Religious Veneration and Compulsory Vaccination

By Hannah Fikar


Image courtesy of Suru Nualpradid at



Like many entanglement issues, compulsory vaccination challenges state police power authority over individual freedoms. Some believers object to this authority when it threatens their freedom of religious practice. Many belief systems prohibit inoculation for a myriad of reasons, but the government currently does not uniformly regulate vaccination exemption. Each state, therefore, must balance personal liberty with public health. To compensate, most states provide some form of religious exemption and a minority even allow for philosophical exemption, or exemption based solely on personal belief not grounded in religious principles. The growing number of exemptions worries many experts who fear an outbreak would affect both unvaccinated and vaccinated individuals. The potential disease outbreaks, which are widely considered preventable, threaten public resources and promise to bring long legal battles as victims may seek retribution.

This guide serves to aid potential researchers in navigating the complicated field of religious exemption to compulsory vaccination. The journal articles provide a more modern background on the culture and science behind the issue as well as potential legal remedies. The books provide different perspectives on the history of vaccination. Court cases demonstrate application in the real world and help to clarify several practical issues, like definition of religion and specific limitations on state police power. The state codes provide examples of all three types of exemptions to allow for a better understanding of how states navigate the issue. Lastly, the online and journalistic sources provide an international perspective and additional background information while clarifying some potential paradoxes.

Journal Articles

Ciolli, Anthony, JD, MBE. “Mandatory School Vaccinations: The Role of Tort Law.” Yale Journal of Biology and Medicine 81 (2008): 129-37.

Ciolli discusses the widespread use of religious and philosophical exemptions and the potential threat it poses to herd immunity. He is skeptical of these kinds of exemptions because of the threat they pose to public health and even to other vaccinated individuals. He argues that the small portion of exemptions stemming from religious belief could cause a public health and economic crisis when combined with the more prominent philosophical exemptions. Ciolli is critical of such exemptions, which skews the tone of the article, but he recognizes that such exemptions may never be threatened because they are afforded protection from the Constitution. However, tort law may provide remedies to victims of public health epidemics if the epidemic was caused by an individual who chose not to be vaccinated. The discussion of possible class-action lawsuits and widespread financial compensation gives insight into possible repercussions of vaccination exemption and how states will have to learn to balance religious freedom of practice with the potential huge legal battles and payouts.

Feemster, Kristen A., Priya Prasad, Michael J. Smith, Chris Feudtner, Arthur Caplan, Paul Offit, and Susan E. Coffin. “Employee designation and health care worker support of an influenza vaccine mandate at a large pediatric tertiary care hospital.” Vaccine 29 (2011): 1762-9. 

This study examined a compulsory flu vaccination program of the staff at Children’s Hospital of Philadelphia. The results showed that approximately three-fourths of those surveys agreed with the policy, even though roughly the same proportion found it coercive. Close to 90% of those surveyed considered vaccination part of their moral or ethical duty as a hospital employee for the safety of the patients, which explains differences in philosophical belief between healthcare workers and the general population in regards to exemption from vaccination. Two workers felt their religions exempted them from vaccination, which suggests a dichotomy of thought between religious belief and vocational duty in some regards. The study also discusses the impact of vaccine education. The authors believe it may not be as effective as it should be and discuss more effective education might help to change how people view their steadfast religious beliefs in comparison to public health pandemics.

Grabenstein, John D. “What the World’s religions teach, applied to vaccines and immune globulins.” Vaccine 31 (2013): 2011-23.

Grabenstein complied an exhaustive list of major world religions, relevant portions of their histories, and major facets that may lead believers to object to vaccination. His article provides key understanding of historical traditions, canons, and texts which may be interpreted to forbid inoculation. Understanding the reasoning behind religious provides useful background information on the subject and may help to clarify why some individuals choose not to vaccinate themselves or their children. He approaches each religion fairly and draws on primary and secondary religious sources. His article is a good starting point for those wishing to know more about the various reasoning behind religious exemption.

Katz, Randall D. “Friendly Fire: The Mandatory Military Anthrax Vaccination Program.” Duke Law Journal 50 (2001): 1835-65. 

