Vaccine mandates and exemptions

“By the way, my kids are fully vaccinated:” Evolving public health discourses of the ‘ethical’ and ‘moral’  

The word ‘vaccine’ is increasingly associated with the perils of controversial subjects: discussions are generally accompanied by a disclaimer, both at the level of introducing the theme, and at the personal level of the speaker, who often feels the need to declare what their own and/or their children’s vaccination status is. In other words, ‘vaccine’ and ‘vaccination’ have entered the realm of taboo, stigma, and shame. These are all arguably elements of a general ethical environment for public and global health policy, where ethical concerns have somewhat shifted from the sphere of individuals’ rights and lived experience to that of ‘the collective good’.  

This trend, I argue, can be traced by looking at childhood immunisation laws and mandates, and how the discourse and narratives around these have evolved over the past few decades. In Italy, this process has culminated in the 2017 Childhood Immunisation Law, which introduced vaccine mandates for ten childhood diseases aimed at children up to the age of 16. Different materials produced by institutions globally, regionally and nationally, as well as by the media and medical professional bodies, illustrate the changing landscape of the ethical and moral visions associated with vaccinations specifically, and also increasingly with the wider field of public health and beyond. 


Personal Belief and Conscience in Public Health Law
 
In the United States, state vaccine mandates are tempered by exemptions that permit individuals to forego vaccination. These exemptions come in three forms: medical, religious, and personal. Medical exemptions have garnered little controversy, and historians have traced the ascendancy of religious exemptions to 1960s Christian Science activism. But less is known about the personal belief exemption. It is, in fact, among the most amorphous constructs in public health law: it has been broadly introduced, repealed, and modified for over a century; statutorily grounded in reasons as varied as “philosophical,” “conscientious,” and “good cause”; and bears the distinction of being present in fewer than half of US states. 

This talk surveys the history of the personal belief exemption in the United States. I begin by tracing its origins to the “conscience clause,” popular in England but rare in the United States, and appraising its valence within the Progressive Era. I then frame the exemption through two perspectives: first, as a legal tool conceptualized by anti-vaccinationists to escape compulsory vaccination within the mechanisms of governance; second, as a “grace” offered by legislators in respect of constitutional protections of religious exercise beyond the context of vaccination. I conclude by discussing the exemption’s modern legacy. Through these threads, I reflect on the changing terrain of values considered personal, philosophical, and moral; the ambiguity between secular and religious conscience; and the fundamental problem of reconciling democratic desire for equality under the law with individual rights to sincerely-held beliefs that sometimes contravene legal and social norms.