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Using religion to avoid vaccination, revisited

Whatever criticisms I may have had for prominent atheists like Richard Dawkins or Sam Harris otherwise, one area that I’m totally down with both of them on is their criticism of the undue respect and consideration we as a society give to religious ideas. This consideration is rarely, if ever, based on the merit of the ideas, but rather solely because they are religious ideas. Many of these ideas, if they were not based on religion, wouldn’t be given anywhere near the respect or deference that they are now. But, because they are based on a faith in the supernatural, for some reason we as a society tend to bend over backwards to show them “respect,” whether they deserve it or not, and accommodate those who hold them. One area where this is especially true is in the area of vaccines and religious exemptions. I’ve written before how this misplaced deference has resulted in a spate of laws that allow parents easily to declare a religious exemption and refuse to have their children vaccinated–all legally. In the last couple of months, news has come out that indicates that the problem of parents taking advantage of “religious exemptions to avoid vaccinating their children has grown worse than previously thought:

BOSTON (AP) — Sabrina Rahim doesn’t practice any particular faith, but she had no problem signing a letter declaring that because of her deeply held religious beliefs, her 4-year-old son should be exempt from the vaccinations required to enter preschool.

She is among a small but growing number of parents around the country who are claiming religious exemptions to avoid vaccinating their children when the real reason may be skepticism of the shots or concern they can cause other illnesses. Some of these parents say they are being forced to lie because of the way the vaccination laws are written in their states.

“It’s misleading,” Rahim admitted, but she said she fears that earlier vaccinations may be to blame for her son’s autism. “I find it very troubling, but for my son’s safety, I feel this is the only option we have.”

An Associated Press examination of states’ vaccination records and data from the Centers for Disease Control and Prevention found that many states are seeing increases in the rate of religious exemptions claimed for kindergartners.

The magnitude of the problem:

From 2003 to 2007, religious exemptions for kindergartners increased, in some cases doubled or tripled, in 20 of the 28 states that allow only medical or religious exemptions, the AP found. Religious exemptions decreased in three of these states – Nebraska, Wyoming, South Carolina – and were unchanged in five others.

The rate of exemption requests is also increasing.

For example, in Massachusetts, the rate of those seeking exemptions has more than doubled in the past decade – from 0.24 percent, or 210, in 1996 to 0.60 percent, or 474, in 2006.

In Florida, 1,249 children claimed religious exemptions in 2006, almost double the 661 who did so just four years earlier. That was an increase of 0.3 to 0.6 percent of the student population. Georgia, New Hampshire and Alabama saw their rates double in the past four years.

The numbers from the various states cannot be added up with accuracy. Some states used a sampling of students to gauge levels of vaccinations. Others surveyed all or nearly all students.

Fifteen of the 20 states that allow both religious and philosophical exemptions have seen increases in both, according to the AP’s findings.

While some parents – Christian Scientists and certain fundamentalists, for example – have genuine religious objections to medicine, it is clear that others are simply distrustful of shots.

Some parents say they are not convinced vaccinations help. Others fear the vaccinations themselves may make their children sick and even cause autism.

In other words, the fear-mongering over vaccines of antivaccinationists, coupled with religious exemption laws in many states, are making it possible for more and more parents simply to lie in order to claim a religious exemption to which they are not (morally, at least) entitled, just as Sabrina Rahim chose to lie through her teeth to do so. (I reject her rationalization that she was “forced” to lie. She wasn’t.) It would be one thing if these parents lived in isolated communities, where they could exist without exposing others to the dangers due to their foolish choice not to vaccinate, but such is not the case. The children of these parents are going to schools or being cared for in day care centers with your children, and their children can and do serve as a nidus for outbreaks of vaccine-preventable disease. This is because no vaccine is 100%, and those who fail to develop immunity are protected by “herd immunity,” the indirect protection of susceptible members of the population by the presence of a high percentage of immune individuals. Generally, if a certain percentage of the population is vaccinated, the exact percentage varying but usually around 90%, the spread of a disease in the unvaccinated proportion of the population is greatly inhibited. It’s like a firebreak against the spread of the disease. Those who refuse to vaccinate in essence take advantage of herd immunity, whether they realize ir or not.

Of course, if the percentage of people unvaccinated increases too much, then outbreaks become much more likely. Moreover, it does not take a lot of unvaccinated to result in outbreaks. In pursuing religious exemptions, these parents are not only lying, but they are endangering other children:

Unvaccinated children can spread diseases to others who have not gotten their shots or those for whom vaccinations provided less-than-complete protection.

In 1991, a religious group in Philadelphia that chose not to immunize its children touched off an outbreak of measles that claimed at least eight lives and sickened more than 700 people, mostly children.

