Can we justify religious immunization exemptions?
Some opening thoughts
People seek out religious or philosophical exemptions from vaccination laws for a variety of reasons. Some maintain that their religion advises against accepting medical treatment of any kind, while many people seek philosophical or personal exemptions because they fear the alleged side effects of the vaccines on their children's health. However, there is both theological and statistical evidence that counters these misgivings.
Even besides this battle of facts and numbers, there is an ethical dilemma to focus on as well. The diseases that are most commonly vaccinated against are highly contagious, and to allow even one child to remain unvaccinated and join a school, day care, youth group, or other community, jeopardizes the health of all those involved. That said, because immunization against preventable diseases is an issue of public health, not a private one, it is unethical to permit non-medical exemptions to vaccination, because they allow individual convictions to jeopardize the health of entire communities.
Arguments concerning vaccination by religion
Although there are different forms of non-medical immunization exemptions, lets focus on religious exemptions for now.
A large scale survey conducted by John Grabenstein in 2012 looked at the religious beliefs applied to vaccination decisions in six major religions: Hinduism, Buddhism, Jainism, Judaism, Islam, and Christianity.
- Hinduism, Buddhism, and Jainism each have prohibitions against violence towards non-human organisms, which would include microorganisms that die in the production of vaccines and as a result of receiving them. However, in both Hinduism and Jainism there is justification for violence used in self-defense, as would be the case with defending one’s self from disease by killing off harmful microorganisms. Jainism also “recognizes a hierarchy of life forms,” where mobile beings are given more protection than immobile ones. Buddhism seems to follow a similar prioritization of humans, and encourages the use of antibiotic agents to ameliorate illness, as illness creates a disharmony between the body and mind; in fact, the 14th Dalai Lama participated in a poliovirus immunization program facilitated in the Tibetan Buddhist community. While there is some contention over whether the trace bovine materials used in some vaccines are an affront to the vegetarian or vegan lifestyles commonly practiced in these three religions, the priority of human survival persists in each.
- In Judaism, textual evidence suggests support for vaccination in that “Judaic principles emphasize the community benefits of disease prevention in a manner superior to individual preference, based on scriptures such as Leviticus 19:16 that counsel not to stand idly by while a neighbor is in trouble." This principle has been used to encourage smallpox vaccination amongst Jews in several eras, and is not the only example to emphasize concern for community health; Deuteronomy 22:8 sets a paradigm for protecting neighbors from foreseeable harm by erecting a railing around one’s roof if it is used as a porch so others may not fall when they walk on it, since used as an example of our obligation to take protective measures for ourselves and our neighbors. Additionally, several metaphors in Proverbs encourage parents to be proactive in preventing harm from befalling their child, such as teaching a child to swim so they may not drown, which is often paralleled to protecting a child from illness through vaccination or other medical attention. Although some Jewish groups, primarily orthodox ones, today decline vaccination, they are more likely to cite general safety concerns than a particular doctrine as their reason.
- Islamic opposition to vaccination is a horse of a different color. As Grabstein describes, “Opposition to immunization programs among selected Muslim communities has occurred during poliovirus immunization programs in Nigeria, Pakistan, and Afghanistan [...] Detailed consideration of the Nigerian situation revealed that what was described as ostensibly religious objections and assertions that vaccines spread the HIV virus or were vehicles for sterilization programs,” which Grabstein argues are indicative of “deeper struggles related to political power, inadequate health services.” Although the poliovirus vaccine boycott occurred in primarily Islamic nations, “most of the objections raised related to social issues, rather than theological issues." Apart from this event, though, there is no evidence of opposition to receiving vaccines for religious reasons or otherwise in the Islamic community.
From a Christian perspective, there is really no denomination that holds an anti-vaccine stance; particular, isolated churches and sects may instill this belief in their congregations, but one would be hard pressed to find any textual foundation to these churches’ assertions. The closest example of such a denomination would be the Christian Scientists, a religious group founded by Mary Baker Eddy who, in her 1875 book Science and Health, argues that physical illness is not a reality, but is only an illusion that is consequent to a flawed mentality that can be fully corrected with prayer and no modern medicine. While members are not explicitly forbidden from receiving vaccinations, Mary Baker Eddy writes in Science and Health, "It is plain that God does not employ drugs or hygiene, nor provide them for human use; else Jesus would have recommended and employed them in his healing. The sick are more deplorably lost than the sinning, if the sick cannot rely on God for help and the sinning can." As a result, members of the Christian Scientist community have traditionally refused vaccines and most forms of medicine, a practice that, as we will see, certainly has had consequences. Similarly, as alluded to before, several other small churches completely avoid medical care in favor of faith healing, such as Faith Tabernacle, Church of the First Born, Faith Assembly, and End Time Ministries. Additionally, the Dutch Reformed Church has seen some objections to vaccines on the grounds that immunization would make a person less dependent on God, and that it is an interference with God’s divine providence.
