Can I exempt my child from vaccines?

Vaccine Exemptions for Children: Medical Indications vs. Nonmedical Requests

Medical exemptions to childhood vaccinations are the only type of exemption supported by evidence, while nonmedical exemptions (personal belief or philosophical) are not recommended as they increase risk of disease outbreaks and compromise community immunity. 1

Medical Exemptions: Valid Reasons

Medical exemptions to vaccination requirements are supported by the American Academy of Pediatrics (AAP) and are available in all states, the District of Columbia, and Puerto Rico. These exemptions are granted for legitimate medical contraindications such as:

• Allergy to vaccine components
• Previous significant adverse reaction to a vaccine or its components
• Underlying health conditions (e.g., immunosuppressed organ transplant recipients) 1

These medically indicated exemptions are important to protect children who cannot safely receive certain vaccines. Since only a small proportion of children have legitimate medical contraindications, these exemptions typically don't compromise community immunity when granted appropriately.

Nonmedical Exemptions: Not Recommended

The AAP explicitly recommends that all states and the District of Columbia eliminate nonmedical exemptions from immunization requirements 1. This position is based on several key findings:

• Higher rates of immunization exemptions correlate with higher rates of vaccine-preventable illnesses and disease outbreaks, including pertussis and measles 1
• Unvaccinated children are often geographically clustered, creating communities with immunization rates too low to sustain community immunity 1
• Children with exemptions are at increased risk for measles and pertussis and can infect others who cannot be vaccinated 2

Legal Framework and State Variations

Despite the AAP's recommendation against nonmedical exemptions:

• Almost half of states allow philosophical (personal-belief) exemptions 1
• Religious exemptions are permitted in many states 1
• Requirements for obtaining nonmedical exemptions vary widely between states 1

Some states have implemented measures to reduce nonmedical exemptions:

• Oregon saw a 17% decrease in exemptions after requiring parents to complete an educational module on vaccine benefits before allowing exemptions 1
• Some states require notarization or affidavits for religious or personal-belief exemptions 1

Public Health Implications

The decision to exempt a child from vaccines has broader implications:

• Vaccination requirements for school attendance protect both the individual child and the community through herd immunity 1
• Population immunization rates of at least 90% are generally required for community immunity, with highly contagious diseases like measles requiring ≥95% 1
• Up to 80% of pediatric deaths associated with influenza have occurred in unvaccinated or incompletely vaccinated children 3
• Children who cannot be vaccinated for medical reasons depend on community immunity for protection 1

Parental Concerns and Healthcare Provider Role

Parents may have concerns about vaccines that lead to exemption requests:

• 54% of parents express concern about serious adverse effects 3
• The most common reason for requesting exemptions (69%) is concern that vaccines might cause harm 4

Healthcare providers play a crucial role:

• Providers are the most frequent source of immunization information for parents 2
• The AAP recommends that clinicians address vaccine refusal by respectfully listening to parental concerns and discussing the risks of nonvaccination 2
• Strengthening personal contact between informed pediatricians and parents is crucial for improving vaccine acceptance 3

Bottom Line

While you may be able to obtain a nonmedical exemption in some states based on personal or religious beliefs, the medical consensus strongly opposes this practice due to the increased risk to both your child and the community. Medical exemptions are the only type supported by scientific evidence and recommended by the AAP. The risks to children from vaccine-preventable diseases are much higher than the risks of vaccines themselves 5.

If you have specific concerns about vaccines, the recommended approach is to discuss these with your child's healthcare provider rather than seeking exemption, as they can provide accurate information about vaccine safety and the serious risks of remaining unvaccinated.