Katz profiles a member of the Air Force who chose not to submit to the military’s mandatory anthrax vaccination because of his religious beliefs. Because anthrax is extremely lethal and especially easy to weaponize, it poses a serious threat to soldiers stationed abroad. Opponents argue that the vaccine requirement is too coercive, does not protect against all forms of exposure, and may not combat all strains of the disease. Although Major Sonnie Bates refused the vaccine for religious reasons, his case also brings into question whether authorities can force subordinates to undergo vaccination. Katz concludes that such coercive behavior is illegal under federal law because the vaccination is still classified as an experimental drug and therefore cannot be administered to unwilling participants. This case provides more information on vaccination outside of schools and examines other situations in which individuals who retain full Constitutional protection may not have to submit to state authority.

Rota, Jennifer S., MPH, Daniel A. Salmon, MPH, Lance E. Rodewald, MD, A B STRACT Robert T. Chen, MD, MA, Beth F. Hibbs, MPH, and Eugene J. Gangarosa, MD, MS. “Processes for obtaining nonmedical exemptions to state immunization laws.” American Journal of Public Health 91 (2001): 645-8. 

Rota and her colleagues surveyed immunization program managers in the 48 states that allow for nonmedical (e.g. religious or philosophical) objections. 25 states only require a parent to sign a form indicating an objection to vaccinating their children, 15 states require a more intensive form of communication with the parent, and 8 states require a parent to receive specialized information before signing a release in the presence of a notary. A third of states have denied requests for religious exemptions largely due to errors with the paperwork or requests worded in a way that did not meet statutory clarity requirements. Half of states are not permitted to deny exemptions, even for clerical errors. Because there is no national requirement and therefore no uniform standard for states to follow, enforcement is up to state discretion and can lead to several logistical issues, including the process to renew an exemption, which standard is required for parents to exempt their children, and the basis on which exemptions are accepted. The study emphasizes the risk posed to vaccinated children when unvaccinated children are introduced into crowded and confined classrooms.

Salmon, Daniel A, MPH; Michael Haber, PhD; Eugene J. Gangarosa, MD, MS; Lynelle Phillips, RN, MPH; Natalie J. Smith, MD, MPH; Robert T. Chen, MD, MA. “Health Consequences of Religious and Philosophical Exemptions from Immunization Laws: Individual and Societal Risk of Measles.” The Journal of the American Medical Association 282 (1999): 47-53. 

Salmon and his colleagues collected seven years of data and concluded that unvaccinated children are 35 times more likely to contract measles than children vaccinated against it. Because of this increased likelihood of contraction, unvaccinated children pose a threat to public health and even to those who are vaccinated. The article discusses how the potential for an epidemic increases as fewer children are vaccinated. The researchers emphasize that immunization is the most cost-effective and most influential solution to prevent outbreaks. However, they consider religious exemption a choice rather than a pious practice, which would cause some believers to disagree. While the article may not treat religious exemption and belief fairly, it makes a powerful statement about the precarious situation that arises when children are not vaccinated in numbers high enough to maintain herd immunity.


Higgins, Chas M. Horrors of Vaccination: Exposed and Illustrated. Brooklyn, NY, Chas M. Higgins, 1920.

Higgins chronicles a myriad of negative reactions to vaccination and presents compelling visual evidence of the horror of botched injections or unanticipated and extreme reactions. Extrapolating from these cases, he concludes that no human should be forced to undergo such exposure. While he likely set out to gather evidence to prove a point rather than to explore it impartially, he raises several compelling issues. The legality of compulsory vaccination is hotly debated, and state police power has greatly expanded since he published his work. However, the cases he presents represent some of the many possible side effects of vaccination and merit further consideration and exploration.

Malone, Kevin M. and Alan R. Hinman. “Vaccination Mandates: The Public Health Imperative and Individual Rights.” In Law and Public Health Practice, edited by Richard A. Goodman, Richard E. Hoffman, Wilfredo Lopez, Gene W. Matthews, Mark Rothstein, and Karen Foster, 262-84. New York, Oxford University Press, 2007.

Malone and Hinman provide a sharp counterpoint to anti-vaccination ideology. Their chapter highlights the great success of inoculation in decreasing disease outbreaks and saving countless lives. They concede that vaccinations are not always entirely safe or effective, and that some injury and illness may result. They go on to outline how potential victims can file for compensation for unsafe or ineffective vaccines. The overwhelming success of compulsory vaccination programs has eradicated a handful of diseases and prevented outbreaks of many more. Such stark results help to justify forced vaccination and define the particular circumstances under which someone may be religiously, morally, or medically exempt.


