Measles is back. In recent weeks, an outbreak that originated in Southern California has spread across the nation (above). Public health officials seem confident the outbreak is explained, in large part, by the fact that significant numbers of parents no longer have their children vaccinated. These parents rely on exemptions that state laws, like California’s, provide for parents who object to mandatory vaccination programs. Perhaps surprisingly, the resistance is disproportionately high in wealthier, better educated, bluer neighborhoods, the sort of communities that pride themselves on their enlightened, progressive outlook.
The outbreak has obvious, unsettling public health implications. We are witnessing the recurrence of a serious, highly contagious disease we thought we had eradicated. In this post, though, I’d like to discuss some important cultural and legal implications. Culturally, the outbreak suggests the growing influence of the Nones—those Americans, maybe as many as 20% of us, without a formal religious affiliation. As I’ll explain, many of the parents who object to vaccination reflect the spirituality of the Nones. Legally, the outbreak seems likely to provide ammunition for opponents of last term’s decision in Hobby Lobby, the Contraception Mandate case. As I’ll explain, though, Hobby Lobby wouldn’t allow parents to claim religious exemptions in this context.
Let’s start with the cultural implications. To understand why the measles outbreak suggests the growing influence of the Nones, consider the reasons parents give for refusing to vaccinate their children. Some parents, it’s true, worry about the threat of toxins and an alleged link with autism. But the link with autism has been debunked; scientifically, there’s nothing to it. Some parents belong to religions that oppose vaccination. But the number of religions that forbid or even discourage vaccination is actually quite small. Conventional religious teachings cannot explain the widespread resistance we’re seeing, particularly in those blue, progressive neighborhoods.
Based on media accounts, much of the resistance comes from parents who object to vaccination, not because of science or conventional religion, but “personal belief.” Indeed, California law speaks in terms of a “personal belief exemption.” Many of the objectors have an intuitive conviction that vaccination is not right, natural, or wholesome. They associate it with capitalism and anti-environmentalism, which they see as morally deficient. Immunization makes these parents sincerely uncomfortable on a gut level. One told the New York Times, simply, “Vaccines don’t feel right for me and my family.”
Now, it’s impossible to hear these objections without thinking of the Nones. The Nones are a diverse group with varied commitments and philosophies. But sociologists have identified a common characteristic. Nones reject organized religion, not faith. In fact, they tend to be quite comfortable with spirituality, as long as it is personal and authentic: they are the “Spiritual but Not Religious.” So when a parent says vaccination seems wrong to her on a visceral level, and that she therefore refuses to allow her children to go through the procedure, she is reflecting the spirituality of the Nones. Of course, I don’t claim that all Nones reject vaccination, or even that all the parents who object to vaccination are Nones. But the Nones’ worldview pretty clearly provides the anti-vaccination movement with much of its considerable force.
Next, the legal implications. It seems to me very likely that opponents will use the outbreak to attack the Court’s decision last term in Hobby Lobby, the Contraception Mandate case. In fact, in her Hobby Lobby dissent, Justice Ginsburg argued that that, under the Court’s reading of RFRA, employers with religious objections could refuse to cover vaccinations for employees. This argument is a bit ironic, since, as I say, most religions don’t object to vaccinations. But some religions do object, and anyway, under Supreme Court precedent, the personal, anti-vaccination beliefs of Nones could be treated, for legal purposes, like traditional religious convictions. So Justice Ginsburg’s argument has a surface plausibility.
The Hobby Lobby Court expressly declined to address the implications of its holding for vaccination requirements. But Justice Ginsburg’s argument is misleading. Under RFRA, the government must offer an accommodation where a less restrictive alternative exists, that is, one that would allow the government to fulfill its compelling interest without substantially burdening the claimant’s exercise of religion. In Hobby Lobby, an alternative did exist. The government could have allowed the employer to opt out of coverage and have the plan administrator itself pay for the contraception. A similar accommodation could be worked out for vaccinations. If an employer didn’t want to pay, the plan administrator could be required to do so.
But here’s the important point: the vaccinations would take place. Hobby Lobby would not allow parents with religious objections to refuse to have their kids vaccinated at all. This is because there is no less-restrictive alternative to a mandatory vaccination protocol. For vaccination to work in preventing the spread of serious disease –surely a compelling government interest—more than 90% of a population must be vaccinated. (Scientists refer to this as the percentage necessary to create “herd immunity”). If the government allowed exemptions for people with religious objections, the percentage of vaccinated children could quickly fall below this number, endangering the whole population. In one California location, for example, the Times reports that exemptions have allowed 40% of schoolchildren to skip their measles vaccination.
Now, there is a complication. All states allow parents to claim exemptions from mandatory vaccination requirements for medical reasons. In some very rare cases, vaccination can endanger the health of a child, and in those circumstances, parents can decline to have their child vaccinated. Well, you might ask, doesn’t the possibility of medical exemptions suggest that the government doesn’t have a compelling interest in vaccinating absolutely everybody? And doesn’t that mean the government must also allow religious exemptions?
Maybe—some lower court caselaw does suggest that outcome. But I doubt it. No medical protocol is ever completely categorical; we don’t insist that doctors carry out a course of treatment even if it’s not medically indicated. It’s hard to imagine the Supreme Court would hold that allowing any medical exemption at all would necessarily require an exemption for religious reasons. It wouldn’t make sense.
Anyway, an outbreak of the sort we’re experiencing now is not an inevitable consequence of Hobby Lobby. It’s worth keeping that in mind in the weeks ahead.