What to do When Parents Want to Exempt Their Children from Immunization
By Margaret 0. Casey, RN, BSN, Region IIa TASC Health Specialist, New York University, NY
One issue related to immunizations that grantees face is to handle the family who claims an exemption-whether for medical, religious, or philosophical reasons. According to the State immunizations requirements provided by Centers for Disease Control and Prevention (CDC) in 1993, every state allows for medical exemptions to immunization; all but three states allow religious exemptions; and 19 states allow a philosophical exemption.According to the Head Start Information Memorandum of July 22, 1994, on immunizations, "Head Start Programs must contact their State Immunization Office before developing immunization exemptions policies, since states have different requirements on how to document theses exemptions." For instance, in New York State parents must submit a written and signed statement regarding their objections to their child's immunization on the basis of genuine and sincere beliefs. School administrators may ask for supporting documents but are not required to do so.
In New Jersey, to claim a religious exemption the parents' statement must include an explanation on how immunizing their child would conflict with their religious tenets. Certainly the safeguarding of a family's religious freedom is important, and each program must familiarize itself with the rules that apply in its State.
However, that does not solve the dilemma faced by a health coordinator when a family with an immunization exemptions wishes to enroll. How can the health of children in that family be protected as well as the health of other children enrolled in the program? This point is particularly important if Head Start programs and Early Head Start programs accept children who may not have been immunized prior to their enrollment. This is a frightening prospect for health coordinators, who may or may not have exemptions policies in place.
The following recommendations should be considered when requests for immunization exemptions are requested:
- Know your State's immunizations policies and write your program's policies to adhere to them.
- Require, as a matter of policy, all supporting documentation allowed by your State's regulations.
- Address the issue of exemptions in the agency's community needs assessment and identify religious groups and organizations opposed to immunization. Members of these groups can then be sought out to serve as members of the Health Services Advisory Committee (HSAC), multi-cultural awareness team, or other such entity that helps the program develop and implement its exemption policies.
- Develop an "outbreak policy" with the HSAC so that the health coordinator has guidelines to follow in the event of a communicable disease outbreak. This policy should include methods to protect the health of un-and under-immunized children, as well as those in contact with them. The policy should out line the responsibilities of each party involved the health coordinator, the family and their medical provider, the program director, and the local public health unit.
- Continue to recommend that Head Start take a proactive role in universal immunization. Choosing not to immunize should only be for carefully selected religious or philosophical reasons-not because of ignorance or lack of access to care.