What just happened?

After an outbreak of measles cases originating in Orthodox Jewish communities, lawmakers in New York voted last Thursday to end religious exemptions for immunizations.

Calling it a public health emergency, Gov. Andrew M. Cuomo immediately signed the bill. “While I understand and respect freedom of religion, our first job is to protect the public health,” Cuomo said in a statement, adding that the new law “will help prevent further transmissions and stop this outbreak right in its tracks.”

New York joins California, Mississippi, and West Virginia in disallowing exemptions on religious grounds.

What are vaccines, vaccinations, and immunizations?

A vaccine is created from the same germs that cause disease, using extremely small amounts of weak or dead microbes such as viruses, bacteria, or toxins. A vaccine stimulates your immune system to produce antibodies, exactly as it would if you were exposed to the disease. After getting vaccinated, you develop immunity to that disease, without having to get the disease first.

Vaccination is the act of getting a vaccine, usually as a shot, while immunization is the process of becoming immune to (i.e., protected against) a disease.

What are the benefits of vaccinations?

Vaccines have proven to be one of humankind’s greatest inventions, and the single most powerful and effective way of reducing disease and improving global health.

Annual use of recommended vaccines for children has been estimated to avert up to 3 million deaths per year globally, with even greater numbers of prevented cases of illness and substantial disability. For children born in the United States in 2009, routine childhood immunization will prevent an estimated 42,000 early deaths and 20 million cases of disease. An additional 1.5 million deaths could be avoided, though, if global vaccination coverage improves.

Are vaccinations required by law?

All states require children to be vaccinated against certain communicable diseases as a condition for school attendance. In most instances, state school vaccination laws apply to both public schools and private schools, as well as colleges and universities. All states also have vaccination requirements for children as a condition for child-care attendance. In about half of the states in the United States, homeschool students are not required to be vaccinated.

Many states also require healthcare workers to be vaccinated against certain vaccine-preventable diseases.

Why are individual vaccinations a matter of public health or concern?

The purpose of vaccinations is not only to immunize an individual but also to provide immunization for an entire community.

When a critical portion of a community is immunized against a contagious disease (typically between 85 percent and 95 percent), the remaining members are also protected because there is little opportunity for an outbreak. Even those who are not eligible for certain vaccines—such as infants, pregnant women, or immunocompromised individuals (for example, children with leukemia)—get some protection because the spread of contagious disease is contained. This is known as “community immunity” or “herd immunity” and is the primary benefit of vaccines both to individuals and also to society.

What does it matter if individuals receive an exemption from vaccinations?

When parents refuse to vaccinate their children for philosophical reasons, they increase the risk of disease exposure for the entire community.

For each virus, statisticians are able to calculate the minimum percentage of community immunity necessary to achieve herd immunity and prevent an outbreak. Though we only need about 85 percent of the community to have immunity to rubella, smallpox, and diphtheria to prevent an outbreak, diseases such as whooping cough (pertussis) and measles require at least 94 percent immunity. This is why many public-health experts argue that exemptions to vaccinations should be limited to those who are unable to vaccinate because of health reasons.

Are vaccines safe?

In 2011, the Institute of Medicine—the health arm of the National Academy of Sciences and an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public—performed an analysis of more than 1,000 research articles on vaccines. The analysis by a committee of experts concluded that few health problems are caused by or clearly associated with vaccines.

Like any other medication, though, vaccines can cause side effects. The review of possible adverse effects of vaccines found convincing evidence of 14 health outcomes—including seizures, inflammation of the brain, and fainting—that can be caused by certain vaccines, although these outcomes occur rarely. The most common side effects are mild, such as redness and swelling where the shot was given.

Can’t vaccines cause autism?

In more than 30 years of research, there has been no causal connection established between vaccinations and autism. For example, a 2013 CDC study looked at the number of antigens (substances in vaccines that cause the body’s immune system to produce disease-fighting antibodies) from vaccines during the first two years of life. The results showed that the total amount of antigen from vaccines received was the same between children with Autism Spectrum Disorder and those who did not have the disorder.

Some people ignore the overwhelming evidence and still believe the connection exist because it was given credence in 1998 by the publication of a fraudulent research paper in the British medical journal The Lancet.

