of living children must now be taken into account as well. For anyone in a “health” movement like MAHA, one can only hope that the large outbreaks and deaths across the country that are following the reduction in widespread vaccination will help them see the light. I would add that the Trump Administration should rid itself of RFK, Jr. once and for all, but President Trump has shown no interest. Last year’s deaths didn’t move him, and this year’s outbreaks haven’t at least to date. It’s frankly part of the pattern of tolerance for death and suffering present in many of the Administration’s policies, including ICE practices and the elimination of USAID. Could the most recent Pennsylvania deaths change his thinking? Who knows? Senator Bill Cassidy, M.D., knew better but let RFK, Jr. be confirmed based on his lies about future vaccine support. If he seeks to regain any self-worth in the wake of the deaths fomented by RFK, Jr., he should consider urging the House to impeach this dangerous quack. Yet, I hold out no hope that the federal government will take the lead in protecting American citizens from preventable death so long as Republicans and the religious right are in control. The power that can save us lies in the state legislatures, which are much closer to these ill and dying victims. What advanced country chooses to increase preventable disease, suffering, and death? Well, an authoritarian culture that does not care about the vulnerable, e.g., the United States right now. Time for state lawmakers to care and act.