More than half of the children who attend Munchkin Land Daycare near Billings, Mont. go, has special needs or a compromised immune system. The children, who range in age from 4 months to 9 years, have conditions such as fetal alcohol syndrome and cystic fibrosis

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and Down syndrome, according to owner Sheryl Hutzenbiler.

These families came to me knowing we could provide them with a safe and healthy environment, Hutzenbiler said. Part of ensuring a healthy environment is having strong vaccination policies, she said, especially for those who have weakened immune systems or are too young to receive the full range of childhood vaccines.

So when Montana Health Department officials revived a proposal that would allow people to claim religious exemptions from vaccination requirements in child care facilities, Hutzenbiler was both stunned and relieved.

Appalled, because allowing more children to claim exemptions could jeopardize community immunity levels needed to defend against highly contagious diseases like measles and whooping cough.

Relieved, because as she sifted through the proposed regulations, she discovered that her facility, which is licensed to care for up to 15 children, would fall into a category of smaller providers that could choose whether to enroll unvaccinated children.

If it came down to it if I had no choice, I would stop enrolling children today, Hutzenbiler said. In five years I would be closed.

Montana, like 44 other states, allows religious exemptions from immunization requirements for school-age children. If the state is successful in expanding its policy to child care facilities, it would become the second state this year to add a religious exemption to immunization requirements for younger children. Mississippi began allowing such exemptions for schools and child care centers in July, following a court ruling that the state’s lack of a religious exemption violated the Free Exercise Clause of the U.S. Constitution.

Until recently, the trend went the other way, with four states California, New York and Connecticut

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and Maine has abolished the religious exemption policy of the past decade. West Virginia has never had a religious exemption.

But religious exemptions, fueled by conservative reactions to COVID-19 vaccinations, have become entangled in partisan politics, said Mary Ziegler, a law professor at UC Davis who specializes in law and history.

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and politics of reproduction, health

concern

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and conservatism.

It tends to break down much more along red state/blue state lines, where progressive states move toward mandating vaccines in more situations and conservative states move more toward broadening exemptions , Ziegler said. So while religious exemptions for vaccines are not a new issue, they have become polarized in a new way.

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The proposal in Montana is similar to one put forward by the Department of Health and Human Services last year, which a legislative committee temporarily blocked after public health advocates and child care providers objected. Then, in October 2022, Health Department officials said they would not enforce a ban on religious exemptions in child care centers.

We are committed to ensuring that these families have viable child care options in accordance with state and federal law, department spokesman Jon Ebelt told the Montana Free Press at the time.

However, in the state’s latest proposal, a 97-page draft rewrite of child care licensing rules, the health department seeks to expand that exemption to child care facilities, where a family can now claim a license only for medical reasons vaccine exemption. (There is an existing religious exemption for the Haemophilus influenzae Type B vaccine.)

KFF Health News sent the health department a list of questions about its decision to include a religious exception in the rule proposal. Ebelt emailed a statement that did not address the exemption at all.

The rules package reduces red tape to increase access to child care for hardworking Montana families and ensures related regulations are aligned with statutory changes mandated by the Legislature in 2021 and 2023, his statement said.

The Montana Religious Freedom Restoration Act prohibits the state from infringing on a person’s right to practice religion. Another law prohibits discrimination based on vaccination status.

A religious exemption under Montana’s proposed rules would require a child’s parent or guardian to submit a form declaring that vaccination conflicts with their religious beliefs.

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or practice. With no mechanism to check the validity of such claims, health professionals worry that exemptions will increase, reducing community immunity levels.

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Waivers result in fewer people getting vaccinated, which could lead to more outbreaks and more sick children, said Dr. Marian Kummer, a retired pediatrician who practiced in Billings for 36 years.

The risk of disease outbreaks would increase not only in those child care centers but also in communities, said Sophia Newcomer, an associate professor at the University of Montana School of Public and Community Health Sciences.

A community is protected by herd immunity against livestock, for example if 95% of the population has been vaccinated against them, according to the World Health Organization. According to the most recent data available, Montana’s vaccination waiver rate among preschoolers was 3.5% in the 2020-2021 school year, which is within that range of protection.

Some have questioned the legitimacy of religious exemptions. Most religions, including a majority of Christian denominations, have no theological objection to vaccination, according to a scientific review published in 2013 in the journal Vaccine. And the US Supreme Court has ruled that there are limits to religious and parental rights: the right to practice religion does not include the freedom to expose the community or the child to communicable diseases or the latter to ill health or death, according to the 1944 ruling in the Prince case. vs. Massachusetts.

The American Academy of Pediatrics has called for the elimination of all non-medical exemptions, including both religious exemptions and personal belief exemptions, as inappropriate for individual, public health and ethical reasons, according to a 2016 policy statement.

In Connecticut, plaintiffs challenging the state’s decision to eliminate religious exemptions said they objected to the use of fetal or animal cell lines in vaccine research and development. But a three-judge panel of the 2nd U.S. Circuit Court of Appeals wrote in August that religious exemptions do not serve to protect the health and safety of Connecticut students and the broader public when it upheld Connecticut’s decision.

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But even in California, which eliminated non-medical exemptions in 2016, efforts are underway to overturn the law. In a lawsuit filed in October. On October 31, several parents, supported by a conservative law firm, challenged the constitutionality of the law. One plaintiff, Sarah Clark, said she believes vaccines conflict with her interpretation of the Bible because they are a foreign substance and are harmful to the body. Att

orne

j. Gen.

eral

Rob Bonta’s office said the next day that the case had not yet been served, but that it would review the complaint and respond if necessary.

Montana’s proposed rule is scheduled for a public hearing on Nov. 13. Some child care providers, like Hutzenbiler, expect it will eventually go into effect. She said she is already drafting language to submit to the state as required under the proposed rules, saying Munchkin Land Daycare will not accept unvaccinated children.

Kiely Lammers, executive director of the nonprofit Montana Families for Vaccines, said state officials should be open to changes and give child care centers with 16 or more children the same choice as smaller facilities to not enroll unvaccinated children.

At the very least, I hope we can make it equal in all circumstances, she said of the rule proposal.

Kummer, the retired pediatrician, said she hopes the proposal generates enough opposition for the state to withdraw plans for the religious exemption. But she doubts that will happen, given the anti-vaccination sentiment of Montana policymakers.

It will take a tragedy in our state or anywhere else for people to wake up to the fact that we need vaccinations, Kummer said.

California News Editor Judy Lin contributed to this report. This article was produced by

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