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An amendment that would give West Virginia parents much greater leeway to exempt their children from mandated school vaccinations was deleted from a House bill at the last minute this week, but the prospect of far fewer students in the state getting immunized remains strong.

As written, the West Virginia bill would still expand and loosen requirements for medical exemptions for students, making them “the broadest … in the country,” one advocate said. The religious and philosophical exemptions that were struck from the House version of the legislation could also be reintroduced and, while it doesn’t carry the same force of law, Gov. Patrick Morrisey’s January order establishing similarly far-reaching exemptions is also hanging in the balance.

Historically, West Virginia has had some of the nation’s strictest childhood vaccination policies and the current move to soften them is occurring against a deadly measles outbreak that has infected more than 300 people in 15 states and taken the life of one school-age child in Texas. 

“It’s hard to wrap your head around why we would do this right now — or anytime,” said Candice Lefeber, executive director of West Virginia’s chapter of the American Academy of Pediatrics. “But at such heightened alertness with measles spreading in our country, it should be a wake-up call. And unfortunately, I don’t think that’s happening,”

West Virginia is not an outlier in its quest to allow parents to opt their children out of the measles, mumps and rubella vaccine that is a requirement in all 50 states for children entering child care and schools. 

On Wednesday, Idaho lawmakers passed a “medical freedom” act that would significantly broaden an existing law banning COVID vaccine mandates to include mandates on any “medical treatment.” If the governor signs it, the bill would apply to public and private schools as well, making Idaho the first state in the country to remove all mandatory school vaccination requirements.

Childhood vaccination rates have been falling since COVID, and there’s fear that decline will accelerate now that Robert F. Kennedy Jr., a well-known vaccine skeptic, is heading the U.S. Department of Health & Human Services. He initially downplayed the measles spread in late February, and in a March 4 Fox News interview, seemed to link the ongoing outbreak and child fatality to malnutrition and poor health while pointing to unproven treatments, such as cod oil.

“The best thing Americans can do is to keep themselves healthy,” Kennedy said in the interview. “It is very, very difficult for measles to kill a healthy, well-nourished person.”

Three months in, the number of measles cases has already surpassed 2024’s total and in the 15 states where it’s spread, 95% of infections have involved a person who was unvaccinated or whose status was unknown. Three of those states border West Virginia, although, so far, the Mountain State has no reported cases. 

‘We just want the policy left alone’

The latest House bill still has a more wide-ranging medical exemption that also protects health care providers who grant them “in good faith” from civil liability, except in cases of “gross negligence or willful misconduct.” 

It also includes no enforcement mechanism from a government oversight body nor is there guidance as to what qualifies someone for a medical exemption. 

Northe Saunders, executive director of the pro-vaccine SAFE Communities Coalition, fears this might lead to bad actors writing “bogus” exemptions. Saunders’ group, which is based in Portland, Maine, opened a West Virginia chapter in February after local advocates asked for their help amid the exemptions push.

“We’re glad that the religious and philosophical exemptions were not part of the bill that came out of committee,” said Saunders, who believes the measles outbreak was a factor in their being cut, “but we expect [attempts to modify the bill] going forward.” 

Saunders said his organization is tracking an additional 20 vaccine-related bills in the West Virginia legislature. And, across 20 states, 47 bills have been introduced which would add or broaden vaccine exemptions.

Parents across the country are able to apply for exemptions if their child is unable to get vaccinated for medical reasons. Most states also have religious exemptions, and 20 have some form of personal belief exemptions, leaving a varied landscape. 

West Virginia is currently one of only five states that don’t allow any exemptions, beyond medical ones. Last school year, they had the highest childhood vaccination rates for four of the major mandated vaccines, significantly outperforming national averages. Almost all kindergarteners there — 98.3% — had received both doses of the measles, mumps and rubella vaccine. 

The state also had the lowest rate of exemption, with less than 0.1% of kindergarteners being exempt from one or more vaccines. And it was the only state that supported Donald Trump for president in November that did not see an average rise in official exemptions. 

That could change, depending on the fate of the pending legislation and the governor’s executive order.

“The current policy as is, is something that is highly favored among myself and my colleagues,” said Andrea Lauffer, an internal medicine doctor and pediatrician at WVU Medicine – Thomas Memorial Hospital in South Charleston. “We just want the policy left alone.”

Michael Ramey, president of the Parental Rights Foundation, noted the role the pandemic has played in the current vaccine skepticism. He said that while his organization does not hold a position on the safety or efficacy of vaccines, it stands in support of bills like the one in West Virginia.

“We welcome a move to give parents greater authority to make the decision that’s best for their individual child,” he said. 

The vast majority of Americans — 88% — believe the benefits of the childhood vaccine for measles, mumps and rubella outweighs the risks, compared with just 10% who say the risks outweigh the benefits, according to a 2023 Pew Research Center poll. Seventy percent of Americans say healthy children should have to be vaccinated to attend school, down from 82% in 2019. And the share of parents who think they should be able to decide against vaccination is up 12 percentage points from four years ago, to 28%.

This shift is being driven by Republicans, 57% of whom now support vaccination requirements — down from 79% in 2019.

‘The heat is on’

The debate over vaccine mandates in West Virginia is not new, but “this year, definitely, the heat is on, for sure, at a higher temperature,” said Sissy Price, a registered nurse who serves as co-director of West Virginia Families for Immunization.

Last year, former Gov. Jim Justice vetoed a bill which would have allowed private and parochial schools to set their own vaccination policies. Meanwhile, Morrisey signed his executive order creating religious and philosophical exemptions on his first full day in office.

The governor wrote that current mandatory vaccine laws force West Virginians who have objections “to choose between their religious belief and their children’s fundamental right to public education.” The order, he said, was based on his interpretation of the Equal Protection for Religion Act, signed by Justice in 2023. 

The pending legislation was meant to clarify and codify his order. Even if the bill’s final version does not include religious and philosophical exemptions, the governor’s executive order would still stand, said Richard Hughes, a George Washington University law professor and leading vaccine law expert. 

While the ability to set new laws lies only with the legislature, the governor does have the ability to interpret those laws, which is what his executive order does, Hughes said.

If the executive order is not in line with what the legislature passes, however, it would remain vulnerable to court challenges.

“The governor could be checked by the courts on this interpretation,” he said.

Introduced Feb. 13, the Senate version of the bill would have allowed parents to simply provide a written statement to exempt their child from vaccines for religious or philosophical reasons and applied to public, private and parochial schools.

In addition to loosening the medical exemption process and protecting medical professionals from disciplinary actions, it would also eliminate the position of state immunization officer and no longer require schools to report a violation if an unvaccinated child without an exemption attempted to enroll.  

At a Feb. 21 committee meeting, both Democratic and Republican senators spoke out in opposition to the bill. Many cited the measles outbreak that began in West Texas in late January as core to their concerns.

GOP Sen. Mike Oliverio read aloud from a letter written by one of his constituents, a retired physician.

“Loosening these requirements will eventually lead to outbreaks of these diseases, including in our children, as the number of vaccinated individuals fall,” he read. “I urge you to vote against this bill for the sake of West Virginia’s children.”

A number of Republican lawmakers also spoke in favor of the bill, which ultimately passed by a 20-12 vote, with two senators absent, before going to the House. 

The House bill that came out of committee this week is now expected to move to the floor, where it will be debated and potentially amended again. If the final House bill that passes still differs from the initial Senate bill, senators will need to either accept the House’s version or head to a conference committee to reconcile the two before sending it on for Morrisey’s signature. 

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