The debate surrounding religious exemptions to school vaccination mandates is heating up across the United States, coinciding with declining vaccination rates among schoolchildren and a resurgence of childhood diseases such as measles. This contentious issue has sparked legal battles and policy debates at both state and federal levels.
In West Virginia, which has historically not permitted religious exemptions under its laws, a prolonged legal struggle is underway regarding the governor’s attempts to introduce such exemptions via executive order. This case is now set to be reviewed by the state’s highest court.
Meanwhile, the U.S. Department of Health and Human Services (HHS), under the leadership of Secretary Robert F. Kennedy Jr.—a noted vaccine skeptic—has supported the notion of religious exemptions in West Virginia. The department has also cautioned other states that failure to adopt similar exemptions could result in a loss of federal funding.
This fall, the U.S. Supreme Court is expected to decide whether to hear a case brought by Amish parents and schools in New York challenging the state’s 2019 repeal of religious exemptions. If the Court agrees to take the case, it could significantly impact vaccine mandate policies across the nation.
“There’s definitely a lot of pressure building on this issue,” remarked Madison Harden-Stein, an assistant research professor specializing in state health policy at Georgetown University. “It is concerning because the decision regarding religious exemptions has traditionally been left to the states.”
Five States Have Refused Exemptions in Recent Years
All 50 states and the District of Columbia mandate vaccinations for children attending school, though Florida recently announced intentions to reduce its vaccination requirements. Every state provides medical exemptions for children with health risks, while many also offer some form of religious or personal belief exemptions.
“Religious exemptions differ significantly from state to state,” noted Dorit Reiss, a law professor at the University of California, San Francisco. “Some states have a simple ‘check the box’ exemption, while others require annual renewals, letters, or notarization, making the process more cumbersome.”
Vaccine mandates are designed to safeguard individual students and achieve herd immunity, which is vital for protecting those who cannot be vaccinated for medical reasons.
“Research shows that when exemptions are easier to obtain, the number of exemptions—and consequently outbreaks—tends to increase,” Reiss emphasized.
Investigations by NBC News in collaboration with infectious disease researchers at Stanford University revealed that since 2019, 77% of U.S. counties have seen significant declines in childhood vaccination rates, while the rates of vaccination exemptions are on the rise.
Reported cases of measles have surged this year, with approximately 1,500 cases nationwide, a stark increase from 285 cases last year and just 13 in 2020, following a previous spike in 2019.
States such as California, Connecticut, Maine, and New York have eliminated their religious exemptions in response to outbreaks of diseases like measles. West Virginia, which enacted its first compulsory vaccine law in 1905, has consistently rejected attempts to introduce religious exemptions until the recent executive order.
While vaccine advocates argue that some families misuse religious or personal belief exemptions to circumvent vaccine mandates, many parents genuinely seek exemptions based on deeply held religious convictions.
Joseph Miller, an Amish father leading the challenge against New York’s vaccination requirements, stated in a court declaration, “Our Almighty God wants us to fully put our faith and trust in Him, which conflicts with placing our trust in vaccines. Forcing us to violate our religious beliefs creates an irreconcilable conflict.”
The First Liberty Institute, a conservative legal organization representing the Amish parents and schools contesting New York’s policies, claims that state lawmakers undermined religious beliefs when they removed the exemptions in 2019. The Amish community holds a “sincere and abiding” objection to vaccinations, rooted in their belief that true salvation comes from living separately from worldly influences.
“In New York today, if a vaccine could harm your lungs, you may be exempted,” the group asserts. “But if it could harm your soul, you may not.”
West Virginia Receives Support from the Trump Administration
The debate over religious exemptions has reached a boiling point in West Virginia, a state that has never allowed non-medical exemptions for school vaccinations. The state board of education has remained firm in maintaining this policy.
Governor Patrick Morrisey, a Republican, issued an executive order shortly after taking office in January to explore policies supporting religious exemptions. “Students will not be denied access to public education due to their religious objections to mandatory vaccinations,” Morrisey stated in May, detailing how parents could obtain exemptions.
This executive order has led to a lawsuit supported by the American Civil Liberties Union, while the state education board’s refusal to accept religious exemptions has prompted separate lawsuits from parents wanting to bypass the vaccination mandate for their children. The West Virginia Supreme Court has agreed to hear the case involving the state board, although it has not expedited the legal proceedings. The state health department has issued over 400 exemptions to families amid this ongoing legal conflict.
In August, HHS sent a letter to West Virginia health agencies involved in the federally funded Vaccines for Children program, expressing support for religious exemptions. The correspondence referred to the state’s 2023 Equal Protection for Religion Act, which mandates that government burdens on individual religious practices must be justified only by compelling interests.