And in 2005, an Indiana girl who had not been immunized picked up the measles virus at an orphanage in Romania and unknowingly brought it back to a church group. Within a month, the number of people infected had grown to 31 in what health officials said was the nation’s worst outbreak of the disease in a decade.

Although I’m dismayed at such behavior and the undue deference to religious ideas that allow such laws to make it easy for parents to lie, I can sort of understand why some parents, mislead by antivaccination misinformation, might decide that they have no choice but to lie to “save their children.” Sort of understand, but not condone. My contempt is more reserved for antivaccination activists who spread the misinformation that leads parents to fear the rare complications of vaccines more than they fear the diseases prevented by the vaccines. In particular, I have a special contempt for physicians who encourage parents to lie this way, physicians such as Dr. Janet Levitan:

Dr. Janet Levitan, a pediatrician in Brookline, Mass., said she counsels patients who worry that vaccines could harm their children to pursue a religious exemption if that is their only option.

“I tell them if you don’t want to vaccinate for philosophical reasons and the state doesn’t allow that, then say it’s for religious reasons,” she said. “It says you have to state that vaccination conflicts with your religious belief. It doesn’t say you have to actually have that religious belief. So just state it.”

Yes, that’s what I like in a physician, a willingness to violate the spirit of the law by hewing to its letter combined with a lack of compunction about giving people reasons to lie about their religious beliefs. Good job, Dr. Levitan! Encourage your patients’ parents to lie! No wonder she gets glowing recommendations on the discussion boards about antivax-supportive pediatricians:

We see Dr. Janet L. Levatin in Brookline (on Beacon St. right over the Boston city line, and on the green line). She does not vax at all except that she special orders single tetanus if you want it. She also prescribes homeopathy before jumping to traditional prescription meds.

In fact, there is a “Dr. Janet Levatin” of Brookline, MA listed as a speaker for the American Institute of Homeopathy and as a homeopathic doctor. I don’t know which one is the correct spelling, but all of the links above are likely describing the same pediatrician, a pediatrician who has been quoted in the homeopathic literature thusly:

There are dissenting points of view. Janet Levitan, MD, a Boston area pediatrician, writes in a recently published article (Resonance, Sept-Oct. 1992),” As a pediatrician I have seen a number of children suffering from both the acute and chronic sequelae (i.e. results) of vaccinations….I do not believe that the immature immune systems of the two-month-old infant is capable of responding effectively to vaccines…In addition to the fact that the vaccines many not ‘take’ well in young infants, I also have concerns about the possible deleterious effects of exposing such tender, young, delicate organisms, our newborns, to such an onslaught of bacterial and viral particles, as well as the potentially toxic chemicals with which they are processed (including mercury and formaldehyde.”

It’s another example of bad reporting that the newspaper failed to mention that Dr. Levitan is not just a pediatrician but a homeopath with a long history of being hostile to vaccination, who even used to write a regular column for The National Journal of Homeopathy in which she apparently parroted some of the dumbest antivaccination canards (the whole “toxic chemicals,” “mercury,” and “formaldehyde” schtick) for a long time. Clearly, she is an activist, not an expert, and her uncritical acceptance of such antivaccination talking points raises serious questions about her critical thinking skills.

Few religions actually explicitly forbid vaccination or even discourage it. Most mainstream religions, in fact, fully support and encourage it as a moral good that benefits the individual and community. However,the pernicious effect of undue deference for religion here is more than because of the few adherents of such religions that do forbid vaccination. Rather, it is due to the deference that society gives to such religious beliefs in forming policy, even if those beliefs are clearly irrational and have the potential to endanger public health. Undue respect for religious beliefs that clash with the scientifically demonstrated ability of vaccines to prevent disease safely enables parents who are either antivaccinationist or who have been mislead by antivaccinationist fearmongering a relatively easy method to bypass vaccination laws and an easy avenue for physicians peddling non-evidence-based attacks on vaccination to help them do so.

ADDENDUM: The California Medicine Man weighs in. Money quotes:

Some states, though not all, allow similar exemptions for purely philosophical reasons (read: reasons based on junk science). Therefore, as the above article reports, many parents are lying about their religious convictions and the state is de facto designating them criminals.

To me, this is unfair. If we’re going to allow parents to refuse the vaccines for their children for any nonmedical reason, it shouldn’t matter why they refuse. Patient autonomy is patient autonomy.


Parents should either be allowed to refrain from the vaccinations for nonmedical reasons or not. If we decide that the decision can be left up to the citizenry then it shouldn’t be up to the state to decide if the belief system from which the decision arose is appropriate or not.

Exactly. Either non-medical exemptions should be allowed for any reason, religious, pseudoscientific, or whatever, or they should not be permitted at all. Why should religious objections to vaccination be privileged above any other objection, such as philosophical or plain “I just don’t want to”? There’s no rational reason why they should.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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