ITHACA, N.Y. — New York State passed legislation eliminating religious exemptions to school vaccine requirements in June. In Ithaca, where vaccination rates are low in several schools, public health advocates and school administrators are hopeful that the new law will improve community immunity. Some parents who were previously granted religious exemptions, however, say they may pull their kids out of school rather than vaccinate.
By repealing the religious exemption for vaccinations, New York mandated that all children who attend daycare, preschool, or school get vaccinated unless they have a medical condition that makes vaccinations unsafe. The legislation directly affects about 26,000 students statewide who were exempt from vaccination requirements in the 2017-18 school year. In Tompkins County, about 280 kids are impacted.
Gov. Andrew Cuomo said the repeal of all non-medical exemptions was necessary to curb the worst outbreak of measles in New York since 1991. Between Sept. 2018 and Aug. 2019, 654 measles cases were confirmed in New York City and 414 in the rest of the state. The outbreaks were concentrated in communities with low vaccination rates.
“The science is crystal clear: Vaccines are safe, effective and the best way to keep our children safe. This administration has taken aggressive action to contain the measles outbreak, but given its scale, additional steps are needed to end this public health crisis,” Cuomo said in a press release announcing the legislation. “While I understand and respect freedom of religion, our first job is to protect the public health and by signing this measure into law, we will help prevent further transmissions and stop this outbreak right in its tracks.”
According to public health experts, at least 95% of people need to be vaccinated to achieve “community immunity” or “herd immunity,” effectively shutting down channels through which measles — and other diseases vaccines protect against, like mumps, rubella, and chickenpox — spread. Reducing the number of people who can transmit measles and other diseases protects people who can’t be vaccinated, like newborn infants and people with contraindicated medical conditions.
“This law was written because vaccines prevent death and permanent disability. Having 95% or more of children in a community vaccinated helps to prevent the spread of disease. Children who have medical exemptions are not able to be protected, except by having the vast majority of our community immunized. This helps to prevent a child that cannot be vaccinated from being exposed to the disease, helping them (and all of us) live longer and healthier lives,” Dr. William Klepack, medical director for the Tompkins County Health Department, wrote in a public letter.
What are religious and medical exemptions?
New York’s school vaccination requirements had two carve-outs until June: students whose parents or guardians said vaccination conflicted with their religious beliefs, and students with a medical contraindication, who would be at risk of a serious adverse reaction to a vaccine. Heading into the 2019/20 school year, religious exemptions are eliminated and medical exemption regulations have been tightened.
Students who previously had religious exemptions will be required to show that they are up to date on shots by 14 days after the first day of school. Depending on the student’s age and whether they had received any vaccinations before, that could mean showing proof of a first course of vaccines or of timely booster shots in keeping with recommended or “catch-up” schedules issued by the Centers for Disease Control and Prevention.
Samantha Hillson, director of health promotion for the Tompkins County Health Department, said community health nurses are working with school nurses and administrators to make sure information from Albany reaches local parents. “Community health nurses have been really constantly educating healthcare providers and school nurses with all the information that is coming out from the state,” Hillson said. She said school nurses are prepared to offer individualized information to parents.
To qualify for medical exemptions, students will need documentation from a licensed physician indicating which vaccines they are unable to receive and the specific medical condition preventing vaccination. This requirement is more stringent than in the past, when doctors could issue letters to schools without explaining the medical justification for an exemption. The rules were tightened via an emergency regulation issued by the New York State Department of Health and Office of Children and Family Services in August, due to concerns that parents denied religious exemptions would seek medical exemptions without legitimate medical reasons. After California removed non-medical exemptions in 2015, the rate of medical exemptions granted in the state tripled, according to the New York DOH.
Students who do not have proof of vaccination or a valid medical exemption by 14 days after the start of school will not be allowed to attend. These rules apply to public and private schools, as well as preschools and day care centers.
Local impact
Tompkins County will feel the impact of the new legislation more than most counties in the state, due to high rates of religious exemptions. About 280 students in Tompkins County had religious exemptions in the 2017-18 school year, with the lowest vaccination rates clustered at four schools: Ithaca Waldorf School, New Roots Charter School, Lehman Alternative Community School, and Fall Creek Elementary School.
As of 2017-18, those four schools had measles vaccination rates below 95%, which is considered the threshold for herd immunity.
About a third of Ithaca Waldorf School students had religious exemptions in 2017-18 and had not received measles vaccines, according to data from the New York DOH.
Emily Butler, director of school administration and doctor of veterinary medicine, said IWS has consistently adhered to the regulations as set out by the Department of Health, as the rules apply to all schools. She said it is not in the school’s purview to take a position regarding the scientific consensus that vaccines are safe and help prevent the spread of disease, but said IWS has always respected parents’ religious beliefs in keeping with state law prior to June.
“We are definitely not an anti-vax school,” Butler said. “We are pro-science, but we also deeply value people’s sincere and genuinely-held religious beliefs. Religious beliefs are really valued here and don’t belong in the purview of the state.”
In the past, Butler was responsible for approving religious and medical exemptions, in consultation with the school nurse provided by the Ithaca City School District. Parents of students who were granted an exemption needed to sign a contract agreeing to keep their kids home from school during a disease outbreak and for the appropriate incubation period after the outbreak was contained, Butler said. She said no measles cases have been diagnosed in kids enrolled at the school.
Butler said the school emailed parents of students with religious exemptions the day after New York’s legislation was passed and followed up with specific information about vaccine timelines to bring students into compliance. She said they tried to send the message, “We will make every effort to work with your family to make sure this process is as smooth as possible.” Several Waldorf families have opted out, however.