That paper was later retracted when it was discovered that the chief researcher, a British surgeon named Andrew Wakefield, had manipulated the data and failed to disclose that he had been paid more than $600,000 by lawyers looking to win a lawsuit against vaccine manufacturers. Wakefield also was found to have committed numerous breaches in medical ethics, including using some of the children named in the lawsuit in his study. In May 2010, British regulators revoked Wakefield’s license, finding him guilty of “serious professional misconduct.” They concluded that his work was “irresponsible and dishonest” and that he had shown a “callous disregard” for the children in his study.

Despite being discredited for fraud and unethical conduct, Wakefield is still considered the primary source and champion for those who erroneously believe in the connection between autism and vaccines.

What about vaccines made from aborted fetal tissue?

There are currently no vaccines created by using cells directly taken from the bodies of aborted fetuses. However, there are some vaccines created from cell lines (such as WI-38, MRC-5, HEK-293, PER C6, and WI-26) that were derived from tissue taken from aborted fetuses from the 1960s. (Update: Another cell line—Walvax-2—was created from an aborted fetus in China in 2015, though there currently do not appear to be any vaccines that use that cell line.) As the National Catholic Bioethics Center explains:

Any product grown in these or other cell lines derived from abortions, therefore, has a distant association with abortion. The cells in these lines have gone through multiple divisions before they are used in vaccine manufacture. After manufacture, the vaccines are removed from the cell lines and purified. One cannot accurately say that the vaccines contain any of the cells from the original abortion.

The key consideration in whether using currently available vaccines is licit or immoral is whether there is material cooperation with the evil act of abortion. If the abortion were conducted in order to harvest tissues that were to be used for the vaccine, then it would clearly be immoral. But in the case of the vaccines created from the cell lines listed above, the abortion was carried out for other reasons, and the tissue was acquired post-mortem for the purpose medical research.

To determine the morality of using the tissue, it is helpful to compare it to another situation: the use of organs from a person who has been murdered. If a doctor were to offer to transplant a kidney or heart from the murder victim into a Christian, we would likely not object. The primary concern would be whether the victim consented to organ donation prior to their death. But no one would say the Christian who received the organ was morally responsible in any way for the murder. Nor should we be overly concerned with the “slippery slope” of people being murdered in order to expand the number of organ donations. (If we saw evidence of that happening, however, we should change our objection.)

Should there be exemptions for vaccinations based on religious liberty or parental rights?

The question of whether exemptions for vaccinations should be allowed is complex. As theologian Al Mohler recently said,

I am very pro-vaccine. But I’m also pro-parental rights, and I want to be an ardent defender of religious liberty. In this kind of situation, it is so complicated that Christians of goodwill, and we need to note this, can come to different conclusions about vaccines, specific vaccines, and in specific cases even regarding specific children.

In thinking through the issue, there are four factors Christians should consider.

First, as elder and pediatric physician Scott James says, “as we who have the mind of Christ (1 Cor. 2:16) consider the questions surrounding vaccination, we should strive to honor him with how we use that mind.” As Christians, our position on vaccinations should be based on the best available empirical evidence and not on anti-science propaganda, anecdotes, celebrity non-endorsements, or unwarranted skepticism of government institutions such as the National Institutes of Health (NIH) and the Center for Disease Control and Prevention (CDC).

Second, we should strive to seek the common good (Jer. 29:7). The harm done to children from not getting vaccinated is exponentially greater than the harm—both physical and moral—of using the vaccines. Because of herd immunity, the choice to vaccinate our children protects those who cannot receive certain vaccinations due to allergies, ages, or a weakened immune system. We must always consider whether we are using our religious liberty or concern for parental rights as cover for a choice that may cause significant harm to the neighbors we are commanded to love (Matt. 22:36-40).

Third, we should remember that rather than using our liberty to avoid vaccinations, evangelicals have historically been at the forefront of promoting vaccinations. The American evangelical theologian Jonathan Edwards died in 1758 from complications that set in after the misadministration of the smallpox vaccination. Despite this setback, as Mohler notes, “Right after the death of Jonathan Edwards, evangelical Christians in the U.S. became some of the most ardent proponents of vaccines, understanding them as God’s gift through the rationality of modern medicine that reflected the orderly universe that God had given us and was a demonstration of common grace.”

Fourth, while we may have a right as parents or religious believers to forgo vaccinations, we also must accept the consequences of our actions. If we choose not to vaccinate our children then we must accept that there will be some public institutions in which they cannot participate. Also, a parent who refuses to have their child vaccinated is morally responsible for the outcome of that choice. If their child were to get sick and/or die because of the rejection of the vaccine or cause other children to become sick, they would be morally culpable.