A measles outbreak in New York city threatens to reintroduce a disease once declared “eliminated.” The city has attempted to contain the outbreak by mandating measles vaccination, and some parents have sued claiming it violates their religious beliefs. Taking the significance of the public health emergency and religious beliefs into account when deciding what to do in these circumstances is difficult. It is too easy to dismiss religious claims as unscientific and foolish in the face of a measles outbreak, but even so, it behooves the parties to seek a compromise.
The Issue
Last week, a New York state court upheld a New York City Health Department emergency order requiring everybody working in five zip codes to be vaccinated against measles, which is a highly contagious virus that can cause fever and rashes. A recent outbreak in Brooklyn and Queens resulted in 359 confirmed cases, which, according to the New York Department of Health, was believed to have originated in the Orthodox Jewish community, although religious leaders have encouraged vaccination.
An organization called PEACH (Parents Educating and Advocating for Children’s Health) spent the past few weeks attempting to convince parents not to vaccinate their children and spreading claims that the vaccine causes autism, a claim that has been discredited.
The Centers for Disease Control reported in 2000 that measles had been eliminated, or absent from continuous transmission in the United States for the prior 12 months, due to widespread vaccination (https://www.cdc.gov/measles/about/faqs.html). However, travelers have unwittingly brought the disease back to the United States; thus, the public health concern in New York is that the spread of the disease could reintroduce measles to the United States and once again place the population at risk.
The Argument Before the Court
A lawsuit was brought by a parent, identified as C.F., on behalf of her minor children, raising “scientific, religious, and moral objections” to the vaccination mandate.
She argued that the vaccine (MMR) caused measles, but, in the words of the ruling, made contentions “completely unsupported by studies, medical literature law and regulation.” The court also found an issue with an affidavit presented by C.F. from a doctor who opined that “the current measles outbreak is not a clear and present danger” but, in the words of the court, “failed to provide any basis for this opinion.”
A religious objection was raised via affidavit stating that using the vaccine validated their religion but failed to provide any clergy statement or religious text to support the opinion.
Finally, the parent argued that it violated “accepted human rights principles” by forcing a medication. However, the court responded that “A fireman need not obtain the informed consent of the owner before extinguishing a house fire. Vaccination is known to extinguish the fire of contagion.”
Compelling Interest
The vast majority of physicians and medical experts believe that measles vaccines are the best way to stop the spread of the disease. Courts have long held that a state may use the least-restrictive means to meet a compelling state interest in the safety of its citizens. The courts have largely left the issue of exemptions to state legislatures.
There are very few religious groups that, as a matter of belief, refuse vaccinations; in the New York case, the parent was unable to provide a clergy or religious text statement.
Failure to vaccinate can also cause harm to the larger community, including those who have genuine medical reasons against vaccination.
Although 47 states have laws that accommodate religious exceptions to vaccine laws, three legislatures, including California, West Virginia, and Mississippi, have repealed religious exemptions, leaving only medical exemptions in place. In most cases, parents seeking a religious exemption from vaccinations are acting at variance with the tenets of their respective faiths. Thus, it has primarily been addressed from a personal belief perspective, and religious exemption claims have primarily been considered a “loophole” or pretextual.
The recent emergency declaration does not specifically strike against New York’s religious objection provision to the existing mandatory vaccination law. Public Health Law §2164(9) involves an exception from a larger vaccination mandate for school children. Specifically, §2164(9) states that: “This section shall not apply to children whose parent, parents, or guardian holds genuine and sincere religious beliefs, which are contrary to the practices herein required, and no certificate shall be required as a prerequisite to such children being admitted or received into school or attending school.”
A Larger Religious Liberty Question
Freedoms are at their most vulnerable during emergencies. Defining a genuine religious objection requires an inquiry that courts have rightfully avoided. The United States was founded on concepts of individual rights, including religious freedom. The idea of individual dissent from collective religious expression or belief stands in stark contrast with the days of homogenous public religious expression when the church or the government would dictate what could and could not be believed. Limits on how far a state should be able to force a person to act against his or her beliefs to serve a greater good and the idea that the state can provide exemptions for certain religious beliefs does not mean that the state is establishing that religion.
Religious exemptions are present in many areas of law, including those that might increase the burden on nonadherents as working shift accommodations in holy day observance cases, religious garb accommodations, exceptions to the contraception mandate, or small business owner conscience exemptions. In almost all of these cases, a religious exemption is sought by a member of a religious minority whose beliefs or practices stand in stark contrast with those of the majority.
Taking the significance of the public health emergency and religious beliefs into account when deciding what to do in these circumstances is difficult. It is too easy to dismiss religious claims as unscientific and foolish in the face of a measles outbreak, but even so, it behooves the parties to seek a compromise. Such compromise on such a binary issue would not be as convenient as a needle prick but could involve more onerous accommodations such as quarantines or other efforts to maximize public safety while avoiding the vaccination itself.
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