More than half of the children who attend Munchkin Land Daycare near Billings, Mont., have special needs or compromised immune systems. The children, ranging in age from 4 months to 9 years, suffer from conditions such as fetal alcohol syndrome, cystic fibrosis and Down syndrome, according to owner Sheryl Hutzenbiler.
“These families came to me knowing that we could provide them with a safe and healthy environment,” Hutzenbiler said. Ensuring a healthy environment includes having high vaccination coverage, she said, especially for those who are immunocompromised or too young to receive the full range of childhood vaccines.
So when Montana health department officials revived a proposal that would allow people to claim spiritual exemptions from vaccination requirements in child care settings, Hutzenbiler was both dismayed and relieved.
Dismayed because allowing more children to qualify for exemptions could undermine the levels of community immunity needed to defend against highly contagious diseases like measles and whooping cough.
Relieved, because in reading through the proposed laws, she discovered that her facility, which is licensed to serve up to 15 children, is also in a category of small providers that would choose whether or not to enroll unvaccinated children. .
“If it got to the point where I wanted it, I had no choice, maybe I would stop enrolling kids today,” Hutzenbiler said. “In 5 years I might be closed.”
Montana, like 44 other states, allows spiritual exemptions from vaccination requirements for school-age children. If the state succeeds in expanding its child care policy, it will do so for the second time this year to add a religious exemption to its vaccination requirements for young children. Mississippi began allowing such exemptions for schools and child care facilities in July following a court ruling that the state’s lack of a religious exemption violated the Education Clause free of the American Constitution.
Until not long ago, the trend was in the opposite direction, with four states – California, New York, Connecticut and Maine – eliminating spiritual exemption policies over the past decade. West Virginia has never had a religious exemption.
But spiritual exemptions, fueled by conservative backlash against COVID-19 vaccinations, have become tied to partisan politics, said Mary Ziegler, a UC Davis law professor specializing in law, the copy history and politics, health and conservatism.
“This tends to break down more along red-blue state lines, where progressive states lean toward requiring vaccines under additional conditions and conservative states lean more toward expanding restrictions. exemptions,” Ziegler said. “So while spiritual exemptions for vaccines are not a new concern, they have become polarized in a whole new way.
Montana’s proposal is similar to one floated by the state Department of Public Health and Human Services last year, which a legislative committee quickly blocked after opposition from public health advocates and providers child care. Subsequently, in October 2022, health department officials said they could not enforce a ban on religious exemptions in child care settings.
“We are committed to ensuring these families have viable child care options consistent with state and federal law,” department spokesperson Jon Ebelt told the Montana Free at the time Press.
However, in the state’s latest proposal, 45 pages into a 97-page proposed rewrite of child care licensing rules, the health department seeks to extend this exemption to child care facilities, where a family can now request a vaccine exemption for medical reasons only. causes. (There is currently a spiritual exemption for the Haemophilus influenzae type B vaccine.)
KFF Health Information sent the health department a list of questions about its decision to incorporate a religious exemption into the proposed guidelines. Ebelt emailed a press release that did not address the exemption at all.
“The set of principles cuts the red ribbon to expand access to child caretakers in hard-working families in Montana and ensures associated laws align with statutory changes ordered by the Legislature in 2021 and 2023 “, indicates its press release.
Montana’s Religious Freedom Restoration Act prohibits the state from infringing on an individual’s right to follow the path of faith. Another law prohibits discrimination based primarily on vaccination status.
A religious exemption under Montana’s proposed rules would require the mother or father or guardian of an infant to submit a form attesting that vaccination is contrary to their spiritual perception, observance or practice. Without a mechanism to verify the validity of such claims, health professionals fear that exemptions will increase, thereby reducing herd immunity levels.
“Exemptions lead to fewer people being vaccinated, which could lead to more outbreaks and more sick children,” said Dr. Marian Kummer, a retired pediatrician who practiced in Billings for 36 years.
The risk of disease outbreaks would increase not only in these child care settings but also in communities, said Sophia Newcomer, an associate professor at the University of Montana College of Public and Community Health Sciences.
A group is protected by herd immunity against measles, for example, if 95% of the population is vaccinated against that disease, according to the World Health Organization. Montana’s vaccination exemption rate among kindergarten students was 3.5% during the 2020-2021 school year, according to the most recent data available, putting it within that safe range.
Some have questioned the legitimacy of religious exemptions. Most religions, as well as a majority of Christian denominations, have no theological objection to vaccination, according to a scientific review published in 2013 in the journal Vaccine. And the United States Supreme Court has ruled that there are limits to spiritual and parental rights: “The right to freely apply faith does not include the freedom to expose the group or child to a contagious disease or the latter to health problems or death,” states the 1944 decision in Prince v. Massachusetts.
The American Academy of Pediatrics has called for the elimination of all nonmedical exemptions, including spiritual exemptions and personal belief exemptions, “as inappropriate for individuals, public health, and moral reasons,” according to a policy of 2016. declaration.
In Connecticut, plaintiffs challenging the state’s decision to remove spiritual exemptions said they opposed the use of trace amounts of fetal or animal cells in vaccine research and development. However, a three-judge panel of the Second U.S. Circuit Court of Appeals wrote in August that the spiritual exemptions did not serve “to protect the welfare and safety of Connecticut students and the general public” when it upheld Connecticut’s decision.
But even in California, which eliminated non-medical exemptions in 2016, efforts are underway to overturn the legislation. In a lawsuit filed Oct. 31, several parents backed by a conservative legislature challenge the constitutionality of the law. One plaintiff, Sarah Clark, said she believed vaccines went against her interpretation of the Bible “because they are a foreign substance and are dangerous to the body.” Atty. Gen. Rob Bonta’s office said the next day that it had not been briefed on the matter but would nonetheless evaluate the criticism and respond as acceptable.
Montana’s proposed rule is scheduled for a public hearing on November 13. Some child care providers, like Hutzenbiler, expect it to finally take effect. She said she is already drafting language to submit the state as required under the proposed guidelines, saying Munchkin Land Daycare would not accept unvaccinated children.
Kiely Lammers, director of the nonprofit advocacy group Montana Families for Vaccines, said state officials should be open to changes and offer child care settings with 16 or more children the same opportunity as smaller establishments not to enroll unvaccinated children.
“I hope at the very least that we achieve a balance in all areas,” she said of the proposed rule.
Kummer, the retired pediatrician, said she hopes the proposal will generate enough opposition for the state to scrap plans for a spiritual exemption. However, she doubts that could happen, given the anti-vaccination sentiment among Montana policymakers.
“It will take a tragedy in our state or elsewhere for people to realize we need vaccinations,” Kummer said.
California News Editor Judy Lin contributed to this report.
This text was produced by KFF Health Newsa national newsroom that produces in-depth journalism on health issues.