Boone v. Boozman, et al, 217 F. Supp. 2d 938 (2002).

Cynthia Boone sued Arkansas Director of Public Health Fay Boozman over the wording of the state’s religious exemption statute. The statute afforded religious exemptions to an individual when “immunization conflicts with the religious tenets and practices of a recognized church or religious denomination of which [they are] an adherent or member.” Boone sued over the “recognized church or religious denomination” wording, claiming that her beliefs are sincerely held and she should therefore be exempt from vaccinating her daughter against Hepatitis B. The court applied the Lemon test from an earlier Supreme Court case and determined that the statute conflicted with the Establishment Clause. By broadening the statute, the state becomes less entangled in religious belief. However, the state cannot regulate belief and an individual could misuse the religious freedom to receive an exemption for a belief that is philosophical rather than religious.

Bruesewitz v. Wyeth, 562 U.S. __ (2011).

Hannah Bruesewitz’s parents sued the company responsible for the DTP vaccine administered to their daughter. They claimed that their daughter developed a seizure disorder from a defective dose of the vaccine. Their case was originally dismissed in Vaccine Court, the special court within the United States Court of Federal Claims established specifically to handle such grievances. They refiled in state court and eventually reached the Supreme Court where the justices upheld the portion of the National Childhood Vaccine Injury Act that relieves manufacturers of liability for damages as long as proper warnings and instructions are provided. Parents looking for religious exemptions may feel more compelled to fight for them if they know there may be no legal remedy for any injuries that occur as a result of the vaccine.

Jacobson v. Massachusetts, 197 U.S. 11 (1905).

Jacobson is the first instance of legal action against a state for compulsory vaccination. Massachusetts enacted a vaccination law during a smallpox outbreak and granted medical exemptions. Jacobson, who did not have any legal claim to an exemption, did not comply with the law and sued the state for violating his Fourteenth Amendment right in addition to violating the spirit of the Constitution. The Court ruled that the Constitution allows for limits on individual rights when states feel it necessary in order to protect the health, safety, and welfare of all citizens. The justices set the bar extremely high for individuals to overcome the broad power grated to states to police the well being of their citizens.

Lemon v. Kurtzman, 403 U.S. 602 (1971).

While not specifically discussing religious exemption for vaccination, Lemon articulated an important test to determine if state laws violate individual religious rights. The Court ruled that a statute must meet three criteria in order to be constitutional. The law must have a secular legislative purpose, the primary effect of the law must be one that neither advances nor inhibits religion, and the law must avoid excessive government entanglement with religion. This test must be considered when evaluating religious vaccination laws and demonstrates how difficult it can be to untangle religious freedoms from the web of a state’s police power.

United States v. Seeger, 380 U.S. 163 (1965).

Seeger does not discuss vaccination directly, but serves as important precedent for vaccination cases. Plaintiff Daniel Andrew Seeger morally opposed warfare and therefore refused to comply with the draft. He claimed the draft violated his religious belief, but neither confirmed nor denied that he believed in any sort of Supreme Being. The draft exemption specified belief in a Supreme Being as a requirement for exemption, but the Court determined that exemption must be granted for both religious and philosophical objections and cannot be based on such a requirement. The decision broadened the definition of “religion,” which has served to grant several religious exemptions for vaccinations.

United States v. Washington, 57 M.J. 394, 399 (C.A.A.F. 2002).

Other than schools, few institutions require compulsory vaccinations. However, the military requires soldiers to receive certain vaccines to protect their health and the health of their fellow soldiers. Airman Christopher Washington disobeyed an order from his superior and refused to submit to the anthrax vaccination and was punished accordingly. He claimed the defenses of necessity and duress, but did not provide proper evidence to support either claim. The military court determined that Washington was less concerned with the vaccine on protected religious grounds and more concerned with finding a reason to leave the military.

Zucht v. King, 260 U.S. 174 (1922). 

Plaintiff Rosalyn Zucht was denied entry to public school because she had not been vaccinated. San Antonio required students to provide a certificate of proof of vaccination to attend both public and private schools. Zucht claimed that the school board did not have the authority to require such documents, but the Court determined that the state may delegate such powers to local municipalities to uphold certain laws.  Zucht further supports the ruling in Jacobson and expanded the state police power to local authorities.

