Should school-age children who have not been vaccinated against a communicable disease be kept from school if a classmate has a vaccine-preventable disease?
Judge William F. Kuntz II of the US District Court for the Eastern District of New York says they should, based on a 109 year-old Supreme Court case ruling that gave broad power to states in public health matters.
Benjamin Mueller, in a column written for the New York Times, noted that Judge Kuntz ruled against three families who claimed their "right to free exercise of religion" was violated because their children were kept from school because of New York's immunization policies. The plaintiffs intend to appeal the decision.
There is a resurgence of some of these diseases in areas with low vaccination rates. Overall, New York has high rates of immunizations, but there are small areas that persist in refusing vaccinations. State law requires that all children be immunized before entering school, unless a parent can prove that it violates his religious freedom or if he has a statement from a doctor who declares the vaccinations harmful.
Parents must provide a written explanation of "genuine and sincere" religious objection, which school officials can refuse or accept. Other reasons for objecting to the immunizations are the belief that they can cause autism, because multiple vaccinations at one time can be traumatic for an infant, or for philosophical reasons.
The case that Judge Kuntz cited was a ruling that upheld a $5 fine to a man who refused to be vaccinated during a smallpox outbreak. This case helped establish the government's right to require immunizations as a matter of public health.
According to Daniel Salmon, deputy director at the Institute for Vaccine Safety at Johns Hopkins Bloomberg School of Public Health:
"â¦it can be difficult for states to balance an obligation to mandate vaccination with some leniency for families who have strong objections. Rules that force parents to articulate their beliefs and require public officials to educate them about the risks of exemption are states' best defense against the spread of disease."
Writing for VOX, Joseph Stromberg reports that 48 states have an exemption from immunizations for religious reasons. The Kuntz ruling will, no doubt, be tested at higher levels before it becomes policy.
In some Ohio schools , as many as 1 in 3 incoming kindergartners and new students in upper grades have parents who are opposed to the immunization program. Misti Crane and Jennifer Smith Richards, writing for the Columbus Dispatch, say that opposition runs highest in parochial and charter schools, and in the Amish country. Even schools that do not fit into these categories can have small pockets of unvaccinated children who can make any outbreak of disease spread more quickly.
The number of children in a school who have opted out of being vaccinated is important to know because of a concept called "herd immunity". This is a situation that requires that a certain percentage of children be vaccinated in order to keep a disease from flourishing in that environment.
"That's because there are among us lots of infants who are too young to be vaccinated, so if they get sick that's really bad," said Dr. William Schaffner, an infectious-diseases expert and professor of preventative medicine at Vanderbilt University. "There are also those among us who for genuine, genuine medical reasons cannot be vaccinated.
"If all of us are protected, we surround the frail among us, and I am unapologetic: I think we all have a responsibility to our own, but also to our brothers and sisters with whom we live."