The Immunization Exemption Crisis


Ron Marino, DO, MPH, FAAP

Ron Marino, DO, MPH, FAAP

 (Dr. Ron Marino, DO, MPH, FAAP is a pediatrician and Associate Chairman and Director of General Pediatrics at NYU Winthrop Hospital.  He is co-chairman of the Yoga and Meditation Committee of the New York State (District II), Chapter 2 (Long Island) of the American Academy of Pediatrics.)

I Found Religion, Then Lost It: The Immunization Exemption Crisis

The New York State Legislature passed regulations in June 2019 removing the religious exemption for vaccination of children entering the school system in 2019.  This appropriate Public health policy, supported by AAP Chapter 2 and numerous other advocates for child health, has given rise to new and creative approaches in the anti-vax community.  Parents are confronted with the prospect of home schooling or exclusion from school if they do not comply with the legislation which is founded on the CDC’s immunization schedule.  The legislation also provides that medical exemptions will be consistent with currently published CDC contraindications and precautions.  As Medical Director for a variety of school systems, medical exemption requests come to my attention for validation.  Somehow parents are finding doctors willing to write exemption requests that are not consistent with CDC guidelines.  When I respond to the school administration that the exemption request is not based on current evidence based recommendations the fireworks begin.  School administrators have been verbally abused, my phone rings off the hook from parents, some doctors call to plead their case; I even received a call from a state assembly person who voted for the legislation asking me to make an exception for her constituent!

Colleagues, please do not write exemption requests that are not consistent with published guidelines!!  There may be some situations that are grey and require discussion, however it is clear that some licensed medical practitioners are writing clearly inappropriate and unsubstantiated medical exemptions.  Ultimately this will place the practitioner at risk and will not prevent the student from being subject to the immunization regulations.  Currently the New York State Department of Health is dealing with requests that need secondary review.  I am sure they are receiving lots of questions.  Parents should know that they can appeal the exemption denial to the state education Department, in the interim they may request a brief stay of the requirement.

We are clearly, as a Society, victims of our great success with immunizations.  Parents no longer see the diseases and have lost fear of what might be if their child contracted the disease and replaced it with distrust of the medical establishment and government.  We need only look back 30-60 years to epidemics of polio, measles, and invasive bacterial diseases to recognize the benefit that immunizations have given us.  Parents of the 1950s clamored to have their children immunized and that effort resulted in a much healthier population.  Every licensed physician in New York State should think carefully before providing a bogus, inappropriate, and professionally unethical immunization exemption request.  Medical Directors and the state office of professional misconduct are watching.  We must take a strong stand to be part of the solution and not part of the problem.