Measles outbreak: How can NJ and NY students be exempt from mandatory vaccines?

Measles outbreaks in New Jersey and New York have raised questions over state laws that allow parents to send their unvaccinated children to school without much difficulty. 

The rate of parents claiming non-medical exemptions for their children has been on the rise nationally and has been cause for concern among health officials battling measles outbreaks in New Jersey, New York and other states. A 95 percent vaccination rate in a given community is considered the threshold to prevent such outbreaks. New Jersey had 94.6 percent of total students fully vaccinated in the 2017-18 school year, according to an annual report by the Health Department.

Michael Weinstein, director of the New Jersey Immunization Network, said New Jersey law regarding religious exemption is counterproductive. 

"It's a conundrum, and we are seeing the implications of it now," Weinstein said. 

All 50 states have legislation requiring students to be vaccinated for diseases like measles, mumps, whooping cough, chickenpox and polio, according to the National Conference of State Legislatures. But circumventing the law in New Jersey and New York can be as easy as a letter signed by a parent, requiring no government authority to approve of it.

States generally allow three types of exemptions: medical and religious — which are both permitted in New Jersey and New York — and philosophical, which cites a personal or moral belief to reject the vaccines, which is permitted in 17 other states, according to the NCSL. 

Medical exemptions are allowed in all 50 states, while religious exemptions are allowed in 47 states, with California, Mississippi and West Virginia having laws requiring vaccinations regardless of religion. New York and New Jersey lawmakers have both recently pushed to remove religious exemptions in the wake of outbreaks in both states.

New York City went as far as to declare a public health emergency Tuesday for parts of Brooklyn's Williamsburg section in response to outbreaks in the community, forcing unvaccinated people living in certain ZIP codes who may have been exposed to measles to receive the vaccine. 

Although both states list guidelines, exemptions in New Jersey and New York are ultimately issued by the educational institution or governing body of the school that the student is attending. 

Story continues below map

NJ exemption law

Medical exemptions are for students whose health would be negatively affected by the vaccines, and the exemption must be written by a licensed physician or nurse practitioner, according to the Department of Health website. It also says that the reasons for medical exemption must be outlined by the Advisory Committee on Immunization Practices and the American Academy of Pediatrics. 

Religious exemptions do not require such oversight. According to state requirements for kindergarten through 12th grade, a religious exemption does not have to include the name of the religion or be notarized. The only requirements are that it has to be filed and signed by a parent or legal guardian of the student. 

When the religious exemption is filed, whoever is in charge of reviewing it can't question the sincerity of the exemption or legitimacy of the religion if it is mentioned by name. 

"It acts the same way [as philosophical exemptions]," said Peter Wenger, chairman of the New Jersey Immunization Network.

600 cases of deadly fungus reported:Two-thirds from NJ and New York City area

Wenger said that although New Jersey law does not recognize philosophical exemptions, religious exemptions are so easy to obtain that people use religion as a reason to object to vaccinations, regardless of their true beliefs. 

"Rules and guidance promulgated by the department explain that, under current law, signed requests for exemptions from mandatory immunizations due to religious beliefs are to be accepted and the religious exemption granted," said Nicole Kirgan, a Health Department spokesperson. 

The only institutions that can refuse to give a religious exemption are ones that are religiously affiliated, Kirgan said. 

Any child exempt from vaccinations may be withheld from school in the event of an outbreak, the department website says.

NY exemption law

Similarly to New Jersey law, medical exemptions in New York must be written by a licensed physician, nurse practitioner or licensed midwife caring for a pregnant student, according to the New York Department of Health website. The reason and length of the exemption must be listed and the reasons for the exemption must be periodically reviewed to determine whether they remain valid. 

Religious exemptions in New York must also be written by a parent or legal guardian if the student is younger than 18, and they do not need to be notarized. The student doesn't need to be part of an "established religion" for the exemption to be considered. The institution then may be able to require additional supporting documents, the website says. 

Sarah Ravenhall, executive director of the New York State Association of County Health Officials, said she is in favor of the elimination of religious exemptions altogether. 

"What we are seeing is a perfect example of how rapidly these diseases can spread," Ravenhall said. "This isn't a New York problem, this is a worldwide problem." 

In New York City, religious exemptions for public schools are granted by the city Department of Education and religious exemptions for private schools are granted by the individual school, said Jill Montag, a Health Department spokeswoman. 

"Parents should talk to their pediatrician and work with their school's health services to make sure that all of their children’s immunizations are up to date," Montag said. 

Exempt students in New York may also be withheld from class or campus in the event of an outbreak. 

Staff Writer Nicholas Pugliese contributed to this article. 

Email: zuritaa@northjersey.com