Thou shall not vaccinate? Religious exemptions growing

Parents are using the state's religious exemption law to avoid vaccines for their children, and the growing anti-inoculation movement cuts across income, theological and educational groups at the Shore, new data show.

The exemptions began growing after 2009, when the state no longer required proof of religious beliefs.

Several Shore schools have among the highest rates of unvaccinated children in the state, including some based in affluent communities.

In the 2013-14 school year, several grade schools had dozens of students with religious exemptions from vaccinations, an Asbury Park Press review of New Jersey Department of Health and Senior Services records found.

"Right now in New Jersey, it's actually easier to get an exemption than it is to get a shot," said Drew Harris, director of the Population Health Program at Thomas Jefferson University, Philadelphia, who has studied the immunization rates in New Jersey.

Fewer students immunized means they have a higher risk of contracting a life-threatening disease, and spreading that disease to others who cannot be vaccinated because of medical reasons or even those who have been inoculated, according to the federal Centers for Disease Control. The theory, called herd immunity, means if nearly everyone has a shot, all in the community have a greater chance of avoiding an infectious disease.

At the heart of the growing anti-vaccination movement is New Jersey's religious exemption, the only non-medical way parents can opt their children out of getting shots for measles, chicken pox and other preventable infections. In 2009, the state lifted its strict proof requirement for religious exemption. Parents now can simply state they are opposed to vaccinations because of their religious beliefs. An attorney general rule said that school officials cannot ask for further proof of their beliefs, as officials did prior to 2009.

In the 2007-08 school year, about 2,105 children, or 0.4 percent, had religious exemptions, according to the health department's vaccination report for 2005-11. The next year, that number jumped to 2,819 children, or 0.9 percent statewide, and reaching nearly 9,000, or 1.7 percent, in 2014.

Monmouth County's has the lowest percentage in the state of vaccinated children, at 92.6 percent. Monmouth County's religious exemption jumped from 264 children, or 0.7 percent, in the 2008-09 school year to 1,273 children, or 3.5 percent, last year. Medical experts say the herd immunity is effective only if 92 to 94 percent of a community is inoculated against measles. The rate is similar for other preventable diseases.

Since an outbreak of measles in California in December that has spread to at least 14 states, public health officials have raised the alarm about the dropping inoculation rate.

The topic remains contentious with some parents who have concerns about the possible side effects of the shots and their doctors' support of vaccination.

"I definitely think that they downplay the risks, and I think parents are finding it frustrating," said Sue Collins, co-founder of New Jersey Coalition for Vaccination Choice.

Collins, who did not vaccinate her kids, said doctors are dismissive of parents who express concerns about the vaccines, including the one for measles, mumps and rubella, or MMR. She said parents should have the choice to decide whether their children get vaccinated and warns about ties to autism, cancer and other illnesses.

Yet no research exists to support such links, medical experts say. One of the most commonly cited studies that claims the MMR vaccine leads to autism has since been debunked. An autism awareness group has publicly supported vaccinations, urging people to ignore the rumors about autism and the MMR vaccine.

In its review of 2013-14 New Jersey inoculation data, provided by Harris of Thomas Jefferson University and the state Department of Health, the Press matched vaccination rates with zip code data provided by the Neilsen Co., a consumer data firm. The Press found:

No relationship between income or education when it came to opting out of vaccinations. Rich communities as well as middle-class had schools with high exemption rates.

In Howell, at least 69 students claimed religious exemptions. In Middletown, there were at least 63 students, at least 115 students in Lakewood and 140 in Toms River. All are at risk for life-threatening illnesses, experts say.

In New Monmouth Elementary School in Middletown, a zip code that has a median household income of $100,864, 14 students claimed religious exemptions out of the 453-student population. The state median income is about $71,000.

Hillel Yeshiva, a private Orthodox Jewish Pre-K to 12 school in Ocean Township, has at least 37 students with religious exemptions out of 712. Other Orthodox Jewish schools reported no or lower exemptions. Hillel Yeshiva did not respond for comment.

