Responding to Requests for Personal Belief Exemptions – Some Helpful Resources

June 2012

Technically Speaking
Monthly Column by Deborah Wexler, MD
Deborah Wexler MD
Technically Speaking is a monthly column written by IAC’s Executive Director Deborah Wexler, MD. The column is featured in The Children’s Hospital of Philadelphia Vaccine Education Center’s (VEC’s) monthly e-newsletter for healthcare professionals. Technically Speaking columns cover practical topics in immunization delivery such as needle length, vaccine administration, cold chain, and immunization schedules.
Check out a recent issue of Vaccine Update for Healthcare Providers. The VEC e-newsletter keeps providers up to date on vaccine-related issues and includes reviews of recently published journal articles, media recaps, announcements about new resources, and a regularly updated calendar of events.
Responding to Requests for Personal Belief Exemptions — Some Helpful Resources
Published June 2012
Information presented in this article may have changed since the original publication date. For the most current immunization recommendations from the Advisory Committee on Immunization Practices, visit
All states have immunization requirements for entry into schools, which have led to our nation’s great success in reaching high immunization levels. School entry laws and mandates vary from state to state, but they typically are in place for entry into childcare, kindergarten, middle school, high school and (less frequently) post-secondary institutions. The specific vaccines that are required vary from state to state as well.
Unfortunately, despite your best efforts to educate parents about the important protection vaccines provide, some will decline to have their child vaccinated and will request a personal belief exemption (PBE) or a religious exemption.
All states and the District of Columbia allow immunization exemptions due to medical contraindications, and 48 of 50 states allow exemptions for religious beliefs. Approximately 20 states allow exemptions based on parents’ personal beliefs. A map of the United States with exemptions indicated by color coding is available at the website of the Institute for Vaccine Safety at Johns Hopkins University.
Here are some excellent resources related to PBEs that may be useful to you in responding to these parents’ requests.
Personal belief exemptions for vaccination put people at risk. Examine the evidence for yourself
This two-page handout from the Immunization Action Coalition (IAC) provides summaries of 14 articles about recent outbreaks of measles, pertussis, and varicella that have been traced to unvaccinated children in states that allow PBEs. The handout provides good background material for healthcare professionals, and it also may be given to parents who want scientific evidence about the effectiveness of vaccination.
What If You Don’t Immunize Your Child?
This double-sided, tri-fold parent brochure details the consequences of not vaccinating your child. It reminds parents that their decision not to vaccinate affects not only the health of their child, but also their family, their child’s friends and their families, and the entire community.
Decision to Not Vaccinate My Child
This one-page vaccine refusal form includes 10 reasons why parents should vaccinate their child. If, after reading the form, a parent still wishes to decline vaccination, they can check boxes to indicate the vaccines they refuse and sign the form to document their refusal. A second page (for the healthcare provider’s use only) explains the importance of using a vaccine refusal form if a parent decides to refuse vaccination for their child.
Sample Vaccine Policy Statement: Ready for you to adapt for your practice
This vaccine policy statement, which was created by a private pediatric practice in Pennsylvania, can serve as a template to reflect your own medical practice’s strong statement on the vital role vaccination plays in safeguarding the health of children.
Here are additional links to valuable resources on PBEs.
American Academy of Pediatrics
Improve Vaccine Liability Protection
Association of State and Territorial Health Officials (ASTHO)
Permissive State Exemption Laws Contribute to Increased Spread of Disease
Centers for Disease Control and Prevention
School Vaccination Requirements, Exemptions & Web Links
Immunization Action Coalition
Immunization Laws Web Page
National Association of County and City Health Officials
Eliminating Personal Belief Exemptions from Immunization Requirements for Child Care and School Attendance
National Conference of State Legislatures
States with Religious and Philosophical Exemptions from School Immunization Requirements
National Network on Immunization Information
Exemptions from Immunization Laws
Pediatric Diseases Society of America
A Statement Regarding Personal Belief Exemption from Immunization Mandates
Vaccine Education Center at The Children’s Hospital of Philadelphia
Vaccines and Society at the University of Pennsylvania
Vaccination Requirements and Exemptions


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