Montana Considers New Wave of Legislation to Relax Vaccination Rules

Sarah SmithMarch 11, 2023

When her youngest daughter, Deb Horning, was 5 years old, she was vaccinated against measles, mumps, and rubella, like many other kindergartners. But unlike many other mothers, Horning was forced to stay away from her daughter for a week after the injection.

Horning, 51, was diagnosed with acute myeloid leukemia, an aggressive cancer in 2014, and the five-year survival rate for those over 20 is 27%. Horning underwent chemotherapy and a stem cell transplant, which severely weakened her immune system. Since the MMR vaccine contains a live virus, she could not get the vaccine herself and had to temporarily avoid her daughter’s vaccination.

Horning is now concerned about Montana legislation that could further compromise her and other immunocompromised people by making it easier to skip routine immunizations.

“If they allow it and a significant number of people don’t vaccinate their children, it could lead to community spread,” Horning said. “And then I’m really in danger, just like a newborn is in danger.”

In 2021, Montana passed House Bill 702 — the first of its kind in the nation — that prohibited discrimination based on vaccine status in settings such as employment, education, and health care. In essence, he banned private businesses and local governments from requiring employees to be vaccinated not only against covid-19, but against any other disease. A federal judge ruled the law unconstitutional in healthcare settings in a lawsuit filed by hospitals, health care providers and nurses. Two other lawsuits challenging HB 702, one from private businesses and the other from tribal peoples, are pending.

This year, lawmakers have made proposals to expand vaccine exemptions in schools and change criteria in the workplace and the legal system.

Advocates for school-related measures include mothers asserting their parental rights over whether to vaccinate their children; a nurse who argued that medical choice should be private; and a child care instructor concerned about the link between vaccines and autism, a claim that has been discredited.

Some experts say these bills, like two-year-old HB 702, are an overreaction to the fear and anger associated with the coronavirus pandemic.

According to Cason Schmit, an assistant professor at Texas A&M University’s School of Public Health, those who advocate vaccine exemptions based on parental rights and personal freedom need to be honest about the consequences. Those impacts could include more people getting sick and dying from preventable diseases, he said.

“We know what the results of such laws are,” Schmit said.

According to a study published in 2019 in the journal Expert Review of Vaccines, non-medical vaccine exclusions have increased over the past two decades in the United States.

Vaccine medical exemptions are granted for conditions that could lead to adverse reactions to the vaccine, such as cancer patients undergoing chemotherapy. The non-medical type includes religious, based on sincere religious conviction, and exceptions to conscience, based on personal or moral convictions.

According to Lauren Wilson, president of the Montana chapter of the American Academy of Pediatrics, in the past 20 years, no state has introduced a liability waiver for children’s vaccines. The National Conference of State Legislatures reports philosophical exceptions in 15 states.

Montana currently allows exceptions based on religion but not conscience for K-12 school vaccinations, and a religious exemption must be granted on the basis of a notarized written application. The medical release must be signed by a licensed healthcare provider.

That will change under Senate Bill 450, sponsored by Republican Senator Daniel Emrich, which would require schools, employers, health care providers, government agencies, and other entities to accept “without question or malice” religious or cooperative exemptions related to certain drugs. including vaccines. Any organization that does not comply will lose public funding.

Religious or belief exemptions can be used for any of the vaccinations required in Montana’s code: chicken pox, diphtheria, whooping cough, tetanus, polio, rubella, mumps, and measles for elementary school attendance, and influenza B before preschool entry.

SB 450 would also remove the requirement that an exemption be granted on a notarized affidavit letter and allow for a signed letter or statement to suffice.

Supporters say SB 450 will retain parental rights as well as the right to choose what to inject into one’s body, and provide an excuse for not getting vaccinated if one is not particularly religious.

Opponents, including the Montana Families for Vaccines, the Montana Medical Association and Wilson, said states with conscience exemptions have the lowest vaccination rates.

“I think part of the problem is that vaccines have become victims of their own success,” Wilson said. “There were many childhood diseases that were eliminated by more than one generation, and people do not remember.”

Another measure, House Bill 715, would require schools to inform parents of what exemptions are available through any communication they already provide to students about vaccines. He also originally added a conscience exemption for schools, but this was dropped from the bill.

Republican Rep. Jennifer Carlson, a sponsor of both HB 715 and 2021 HB 702, expressed doubt that HB 715 will significantly impact vaccination rates. During a hearing before the legislature on February 27, she said the state’s vaccination rate is 95-97%, despite existing medical and religious exceptions.

In the 2018-19 school year, 96% of Montana kindergarten students were vaccinated against measles, mumps, and rubella, and 3% were exempted for religious reasons, according to the state health department. In the 2020-21 school year, that proportion dropped to nearly 93% of Montana’s kindergarten students, according to the Centers for Disease Control and Prevention.

Nationwide, about 94% of preschoolers receive the two recommended doses of the MMR vaccine, and 2% remain unvaccinated due to non-medical exceptions.

Carlson emphasized that HB 715 was not related to covid and that she was not opposed to vaccinations, saying at the hearing that she and her five children received childhood vaccines.

“This bill is not a debate about the effectiveness of vaccines,” Carlson said.

Dr. Marian Kummer, a retired pediatrician and board member of Montana Families for Vaccines, said she was concerned that if HB 715 and SB 450 became law, it would leave the state vulnerable.

“Fear is what will happen if they go through a personal exemption — the number of exemptions will increase and that will put more communities at risk for outbreaks of these diseases,” Kummer said.

To maintain immunity against measles, 95% of the population must be fully vaccinated against the disease with both MMR shots. Kummer said if there are more exemptions, the state could fall below that threshold.

The 2021 Legislature passed legislation removing the requirement to report vaccine quantities to the Montana Department of Public Health and Human Services and local health departments.

Democratic Rep. Ed Staffman drafted a bill that would improve reporting on vaccines and exemptions. Staffman said there will be an increase in outbreaks at some point due to an increase in exceptions, and data will be critical.

“When this outbreak happens here, we will be in big trouble,” Staffman said.

In the workplace, Senate Bill 369 would require workers’ compensation insurance to cover adverse reactions to employer-prescribed vaccines.

And in the courthouse, House Bill 684 prohibits the use of vaccination status as evidence or basis for decisions in custody or guardianship cases. It will also ensure that vaccination status cannot be used as a factor in determining adoption criteria.

The bill’s sponsor, Republican Caleb Hinkle, said including vaccination status in evidence could lead to biased decisions because of how politicized vaccinations have become.

But Texas A&M’s Schmitt said the measure could limit judges’ ability to make decisions about what’s in the child’s best interests.

Keely Larson is a KHN Fellow at UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, and Kaiser Health News. Larson is pursuing a master’s degree in environmental and natural resource journalism from the University of Montana.

KHN (Kaiser Health News) is a national news service that produces in-depth journalism on health issues. Together with Policy Analysis and Polling, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is a charitable, non-profit organization providing health information to the nation.