More than half of the children who attend Munchkin Land Day Care near Billings, Montana, have special needs or compromised immune systems. The children, who range in age from 4 months to 9 years, have conditions that include fetal alcohol syndrome, cystic fibrosis and Down syndrome, according to owner Cheryl Hutzenbiller.
“These families came to me knowing that we could provide them with a safe and healthy environment,” Hutzenbiller said. Part of ensuring a healthy environment is having a strong vaccination policy, he said, especially for those who are immunocompromised or very young to receive the full slate of childhood vaccines.
So, when Montana health department officials revived a proposal that would allow people to claim religious exemptions from vaccination requirements at child care facilities, Hutzenbiller was both disappointed and relieved. Frustrated, because allowing more children to claim the exemption could compromise the level of community immunity needed to protect against highly contagious diseases like measles and pertussis. Relieved, as he scored the proposed regulations, he found that his facility, which is licensed to care for up to 15 children, would be in a category of smaller providers who could choose whether to enroll unvaccinated children.
“If it came down to where I was, I had no choice, I would stop enrolling children today,” Hutzenbiller said. “In five years, I’ll be off.”
Montana, like 44 other states, allows religious exemptions from immunization requirements for school-age children. If the state is successful in extending its policy to child care facilities, it would become the second this year to add a religious exemption to its immunization requirements for young children. Mississippi began allowing such exemptions for schools and child care schools in July after a court ruled that the state’s lack of religious exemptions violated the U.S. Constitution’s Free Exercise Clause.
Until recently, four states — California, New York, Connecticut, and Maine — bucked the trend, removing religious exemption policies over the past decade. West Virginia never had a religious exemption.
But religious concessions have become mired in partisan politics because of the conservative response to Covid-19 vaccinations, said University of California-Davis law professor Mary Ziegler, who specializes in law, history and reproduction, health care politics, and conservatism.
“It tends to break down much more along the red state-blue state line, with progressive states moving more toward mandating vaccines in more circumstances and conservative states moving more toward expanding exemptions,” Ziegler said. “So, as much as religious exemptions for vaccines aren’t a new issue, they’ve become polarized in a new way.”
Montana’s proposal is similar to one last year by the state Department of Public Health and Human Services, which was temporarily blocked by a legislative committee after public health advocates and child care providers objected. Then, in October 2022, health department officials said they would not enforce the ban on religious exemptions at child care centers.
“We are committed to ensuring these families have effective child care options in accordance with state and federal law,” department spokesman John Ebelt told the Montana Free Press at the time.
However, in the state’s latest proposal, 45 pages into a 97-page draft rewrite of child care licensing rules, the health department wants to expand that exemption to child care facilities, where a family can now claim the vaccine exemption only for medical reasons. (There is an existing religious exemption for the vaccine against Haemophilus influenzae type b.)
KFF Health News sent a list of questions to the Department of Health regarding the decision to include religious exemptions in the proposed rule. Ebelt emailed a statement that didn’t mention a discount at all.
“The rule package cuts red tape to increase access to child care for hard-working Montana families and ensures that related regulations align with statutory changes enacted by the Legislature in 2021 and 2023,” his statement said.
The Montana Religious Freedom Restoration Act prohibits the state from infringing on a person’s right to practice their religion. Another law prohibits discrimination based on vaccination status.
A religious exemption under Montana’s proposed rules would require a child’s parent or guardian to submit a form stating that vaccination is contrary to their religious beliefs, observances or practices. With no mechanism to check the validity of such claims, health professionals worry that exemptions will increase, reducing levels of community immunity.
“Exemptions lead to fewer people being vaccinated, which can lead to more outbreaks and more sick kids,” said Marian Kumar, a retired pediatrician who practiced in Billings for 36 years.
Sophia Newcomer, associate professor at the University of Montana School of Public and Community Health Sciences, said the risk of disease outbreaks would increase not only in those child care centers, but also in communities.
According to the World Health Organization, a community is protected by herd immunity from measles, for example, if 95% of the population is vaccinated against it. Montana’s vaccine exemption rate among kindergartners in the 2020-21 school year was 3.5%, according to the most recent data, putting it within that range of protection.
Kiley Lammers, director of the nonprofit advocacy group Montana Families for Vaccines, said the health department’s proposed changes would also eliminate a requirement that child care facilities keep infected and unvaccinated children and staff away when someone becomes ill with a vaccine-preventable disease.
Some have questioned the validity of religious exemptions. According to a scientific review published in 2013 in the journal Vaccine, most religions, including most Christian denominations, have no theological objections to vaccination. And the US Supreme Court has ruled that religious and parental rights have limitations: “The right to free exercise of religion does not include freedom to expose the community or the child to infectious disease or subsequent ill health or death,” 1944 said. rule in Prince v. Massachusetts.
The American Academy of Pediatrics called for the elimination of all non-medical exemptions, including both religious exemptions and personal-faith exemptions, “as inappropriate for personal, public health, and ethical reasons,” according to a 2016 policy statement.
In Connecticut, plaintiffs who challenged the state’s decision to remove religious exemptions said they objected to the use of embryonic 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 public at large” when it upheld Connecticut’s decision.
Yet in California, which eliminated non-medical exemptions in 2016, efforts to overturn the law are underway. In a lawsuit filed Oct. 31, several parents backed by a conservative law firm are challenging the law’s constitutionality. One defendant, Sarah Clark, said she believes vaccines run counter to her interpretation of the Bible “because they are a foreign substance and harmful to the body.” Attorney General Rob Bonta’s office reported this information. 1 It has not yet been served with the case but will review the complaint and respond as appropriate
Montana’s proposed rule is scheduled for a public hearing in November 13. Some child care providers, such as Hutzenbiler, ultimately expect this to have an effect. He said he is already drafting language to submit to the state under the proposed rule, saying Munchkin Land day care will not accept unvaccinated children.
Lammers said state officials should be open to change and give childcare centers with children 16 or older the same choice as smaller facilities to not enroll unvaccinated children.
“I’m hoping at the very least we can equalize it across all settings,” he said of the rule proposal.
Kumar, a retired pediatrician, said he hopes the proposal will draw enough opposition that the state will scrap plans for religious exemptions. But he doubts that will happen because of the anti-vaccination sentiment of Montana policymakers.
“It’s going to take a tragedy in our state or somewhere else for people to wake up to the fact that we need vaccines,” Kumar said.
California News Editor Judy Lynn contributed to this report.
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