“West Virginia is a participant in the Vaccines for Children program and receives $1.37 billion annually from the Centers for Medicare and Medicaid Services,” the letter, signed by Paula M. Stannard from HHS’s office for civil rights, stated. “Therefore, West Virginia is obligated to ensure that its VCP providers comply with applicable state laws like the EPRA, which requires recognition of religious exemptions.”
On September 4, HHS issued a “Dear Colleague” letter to vaccine program participants nationwide, asserting that states with religious freedom statutes similar to West Virginia’s must provide religious exemptions to their vaccine mandates.
“Today’s letter clarifies that providers must respect state laws that protect religious and conscience-based exemptions to vaccine mandates,” Kennedy stated in a news release accompanying the letter. “States have the authority to balance public health goals with individual freedom, and respecting these decisions fosters trust.”
Proponents of vaccine mandates without religious exemptions expressed alarm at the HHS communications. “This is definitely concerning, especially in light of other vaccine-related rhetoric from HHS,” commented Harden-Stein from Georgetown.
“This represents a significant overreach of federal authority,” Reiss from UC-San Francisco added. “School immunization mandates have always been a state concern. The federal government has never dictated state actions. This letter not only threatens the loss of federal funding over school mandates but strongly implies that the federal government will reinterpret state laws without the states’ consent. That constitutes a major overstep.”
Reiss believes the nationwide letter is primarily targeting Connecticut, which is unique among states without religious exemptions for also having a state religious freedom statute similar to the one highlighted in the HHS letter.
Amish Schools in New York Face Financial Sanctions
Connecticut eliminated its long-standing religious exemptions for vaccine mandates in 2021 following a nationwide measles outbreak. The state allowed children with prior religious exemptions to retain them until they completed their education.
A legal challenge to this decision based on the First Amendment’s free exercise clause failed in both federal district and appeals courts, and the Supreme Court declined to take up the case last year.
In 2011, the Supreme Court also opted not to hear a challenge to West Virginia’s lack of a religious exemption.
However, the New York case presented by the Amish families offers the Court a new opportunity to address the issue. The justices will likely decide in the coming months whether to review the appeal in Miller v. McDonald, which questions whether the state’s refusal to provide religious exemptions while allowing medical ones violates the free exercise clause, particularly concerning the Amish litigants involved.
In 2022, New York’s state health commissioner upheld significant financial penalties against three Amish schools for not complying with the law that abolished religious exemptions. The penalties ranged from $20,000 to $52,000. The health department asserted that while it did not doubt the genuineness of the schools’ religious beliefs, failing to impose penalties would contradict public policy and the intent of the state legislature.
The schools and several parents initiated a lawsuit but lost in federal district and the U.S. Court of Appeals for the 2nd Circuit in New York City.
The 2nd Circuit upheld the law based on a 1990 Supreme Court ruling, Employment Division, Department of Human Resources of Oregon v. Smith. This decision diminished the scrutiny applied to government actions that infringe on religious exercise, allowing for a more lenient rational-basis test.
In their Supreme Court appeal, the Amish challengers seek clarification on whether the free exercise clause mandates strict scrutiny for vaccine laws that permit secular exemptions but not religious ones. They argue that, if necessary, the court should overturn Smith.
“This case warrants the Court’s attention due to its exceptional importance and the confusion surrounding the application of Smith in today’s context,” stated Kyle D. Hawkins, an attorney representing the challengers. “We believe this issue carries significant relevance nationwide.”
New York state officials have yet to file their response to the appeal, but the case arrives at a time when the conservative majority on the Supreme Court has shown a general receptiveness to free exercise claims. A majority of justices have also indicated a willingness to reconsider Smith, although discussions about what standard might replace it are ongoing.
The New York challengers have also highlighted the relevance of Wisconsin v. Yoder, the 1972 case in which the Supreme Court ruled that the Old Order Amish could not be compelled to send their children to school beyond the eighth grade.
The 2nd Circuit, in the New York vaccine case, suggested that Yoder was a limited case and that the hardships faced by the Amish schools due to the lack of a religious exemption were “not equivalent to the existential threat posed in Yoder.”
This appellate decision was issued on March 3, just months before the Supreme Court’s June 27 ruling in Mahmoud v. Taylor, which determined that parents with religious objections must be allowed to opt their children out of LGBTQ+ lessons. In Mahmoud, the court rejected the notion that Yoder was limited, asserting that Smith does not apply if the religious burden imposed is akin to that in Yoder.
The New York challengers argue in their brief that “as in Yoder, vaccination is ‘in marked variance with Amish values and the Amish way of life.’ … And as in Yoder, forcing Amish parents to vaccinate their children would ‘endanger their own salvation and that of their children.’”