State Codes

6 Code Colo. Regs. 1009-2.

Colorado permits exemption from vaccination for medical, religious, and philosophical reasons. State code defines the requirements for parents to receive any of the three types of exemption, but invalidates all of them in the event of an outbreak.

Mass. Gen. Laws ch.111 §183.

Massachusetts only permits medial and religious exemptions to vaccinations. State code outlines the process for obtaining exemptions and allows local authorities to require compulsory vaccination of all citizens if deemed necessary.

Miss. Code Ann. § 41-88-3.

Mississippi only allows for medical exemptions. Vaccinations are required for all children based on the recommendations of the Advisory Committee on Immunization Practices. This practice has no doubt helped Mississippi achieve the highest rates of immunization in the country. 

Online and journalistic sources

Center for Law and the Public’s Health. “School Vaccination Requirements: Historical, Social, and Legal Perspectives.” Published February 15, 2002.

This assessment of vaccination policy, based off a Kentucky Law Journal article of the same name, provides useful background information on religious exemptions to vaccination. It details the history of vaccines and the rise of anti-vaccine feelings in response to compulsory programs. The authors outline the merits of those for and against school compulsory vaccination programs and ultimately conclude that vaccines are the cheapest and best way to prevent many deadly diseases and that the benefit to the public is greater than the individual payoff of exemption.

Congressional Research Service. “Mandatory Vaccinations: Precedent and Current Laws.” By Jared P. Cole and Kathleen S. Swendiman. CRS 7-5700. Washington, D.C.: U.S. United States Library of Congress. Published May 21, 2014.

This congressional report outlines the federal government’s role in compulsory vaccination. Because there is no federal requirement for vaccinations, Congress has said very little about the subject. The report outlines the role vaccines have played in improvements in public health. The federal government has little say in individual cases, but the Commerce Clause allows for authorities to limit travel between states in times of epidemic. The report focuses on a more broad conception of national health and safety as opposed to the regulations in each state.

Frankel, Todd C. “Mississippi – yes, Mississippi – has the nation’s best childhood vaccination rate. Here’s why.” Washington Post, January 20, 2015.

Allowing only medical exemptions for vaccinations, Mississippi has the highest rate of vaccination among children. This statistic comes as a surprise since the state is, in every other aspect of public health, considered the unhealthiest state in the country. The dichotomy between vaccination and other aspects of health comes from public support of compulsory vaccination. The lack of religious exemption is especially surprising in a state like Mississippi where school prayer is taking root. The difference in allowable religious practices greatly improves public health but may lead to other free exercise issues.

Izadi, Elahe. “Religious vaccination exemptions will completely end in Australia.” Washington Post, April 20, 2015.

Following Mississippi’s lead, Australia is planning to end religious exemptions to vaccinations for those receiving state benefits. According to the article, Australian, who are much less religious than Americans, are more willing to separate morality from religion. While the law will disproportionally target Christian Scientists, the main group claiming exemptions and collecting welfare, it will likely improve public health and reduce the risk of an epidemic.

National Vaccine Information Center. “The National Childhood Vaccine Injury Act of 1986.” Accessed April 28 2015.

The 1986 National Childhood Vaccine Injury Act outlines the proper channels to express grievances with vaccines and aims to protect children and other groups receiving vaccinations. The National Vaccine Information Center provides statistics on vaccine claim payouts and displays the text of the Act. Understanding the Act helps to clarify under what pretenses an individual can claim damage and further clarifies the role the federal government plays in compulsory vaccination.

National Vaccine Information Center. “State Law and Vaccine Requirements.” Accessed April 28, 2015.

The National Vaccine Information Center provides information on the vaccine requirements and exemptions for all 50 states. Additionally, it provides resources to educate parents about vaccination but is skewed toward encouraging vaccination for public safety reasons. The map clearly shows which exemptions are allowed in each state and allows for easy access and comparison between states.

United States Court of Federal Claims. “Vaccine Claims/Office of Special Masters.” Accessed April 28, 2015.

The Office of Special Masters, or “Vaccine Court” as it is more commonly referred to, was established to hear cases regarding vaccine-related injury. The court’s website provides detailed information on how to file a claim, past decisions, and the court’s history. Many religious exemption cases pass through this court, making it an important part of the issue. Understanding the Vaccine Court’s role in the legal process helps to clarify how definitions change, why statutes may or may not be constitutional, and when a claim for damages is legitimate.