Massachusetts Medical Society: Physician Sign-On Letter Urging State to Strike Non-Medical Exemption to Vaccination Requirements for School

Physician Sign-On Letter Urging State to Strike Non-Medical Exemption to Vaccination Requirements for School

The Honorable Marjorie Decker
House Chair, Committee on Public Health
State House, Room 33
Boston, MA 02133

The Honorable Joanne Comerford
Senate Chair, Committee on Public Health
State House, Room 413-C
Boston, MA 02133

Dear Chairs Decker and Comerford:

As you are aware, vaccines are a critical public health tool that provide a safe and effective means to protect children and adults from infectious and potentially deadly diseases. We are witnessing firsthand the benefits and crucial role of vaccinations in protecting society from harmful disease as the COVID-19 vaccine and booster shots have become the key public health tool in combatting the pandemic and curtailing new variants.

The COVID-19 pandemic severely disrupted people’s – especially children's – ability to access routine preventive care, such as the recommended vaccination schedule. Preventable diseases pose a growing threat to the health of our population as a result of decreased vaccine uptake both before and during the COVID-19 pandemic. This trend is due in large part to increases in non-medical vaccination exemptions. Over the past several decades – especially in this moment – the public health of the Commonwealth has benefited greatly from the societal commitment to vaccination; however, in more recent years, vaccination rates have fallen, jeopardizing our herd immunity against preventable infections and diseases that were, until recently, effectively eradicated. For these reasons, we the undersigned members of the physician community, write to you to underscore that striking non-medical vaccination exemptions from school entry requirements would be a significant advance to assuring the health of children and communities as a whole, and as Joint Rule 10 approaches, we urge a favorable report of H.2411, An Act Relative to Vaccinations and Preventing Future Disease Outbreaks.

To protect the public’s health, Massachusetts law requires certain vaccinations before children enroll in school. At present, the law notes two exemptions from this requirement. First are medical exemptions for conditions that preclude vaccination. Such exemptions require a physician’s signature and account for only a small proportion of exemptions claimed. The second type of exemption is a religious exemption, which a parent may claim based on sincerely held religious beliefs. Religious exemptions constitute the overwhelming majority of all exemptions in Massachusetts, even though no major religion today harbors doctrinal objections to vaccination.

Over 80 percent of the vaccination exemptions in Massachusetts are based on a purported religious objection, more than a seven-fold increase over the past twenty years, despite no corollary shift in religious demographics. Despite overall high rates of vaccination, there exist places in the Commonwealth where exemption rates exceed 20 percent. Data suggest vaccine-hesitant parents are increasingly using the broadly accessible religious exemption in order to avoid immunization of their children. Often, concerns about the safety and efficacy of vaccination are based on mistruths and misinformation spread through social media. As physicians, our role is to keep our patients and the public safe and healthy. Immunizations serve a vital function in protecting both the vaccinees and their contacts who may be unprotected by virtue of age or medical contraindication. Parents should feel comfortable voicing concerns or questions they have about vaccination and physicians should be prepared to listen and respond effectively and empathetically. It is imperative that we, physicians and the Commonwealth alike, not only address vaccine misinformation with accepted science and data but also share with well-intentioned parents the potentially harmful and deadly clinical consequences that could arise if a child contracts a vaccine-preventable illness.

By allowing only bona fide medical exemptions to mandatory school immunizations, H.2411 serves our communities well, offering the surest path to community immunity against deadly, contagious infections. As the COVID-19 pandemic has taught us, acting proactively to protect the health of our people, particularly those made most vulnerable, averts dangerous illness and saves lives. In the interest of public health, we the undersigned urge the committee to promptly report favorably H.2411 in hope that the legislature may pass this in a timely manner.


Carole E. Allen, MD, MBA, FAAP
President, Massachusetts Medical Society

Lloyd Fisher, MD, FAAP
President, Massachusetts Chapter of American Academy of Pediatrics

Julie Johnston, MD, FAAFP
President, Massachusetts Academy of Family Physicians

Elisa Choi, MD, FACP, FIDSA
Governor, MA Chapter, American College of Physicians

Zoe Tseng, MD, FACP & Shela Sridhar, MD
Co-Chairs, MA Chapter, American College of Physicians Health and Public Policy Committee

Glenn Markenson, MD
President, Massachusetts Chapter of the American College of Obstetricians & Gynecologists

View a PDF version of this letter here.

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