Another notable case in the Christian community is the Catholic Church’s position on immunization against rubella (part of the measles, mumps, and rubella [MMR] vaccine in the U.S.). While Catholicism has not taken an opposing stance to immunization, contention over the MMR vaccine in particular arises because the cell culture from which all rubella vaccines are developed was sourced from the stem cells of therapeutic abortions conducted in the 1960s. It is no secret the Catholic church's opposition to abortion and supporting any efforts to make it more accessible to women. However, despite the production of the rubella vaccine being considered morally unjustifiable, accepting the rubella vaccine is “morally justified as an extrema ratio due to the necessity to provide for the good of one's children and of the people who come in contact with the children (pregnant women),” especially because there does not yet exist an alternative form of protection. It is clear, then, that the Catholic community does not oppose immunization on principle, but rather expresses concern over the source of materials used in vaccines. Ultimately, though, the Catholic Church prioritizes ensuring the health and safety of present children over their stance against abortion.
No harm done?
Unfortunately, the consequences that follow denying children immunizations for non-essential reasons have been grave and numerous.
For example, in 1991 a measles outbreak amongst a religious group in Philadelphia that rejected vaccination claimed eight lives and sickened over 700 people, mostly children. Demonstrating the intense impact even one person can have, in 2008 in Indiana, a young, unvaccinated girl contracted measles while visiting an orphanage in Romania and brought the disease back to her church group. In the next six weeks following her return, a total of 34 measles cases were confirmed, with 94 percent of the cases occurring in unvaccinated members of the church. More recently, in January 1 through August 24 of 2013 New York saw the highest reported number of measles cases in the United States since 1996 at 58 cases. Of the cases, 82 percent occurred in unvaccinated people, and 79 percent of those declined vaccination for philosophical reasons. Given these examples and the myriad of other identical cases plaguing the United States, no person could deny the far-reaching suffering that occurs as a consequence of rejecting vaccination. On a larger scale, in 2013 the CDC found that 90 percent of pediatric flu deaths that season were individuals who had not received a vaccine for it.
Consider what other regulations society has permitted so as not to put children at risk and to keep their health and safety a priority. If a family were to starve their children, society would be reasonably outraged and demand the situation be rectified, likely with some sort of legal intervention; the child's health is endangered, generating a proactive response from society. If a family were to refuse their children a bath, a toothbrush, or clean clothes and bedding, again, society would be understandably appalled at the parents who could be so cruel as to neglect their child, allowing them to fester in their own filth. Again, legal services would certainly be employed to return the child to healthy, safe state.
So when we acknowledge that there are a myriad of regulations in place to protect a child's well being, how different is requiring that a child be vaccinated as deemed appropriate by whatever institution requests it? Without them, a child is left vulnerable to disease and illness, just as they are if starved or neglected or denied proper hygiene. Since harm to the child is what motivates us to prevent and punish such actions, ought not this same reasoning be applied to vaccination exemptions?
This is not at all a hypothetical question; very real cases exist of the suffering that has befallen children who did not receive vaccinations, or really any substantial medical attention despite their physical plight. One need not look any further than the Christian Scientist community for examples. Several cases of children, including infants, dying of ailments like bacterial meningitis and bacterial pneumonia (both of which are preventable with vaccination) have landed parents with charges of felony child endangerment and involuntary manslaughter.
While some families may deny the effectiveness of vaccines, once their child becomes sick, it is possible they have enough sense to get medical attention for said child, giving them the opportunity to recover. But does the fact that they recovered negate that they were endangered in the first place by their parents' decision? For a somewhat caricatured parallel, just because Michael Jackson's son Blanket did not fall several stories off of that balcony to his death when he was dangled over it does not mean holding an infant over the edge of a building was a good, justifiable action. The potential for harm was greatly maximized (in both situations), directly violating a parent's duty to protect their child from harm.
From a religious standpoint, several major religions emphasize the importance of protecting one’s self, neighbors, and children from foreseeable harm. Utilitarian thought shares a similar perspective, where the right action is the one that that does the most good for the most people. Spreading highly contagious, miserable, preventable illnesses certainly does not coincide with these principles, so allowing the personal beliefs of select individuals to compromise the health of everyone they come into contact with is unjust.
From another religious and a deontological perspective, parents have a duty to protect their children from harm. Society recognizes this obligation, resulting in intense legal repercussions for instances of child neglect and abuse because the health and wellness of the children are endangered. Such should be the case with nonmedical exemptions from vaccination, as they leave children vulnerable to contracting potentially fatal illnesses, transgressing the dutiful relationship between a parent and a their child.
Based on religious and secular reasoning, state immunization laws checks out as ethical structures, and religious exemptions are thoroughly unethical. The extent to which religion is allowed to influence public policy, or abiding to public policy, in the United States is limited. While people who seek religious vaccination exemptions may do so in the name of their First Amendment right, it is important to realize that plenty of practices that harm others done in the name of the First Amendment have since been severely restricted. An example would be the state and federal laws that prohibit protesting less than 300 feet and two hours before or after a funeral or burial service, inspired by the relentless activity of the Westboro Baptist Church. Despite their claims that their First Amendment right was violated, their cases have been routinely denied, ensuring grieving families the peace and privacy to mourn lost loved ones. Our sensitivity to the emotional health of the public not being interfered with by religious activity is significant and should set a precedent for protecting the physical health of the public from the religiously or philosophically backed practices of a select few.
In the case of immunization, this is almost a moot considering the general openness the major religions express towards vaccines, thus making them unsuitable grounds on which to seek exemption. While religious freedom is a right in the U.S., the extent to which one practices their religion is limited, as boundless religious freedom would surely violate the rights of those being imposed on by the others’ beliefs. Such is the case with immunization, where one’s religious preference ought not be allowed to jeopardize the health and safety of others.