The Massachusetts Medical Society (MMS) wishes to be recorded in strong support of H.604, An Act relative to routine childhood immunizations/S.1391, An Act relative to vaccines and preventing future disease outbreaks.
The MMS is a professional association of over 25,000 physicians, residents, and medical students across all clinical disciplines, organizations, and practice settings. The Medical Society is committed to advocating on behalf of patients, for a better health care system, and on behalf of physicians, to help them provide the best care possible. The Medical Society has long supported policy measures that strengthen public health. Vaccines are a critical public health tool that provide a safe and effective means to protect society from infectious and potentially deadly diseases.
Preventable diseases pose a growing threat to the Commonwealth because of missed vaccines, but also because vaccination rates began falling long before the COVID-19 pandemic, largely due to increases in non-medical vaccination exemptions. Over the past several decades, 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 necessary herd immunity to preventable infection and disease that had been, until recently, effectively eradicated. The Medical Society opposes non-medical vaccination exemptions. It is for this reason that the Medical Society would like to voice its support for H.604/S.1391, which provides the strongest possible childhood immunization policy to ensure the health and safety of our patients.
In the interest of public health, and specifically the health of children in Massachusetts, state law requires children to be vaccinated prior to enrolling in school. The law, however, provides for two exceptions to this requirement—one medical and one non-medical (religious). H.604/S.1391 would strike the non-medical (religious) exemption from the vaccination requirement, which currently allows parents or guardians who object to vaccinations on grounds of sincerely held religious beliefs to send their child to school without being vaccinated.
Vaccination plays a crucial role in establishing herd immunity, which occurs when a significant portion of the population is immune to a particular disease. This protective effect extends to those who cannot receive vaccines due to medical reasons or those who are immunocompromised. Schools are communal settings where large numbers of children and adults come into close contact. However, due to rising non-medical exemption claims, the Commonwealth now has thousands of children attending schools across the state with vaccination rates well-below the 90-95% herd immunity threshold for all vaccine-preventable diseases. Although Massachusetts’ vaccination rate overall is among the highest in the country, certain districts in the state are experiencing disproportionately high exemption rates, which puts the entire Commonwealth’s herd immunity at risk, as outbreaks—even localized outbreaks—can overwhelm the broader population’s collective immunity. Distressingly, the 2019 measles outbreak in New York caused a public health emergency, despite the state having a higher overall rate of vaccinated children entering school than Massachusetts. H.604/S.1391 will bolster herd immunity, reducing the overall risk of disease transmission within the school community and beyond.
According to the Massachusetts Department of Public Health (DPH), most exemptions claimed in Massachusetts are non-medical (religious) objections. In fact, the use of non-medical exemptions for vaccination requirements is at an all-time high in the Commonwealth, despite declining religious demographics. As physicians, our role is to keep our patients and the public safe and healthy. Parents should feel comfortable voicing concerns or questions they have about vaccination and physicians should be prepared to listen and respond effectively and with empathy. It is imperative that we as physicians not only address vaccine misinformation with accepted science and data, but also share with parents the potential harmful and deadly clinical consequences that could arise if a child contracts a vaccine-preventable illness.
To that end, this legislation would eliminate the non-medical exemption and restore valuable public health protections by improving herd immunity. Rather than acting reactively by waiting for an inevitable disease outbreak to occur, the Medical Society urges the legislature to protect the health and safety of our children and our communities by proactively enacting a measure that will have a substantial public health impact. In 2019, the US experienced the largest measles outbreak in over a quarter of a century, with more than 1,200 cases of measles having been reported across 31 states—the largest number of people sickened since 1992, according to the Centers for Disease Control and Prevention (CDC). These diseases are preventable and the vaccines to prevent them are proven, safe, and effective. Massachusetts should follow the lead provided by several other northeastern states–New York, Connecticut, Maine–that recently eliminated non-medical exemptions to vaccination requirements to address the issue in a prudent manner.
Importantly, H.604/S.1391 would require DPH to receive and publish data on the rates of immunizations and exemptions for each school and district for each school year. While the medical exemption has existed for years in Massachusetts—and the Medical Society supports its retention—it has evolved into a system that lacks standardization. Rates of students with an exemption to one of more vaccines are captured in the annual immunization survey of kindergartens (as well as seventh grades, childcare, and colleges). However, because this survey is not mandatory, more than one-third of all kindergartens in Massachusetts did not have data reported from the 2022-2023 school year. School immunization data provide insight into vaccine coverage in communities across the state and highlight areas that may be more susceptible to vaccine-preventable diseases. Data on immunization rates also enable parents to make informed decisions about their child’s education and health. For parents of immunocompromised children, this information is particularly valuable because it allows them to assess the risk of potential exposure to vaccine-preventable diseases at their child’s school and take necessary precautions. Requiring all schools to report immunization rates, as proposed in H.604/S.1391, is critical for monitoring and protecting the overall health of each community and individual child in the Commonwealth.
Thank you for your consideration of our comments and for your important work on this pressing topic. To prevent future disease outbreaks, the Medical Society respectfully urges a favorable report on H.604/S.1391.
View a PDF version of this testimony here.
