Vaccine exemptions shouldn’t be a packaged deal
Joseph I. Golden, MD, MPH, Member of the League of Women Voters of West Virginia in Beckley
Today, we hear frequent discussion on the issue of non-medical exemptions for the vaccinations required for children to enter public schools in West Virginia. These requirements have been in place for decades, and the result is that West Virginia has one of the lowest rates of common childhood infectious diseases in the United States.
Current West Virginia law and regulations, upheld by the West Virginia Legislature in their 2025 session, stipulate that a child must be up to date in vaccinations that cover the following diseases: Diphtheria, Tetanus, Whooping Cough (Pertussis), Polio, Chicken Pox (Varicella), Measles, German Measles (Rubella), Mumps, and Hepatitis B. Although it is possible for a small percentage of eligible children to have a reaction or medical contraindication to the vaccine for one of these illnesses, there is no medical evidence that that child would have a problem for the other vaccines. For example, a child that has Leukemia, or a diagnosed immunodeficiency, or is on an immune suppressing drug for a serious illness (for example, Crohn’s disease) should not be given an altered live vaccine, such as the MMR (Measles, Mumps, Rubella). However, there are recommendations to immunize with vaccines made from non-reproductive (and non-infectious) particles of the parent virus or bacteria. These vaccines are often advised to stimulate what immune function remains for people with immunodeficiencies to further protect them from these specific diseases.
If a parent is seeking exemptions from vaccinations for their child, it is medically sensible to have the exemption specify which vaccine the parent is concerned about, and judge their request only for this single vaccine, not all vaccines. This is the process for children with specific medical exemption requests. Such an approach should be applied to all other requests as well.
Parents who request non-medical exemptions, for example, for philosophical or religious reasons, should understand that if their child does not receive vaccinations, that child is at risk for getting these infectious diseases. In addition, that child could be part of the chain of transmission of the disease to other people who are susceptible due to medical conditions. All children aged less than one year are most vulnerable. Their immune systems have not yet matured sufficiently to mount full-scale immune responses to the infectious diseases that vaccines were created to prevent.
For example, in the United States in 2024 there were 10 childhood deaths due to Whooping Cough (Pertussis). Six of these deaths were in children younger than one year. The other 4 were in children older than 1 year. In 2024, there were 34,435 documented cases of Whooping Cough in the United States. This disease is hard to eradicate, but vaccination greatly lowers the risk of hospitalization and death. By contrast, in 1950, there were 265,269 recorded cases in the United States. In 2020, there were only 6,124 cases; this much lower incidence is probably due to transmission precautions taken by those who were protecting themselves and their families from Covid.
Some people who request religious exemptions do so based on the belief that vaccine development involves the use of fetal cells. This is simply not the case for most of the vaccines required to enter public schools. The Rubella vaccine was developed from cell lines derived originally from fetal tissues obtained in the 1960s. But, until the Roe vs. Wade decision in 1973, termination of pregnancies was only allowed to save the life of the mother. One other vaccine developed from fetal cells is the Rabies Vaccine. If a human gets Rabies, it is almost uniformly fatal. Yet, it is hard to imagine a parent refusing this vaccine for their child who has been in contact with an animal carrying Rabies virus.
Exemptions from vaccinations should be requested and handled only for specific disease vaccine agents and not all vaccines as a package. Furthermore, those parents who request exemption on non-medical bases should consider that their child is not only at risk for contracting one of these childhood diseases and suffering serious consequences, but they could also transmit any of the vaccine preventable diseases to children less than one year of age, to children and adults with diseases that render them with weakened immune systems, and to people with chronic diseases, such as lung, kidney, and liver impairment, that cause their immune system to be weakened.
Some states that permit philosophical or religious exemptions require specific medical education for parents on the benefits and risks of immunizations. Those states recognize that parents alone may not have the medical knowledge or objectivity to make such decisions on their own. The bills considered during the 2025 legislative session did not provide for such guardrails.
We do have evidence that West Virginia’s current vaccination law works. According to WV Public Broadcasting, our state’s childhood vaccination rate was the lowest in the country — 56.6 percent — in 2021. However, our vaccination rate leads the nation once those children reach school age. That is the stunning impact of our current law requiring vaccinations. Moreover, we do not see outbreaks in infectious diseases and associated deaths among children that have become common in news from other states.