As of Sept. 1, Butler said about 10 to 12 kids from six families canceled their enrollment contracts. As a small, private school that relies on tuition, the drop in enrollments definitely impacted IWS’s bottom line, Butler said.
Principals from New Roots, LACS and Fall Creek Elementary did not respond to interview requests. Ithaca City School District Board of Education member Sean Eversley Bradwell said principals and district administrators have sent three letters to families with a religious exemption on file to provide information about bringing their kids into compliance.
Before the new legislation, religious exemption rates at Fall Creek and LACS were already trending slightly downward. Fall Creek religious exemptions peaked at about 14% in the 2013-14 school year and fell to about 7% in 2017-18 according to data reported to the New York DOH. LACS religious exemptions peaked at about 16% in the 2015-16 and 2016-17 school years, before falling slightly to about 14% in 2017-18.
In 2017, ICSD began reviewing religious exemptions more stringently and, controversially, revoking those judged illegitimate. While 2018-19 data is not yet available at the individual school level from the DOH, the number of religious exemptions fell across the district. About 3.5% of ICSD students had religious exemptions in 2017-18, compared to 2.4% in 2018-19.
Eversley Bradwell said 133 students had a religious exemption on file last year, and that he expects vaccination rates will go up with the repeal of those exemptions.
“Beyond outreach, the new law is expected to bring schools with low vaccination rates into compliance as the new law removes religious exemptions,” he said via email.
He said as of Aug. 30, the district could not confirm whether students would be pulled out of the school district due to the new law. “While ICSD Administrators have been in conversation with families who are considering un-enrollment, at this time, the District is unable to provide a number of students who have un-enrolled.”
Parents who choose not to vaccinate their kids will be required to homeschool, unless they move to a state that allows religious or personal belief exemptions. Students with disabilities will still be eligible for special education services, pursuant to an individualized education services plan, which parents must request in writing through the Board of Education, according to guidance issued by the New York DOH.
Objections to the new law
Parents whose kids previously had religious exemptions, along with activists and advocates who oppose vaccine mandates, have argued that the New York legislation infringes on their religious freedom and unfairly denies educational services to unvaccinated kids.
Attorneys Robert F. Kennedy Jr. and Michael Sussman, who have represented parents and activists opposed to vaccination in multiple lawsuits, filed cases this summer arguing New York’s law violates the First Amendment of the U.S. Constitution by restricting religious practice and the Individuals with Disabilities Education Act by barring unvaccinated kids with disabilities from in-school special education services. The courts have upheld the legislation in both cases, refusing to stop or delay the implementation of the vaccine mandate.
In the New York State Supreme Court in Albany County, Judge Denise A. Hartman released a decision on Aug. 23 denying a preliminary injunction, which would have delayed the implementation of the legislation. Hartman’s decision cites decades of precedent upholding states’ authority to require vaccinations to achieve community immunity.
In the IDEA case filed in the U.S. District Court Eastern District of New York, Judge Allyne R. Ross likewise refused to delay the law’s implementation. The legislation, she wrote, applies equally to all students. If kids lose school services, it is because their parents have made an affirmative choice not to vaccinate them, Ross’s decision holds.
Sujata Gibson, an Ithaca attorney who has served as a legal resource for parents seeking religious exemptions in the Ithaca City School District, said New York pushed through the repeal of non-medical exemptions too hastily, creating “a situation that’s total chaos.” California’s repeal, she said, left an exemption in place for students with disabilities, so they could continue to receive in-school services without being vaccinated.
Gibson said she’d heard from local families who were expecting to receive special education services through summer programs but who had to keep their kids home after the law took immediate effect on June 14. “A lot of these families are kind of panicking,” Gibson said.
Mary Archin, who operates Lovely Day Preschool for infants to three-year-olds at her home, said she’s enrolled kids from several families over the years who either objected to vaccines on religious grounds or who were waiting until their kids were older before starting vaccinations. She said her daycare is fully enrolled for the coming year but is worried the new requirements will cut into daycare enrollments going forward and will limit parents’ options for daycare placements. She said she has spoken to other home daycare operators who have reduced their hours or closed because unvaccinated kids are no longer eligible to attend.
Several local parents are considering pulling their kids out of public and private schools and preschools, according to a parent who asked to remain anonymous. A group of Ithaca area parents has participated in webinars to learn about homeschooling requirements and to come up with alternatives to school programs, the parent said.
Looking ahead
By two weeks after the start of school, the deadline for proof of vaccination, all Tompkins County Schools should be comfortably above the community immunity threshold. Covenant Love Community School has the highest rate of medical exemptions in the county, at 2.3% in 2017-18, with all other schools reporting a medical exemption rate below 2%.
While some parents who had religious exemptions plan to unenroll their kids, more are expected to bring their kids into compliance with the vaccine schedule. Karen LaCelle, a community health nurse with the Tompkins County Health Department, said their vaccine clinic has been busier than usual this summer as kids get caught up with requirements. She said the office hasn’t received more requests for immunization records than usual from families moving out of state.
LaCelle said she is confident vaccination rates will increase, which will boost public health.
“The higher the immunization rate, the more protection afforded to the vulnerable who can’t be vaccinated,” she said.
Hillson said the department has been working with school administrators and nurses to share information from the state DOH and ensure schools and parents have accurate information about vaccines. “We’re always trying to promote the message that vaccines prevent disease and that really they’re meant to protect those who cannot be immunized or fully immunized, those who are most vulnerable,” she said.
Featured image courtesy of SELF Magazine/Flickr