Westminster Nursery School & Kindergarten, an extension of the Westminster Presbyterian Church in Toms River, had 29 students with religious exemptions out of 335. The median household income there is closer to the average, at $75,827. The school declined to comment.

Atlantis Preparatory School, a private school in Wall, has 27 students with religious exemptions out of 253 total students. The school nurse said she encourages vaccinations, but cannot control parental decisions. The median household income was $97,000 in that zip code.

The Neptune Township Early Education Center, a public school, 19 students had religious exemptions out of 207 students. That zip code has a median household income of $62,364. The superintendent said the school does its best to follow the state requirements.

Oxycocus Elementary School in Stafford, a public school, has 18 students with religious exemptions out of 177 students. The median household income was $71,544. School officials did not respond for comment.

The inoculation data are still in a rough form. Schools do not have to report vaccination information for all grades every year, researchers at Thomas Jefferson University say. Because of that, the data remain incomplete.

Harris also said the reporting system leaves too many school officials and public health officials in the dark about which communities have low inoculated rates and which are well-protected. The state does not even know which vaccines for which students have religious exemptions.

Harris said it is too early for his team to identify any patterns or links among these unvaccinated populations, but said it could be a sign of a rapidly spreading backlash against vaccines.

"It could turn out that there's not a pattern and what it could be is a trend, a fad or a social phenomenon that works through the community that vaccines are bad," Harris said.

Dr. Glenn Fennelly, an infections disease expert and chairman of the pediatrics department at Rutgers University, Newark, said the best defense against potential outbreaks for infectious diseases, including measles, may be removing the religious exemptions.

"It's hard to say whether that (religious exemptions) is the common most single reason for vaccination refusal," Fennelly said, "but ultimately we have to be absolute about it. We have to have no religious exemptions or conscientious exemptions for an infection like measles that can put other lives at risks."

A failing honor system?

Unlike other states, New Jersey does not have philosophical exemptions for vaccinations, but it does allow medical exemptions for immune-compromised people, along with religious exemptions.

Parents at Hillel Yeshiva are among a minority that chooses not to vaccinate their children, according to the Orthodox Union and the Rabbinical Council of America. The two organizations recently urged parents to vaccinate their children against measles, rubella, polio and other preventable diseases.

"Judaism places the highest value on preserving human life," a joint statement from the groups said.

Several school officials who would comment on the vaccination trend said they had little control over whether a person chooses a religious exemption.

"The district does all within its legal capabilities to have parents vaccinate children, (but) parents have the right to choose," David A. Mooij, superintendent of Neptune Township School District, said in a statement. "Consequently, a ranking results over which the district has little or no control."

Collins, of Vaccination Choice, said parents should feel like they are the ultimate decision makers, especially when it's a matter of religious freedom.

"It gets into a very dangerous place when we're putting a state official in the capacity of judging who has a relationship with their higher power and whether it's okay or not," she said.

Collins said she did not know whether parents are taking advantage of the religious exemption law for philosophical reasons, but she said she makes the effort to remind people what the vaccination law dictates.

Without more research, it is almost impossible to tell why people seek religious exemptions, Harris said. Some data from religious schools that don't prohibit vaccination suggest parents might be taking advantage of the vaccination law. However, he suggested there appears to be students in a wide range of institutions claiming the exemptions.

That's why, he said, he also has concerns about the state's current religious exemption laws.

"If you have this more rigorous process...it increases the number of kids that are fully vaccinated and decreases the number of exemptions that are granted," he added.

But Collins says not so fast. Such a law could risk violating the religious rights of those whose creed prohibits vaccinations.

"You can't limit someone's religious beliefs to a physical building," she said. "It's just, to me it's kind of just an area, when exempt people saying you have to belong to this (religious) group...then you're getting into religious discrimination."