After her youngest daughter turned 5, Deb Horning ensured that she received her measles, mumps, and rubella vaccine, just like other children in her kindergarten. However, unlike most mothers, Horning had to keep her distance from her daughter for a week following the vaccination.
Horning, 51, was diagnosed in 2014 with acute myeloid leukemia, an aggressive cancer — the five-year survival rate for those older than 20 is 27%. Horning had been through chemotherapy and a stem cell transplant, which severely weakened her immune system. Because the MMR vaccine contains live virus, she couldn’t get the vaccine herself and had to temporarily avoid her vaccinated daughter.
Now, Horning is concerned about the potential impact of Montana legislation on her and fellow immunocompromised individuals. The legislation could potentially exacerbate their compromised health conditions by facilitating a simpler process for more people to choose not to receive routine vaccinations.
Horning said that if this is permitted and a substantial number of individuals choose not to vaccinate their children, there is a possibility of community spread. Consequently, both Horning and newborns would be equally at risk.
In 2021, Montana passed House Bill 702 — the first of its kind in the nation — which prohibited discrimination based on vaccine status in settings like employment, education, and health care. In effect, it banned private businesses and local governments from requiring employees to be vaccinated, not just against COVID-19, but any disease. A federal judge ruled the law unconstitutional in health care settings in a lawsuit filed by hospitals, medical providers, and nurses. Two other lawsuits challenging HB 702, one by private businesses and another by tribal nations, are pending.
Lawmakers have presented proposals this year to broaden vaccine exemption policies in schools and modify criteria in the workplace and legal system.
Proponents of the school-related measures include mothers advocating for their parental rights over whether to vaccinate their children; a nurse who maintained that medical choices should be private; and a day care instructor concerned about the connection between vaccines and autism, a claim that has been discredited.
According to certain experts, bills such as HB 702, which were introduced two years ago, are seen as an exaggerated response to the fear and anger stemming from the COVID pandemic.
Cason Schmit, an assistant professor at Texas A&M University School of Public Health, emphasized the need for proponents of vaccine exemptions to acknowledge the potential repercussions. Specifically, he highlighted the possibility of increased illness and mortality resulting from preventable diseases.
According to Schmit, we are aware of the consequences that arise from such laws.
According to a study published in 2019 in the Expert Review of Vaccines journal, nonmedical vaccine exemptions have increased over the past two decades in the U.S.
Medical exemptions are given to individuals who may experience negative reactions to vaccines due to certain conditions, like someone with cancer undergoing chemotherapy. On the other hand, nonmedical exemptions include religious exemptions (based on sincerely held religious beliefs) and conscience exemptions (based on personal or moral beliefs).
According to Lauren Wilson, president of the Montana Chapter of the American Academy of Pediatrics, no state in the last 20 years has implemented a conscience exemption for childhood vaccines. The National Conference of State Legislatures reports philosophical exemptions in 15 states.
At present, in Montana, religious exemptions are permitted for K-12 school vaccinations, while exemptions based on personal conscience are not accepted. Religious exemptions require a notarized affidavit, whereas a medical exemption necessitates the signature of a licensed healthcare provider.
That would change under Senate Bill 450, sponsored by Sen. Daniel Emrich, R-Great Falls, which would require schools, employers, health care providers, state agencies, and other entities to accept “without question or malice” religious or conscience exemptions pertaining to certain medications, including vaccines. Any entity that doesn’t comply would lose state funding.
Religious or conscience exemptions could be used for any of the immunizations required in the Montana code: varicella, diphtheria, pertussis, tetanus, poliomyelitis, rubella, mumps, and measles for attendance in primary schools, and influenza B before starting preschool.
SB 450 would additionally eliminate the need for a notarized affidavit as a requirement for an exemption, permitting a signed letter or statement to be considered satisfactory.
Advocates argue that SB 450 aims to uphold both parental rights and individual autonomy over one’s own body, allowing individuals to reject vaccination even if they have personal beliefs that are not based on religious grounds.
Those in opposition, such as Montana Families for Vaccines, the Montana Medical Association, and Wilson, argue that states that allow conscience exemptions have the lowest rates of vaccination.
According to Wilson, “One of the issues is that vaccines have suffered due to their own triumphs. Numerous childhood diseases have vanished for over a generation, and people have forgotten about them.”
Another measure, House Bill 715, would require schools to inform parents which exemptions are available through whatever communication they already provide to students about vaccines. It initially added a conscience exemption for schools, too, but that was taken out of the bill.
Rep. Jennifer Carlson, R-Manhattan, the sponsor of both HB 715 and 2021’s HB 702, cast doubt on whether HB 715 would significantly affect vaccination rates. She said during a legislative hearing on Feb. 27 that the state has a 95%-97% vaccination rate regardless of its existing medical and religious exemptions.
In the 2018-19 school year, 96% of Montana’s kindergartners were vaccinated against measles, mumps, and rubella, while 3% were excused under religious exemptions, according to the state’s public health department. According to the Centers for Disease Control and Prevention, the share dropped to nearly 93% of Montana kindergartners in the 2020-21 school year.
Nationally, about 94% of kindergartners receive two recommended doses of MMR vaccine and 2% remain unvaccinated because of nonmedical exemptions.
During the hearing, Carlson made it clear that HB 715 was not related to COVID and clarified her stance on vaccinations. She expressed that she is not against vaccinations and highlighted that she and her five children have received their childhood vaccines.
According to Carlson, “The focus of this bill is not to question the effectiveness of vaccines.”
Dr. Marian Kummer, a retired pediatrician and board member of Montana Families for Vaccines, expressed concern about the potential vulnerability of the state if HB 715 and SB 450 are enacted into law.
Kummer expressed concern about the potential consequences of passing the personal exemption, emphasizing that it would increase the exemption rate and consequently pose a greater risk of disease outbreaks in various communities.
To maintain immunity against measles, 95% of a population needs to be fully vaccinated — having both MMR shots — against the disease. Kummer said if there are more exemptions, the state could fall below that threshold.
The 2021 Legislature passed a law that eliminated the requirement that vaccine rates be reported to Montana’s Department of Public Health and Human Services and local health departments.
Rep. Ed Stafman, D-Bozeman, has drafted a bill that would boost vaccine and exemption reporting. Stafman said that at some point there will be an increase in outbreaks because of increasing exemptions, and data will be crucial.
Stafman expressed concerns about the consequences we will face once the outbreak occurs in our vicinity.
In the workplace, Senate Bill 369 would require workers’ compensation insurance to cover adverse reactions to employer-mandated vaccines.
And in the courthouse, House Bill 684 would prohibit the use of vaccination status as evidence or grounds for decisions in guardianship or custody cases. It also would make it so vaccination status can’t be used as a factor in determining criteria for adoption.
That bill’s sponsor, Rep. Caleb Hinkle, R-Belgrade, said including vaccination status in evidence could lead to biased decisions because of how politicized vaccinations have become.
However, according to Schmit of Texas A&M, the measure has the potential to limit judges’ capacity to make decisions based on what is deemed most beneficial for a child.
