All states require children to be vaccinated against certain communicable diseases as a condition for school attendance. In most instances, state school vaccination laws expressly apply to both public school as well as private schools with identical immunization and exemption provisions. All states establish vaccination requirements for children as a condition for day care attendance. These requirements also mirror the requirements for public school children and are often located in the same school vaccination provisions.

As it turns out, 2019 is a record year for measles outbreaks, with nearly 500 cases reported thus far in 19 states, according to the Centers for Disease Control and Prevention. Nevertheless, 47 states currently have exemptions available to those who claim that they oppose vaccination on religious grounds, and 17 states allow parents to invoke a “personal belief” exemption from otherwise mandatory vaccines for school-aged children, meaning that immunization essentially violates your parenting philosophy.

State law not only establishes exemptions for school vaccination requirements but also establishes requirements regarding the exemption application process and the implications of an exemption in the event of an outbreak. Last count, there are nine attributes in school vaccination exemption laws: 1. Permitting medical or religious exemptions only. 2. Excluding philosophical exemptions. 3. Allowing exempted students to be excluded from school during outbreaks. 4. Requiring parental acknowledgment during the exemption application process that exempted students can be excluded from school during outbreaks. 5. Establishing that exemptions might not be recognized in the event of an outbreak. 6. Requiring parental affidavit or notarization in the exemption application process. 7. Requiring enhanced education on vaccinations in the exemption application process. 8. Distinguishing between temporary and permanent medical exemptions in the exemption application process. 9. Requiring annual or more frequent physician recertification for medical exemptions.

The exemptions are problematic for a number of reasons. First, there is virtually no canonical basis for vaccine avoidance among the world’s major religions, most of which came into being before Edward Jenner developed the first widely used vaccine, against smallpox, at the end of the 18th century. Rabbis since then have repeatedly stressed the importance of protecting children through vaccination. Regardless, religious waivers provide cover to those who resist vaccines simply because they chose to question established science. Four states do not however provide for religious exemptions: California, West Virginia, Mississippi and Arizona. Maine is on the verge of eliminating its religious exemption.

Currently, more than a dozen states offer philosophical exemptions, sometimes known as personal-belief exemptions, which don’t require that a parent’s desire to opt out be specifically about their religious beliefs. Instead, they can include exemptions for “conscience or moral ideology.” A few years ago after a measles outbreak linked to Disneyland, California eliminated its belief exemptions, leaving no parent able to excuse a child from certain shots because of philosophical objections. In November a study looking at the effects of the legislation found immunization rates of children entering kindergarten in California to have reached a near all-time high.

All 50 states, plus Washington, D.C., allow exceptions for medical reasons, but medical exemptions are becoming increasingly difficult to obtain because almost all medical reasons for delaying or withholding vaccines have been eliminated by government and medical trade officials. Most doctors and health care workers follow federal vaccine recommendations published by the Centers for Disease Control (CDC) outlining what is and is not considered a medical contraindication to vaccination. Examples include a child who has a condition suchas cancer or an immune disorder such that a vaccine could be harmful to the child’s health.

At a time when measles outbreaks are mounting among clusters of unvaccinated children, a recent large study found no association between the measles vaccine and autism, a reason often given by parents for rejecting inoculation. The new research confirms what has long been widely accepted in the scientific community, echoing findings of a 2002 study by members of the same team of scientists about the vaccine, known as MMR because it protects against measles, mumps and rubella. Nevertheless, there is this resurging suspicion about vaccine safety, promulgated on the internet and on mainstream sites such as Amazon, Facebook and Pinterest. Many of those companies have taken steps in recent weeks to remove anti-vaccine content, and just recently the president of the American Academy of Pediatrics, Dr. Kyle E. Yasuda, wrote to the chief executives of Google, Facebook and Pinterest, urging further action in “an urgent request to work together to combat the dangerous spread of vaccine misinformation online.”

In 2000, health officials announced that they had rid the country of measles. Yet since then, there have been years when the number of cases has surged. From Jan. 1 to April 26, 704 individual cases of measles have been confirmed in 22 states. This is the greatest number of cases reported in the U.S. since 1994 and since measles was declared eliminated. If that pace continues, we could be looking at an epidemic. Several state legislatures are weighing measures that would tighten vaccination requirements or eliminate the nonmedical exemptions that have allowed parents to avoid immunizing their children. Connecticut, thankfully, is among them. Children don’t live in bubbles isolated from others, and parents should not be allowed to place their philosophical mores above the health and well-being of those around them.

It is well settled that, constitutionally, Americans have an expectation that their religious beliefs will be respected and safe from government intrusion, and that a state must have a “compelling State interest” before this right can be taken away. Limiting the spread of serious communicable diseases has been defined as a “compelling State interest” in court cases after the 1905 U.S. Supreme Court decision Jacobson v. Massachusetts affirmed the right of states to mandate smallpox vaccine. Health advocates, experts and international agencies have continued to raise alarms about “vaccine hesitancy” and the World Health Organization recently dubbed it one of the top global threats of 2019. By any standard, “a compelling state interest” has been established.