Confusion on New Vaccine Exemption Bill

Just this morning, CNN published an article stating that a new study performed by the American Academy of Pediatrics said that 20 states were proposing new bills to expand the exemptions for child vaccinations.

So, what does that mean exactly? While there is a federal bill in place for vaccinations, each state has its own protections. Here’s an outline:

National Vaccine Information Center, 2019

	Philosophical	Religious	Medical
Alabama Child shall be exempt from immunization requirements if the parent objects in writing if such immunization conflicts with their religious practices. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Alaska Child is exempt from immunization if there is an affidavit signed by the parent, affirming immunization conflicts with the practices of the church or religious denomination. Medical exemptions are also allowed. In 2017, Alaska’s vaccine registry law changed from an opt-out registry to a mandatory registry and health care professionals must now report any vaccine administered to children and adults within 14 days of administration to Alaska’s vaccine registry. -National Vaccine Information Center		✔	✔
Arizona Student is exempt from required immunizations if the parent of the student submits a signed statement stating they have received information about immunizations provided by the department of health services, understands the risks and benefits of immunizations and non-immunization and due to personal beliefs, the parent does not consent to the immunization. Student is exempt from required immunizations if parent objects due to conflicts with their religious practices. Medical exemptions are also allowed. -National Vaccine Information Center	✔	✔	✔
Arkansas Immunization requirements shall not apply if the parents of the child objects that immunization conflicts with their religious or philosophical beliefs. To obtain an exemption parents/guardian/student must: Sign a notarized statement requesting a religious, philosophical or medical exemption from the Department of Health, Complete an educational component developed by the Department of Health, Sign an informed consent with a refusal to vaccinate statement and Sign a statement of understanding that the unimmunized child/student may be removed from school during an outbreak. The pertussis vaccination requirement shall not apply to any child with a sibling who has had a serious adverse reaction to the pertussis antigen, which resulted in permanent disability. Medical exemptions are also allowed. -National Vaccine Information Center	✔	✔	✔
California Personal and religious belief exemptions are not allowed in California daycare, preschool, and K-12 schools. -National Vaccine Information Center			✔
Colorado A parent or emancipated student may submit their own signed statement of religious or personal belief exemption to vaccination to the school. -National Vaccine Information Center	✔	✔	✔
Connecticut Any student or child whose parent presents a statement that such immunization is contrary to the religious beliefs of such student or child is exempt from immunization requirements. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Delaware Exemption from immunization requirements is allowed for student or child whose parents or legal guardian, reject the concept of immunization because of individual religious beliefs. There is a specific affidavit to be notarized. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Washington DC Exemption will be obtained when responsible person objects in good faith and in writing, to the chief official of the school, that immunization would violate his or her religious beliefs. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Florida A request for a religious exemption from immunization requirements must be presented to the facility/school on the Department of Health’s Religious Exemption From Immunization form (DH 681 Form). The DH 681 Form is issued only by county health departments and only for a child who is not immunized because of his/her family’s religious tenets or practices. If a parent requests such an exemption, the county health department staff must use the current DH 681 Form, which has been signed by the parent affirming the written statement on the form that a religious conflict exists. This form must be issued upon request. No other information should be solicited from the parent or guardian. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Georgia For a child to be exempt from immunizations on religious grounds, the parent or guardian must furnish the school/facility with a notarized affidavit stating that immunization conflicts with his or her religious beliefs. There is no standard form for Religious Exemption, however, in 2015 the Department of Health created a form which appears to be an overreach of their authority. NVIC recommends that parents with concerns about the exemption form provided by the Department of Health seek legal advice. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Hawaii A religious exemption shall be granted to a student whose parent, custodian, guardian, or other person in loco parentis certifies that the person’s religious beliefs prohibit the practice of immunization. Requests for religious exemptions based on objections to specific immunizing agents will not be granted. Students who have reached the age of majority shall apply on their own behalf. The certification shall be retained in the student’s health record. Reports of such exemptions shall be submitted to the department by each school. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Idaho Any minor child whose parent or guardian has submitted a signed statement to school officials stating their objections on religious or other grounds shall be exempt from the provisions of this chapter. Medical exemptions are also allowed. -National Vaccine Information Center	✔	✔	✔
Illinois Parents or legal guardians who object, for religious reasons, to their child being immunized for school entrance must submit a Certificate of Religious Exemption, which now must be signed by a health care provider. Signed into law on August 3, 2015, this new legislation requires a health care provider to sign the certificate confirming they have provided education to the parents or legal guardians about the benefits of immunizations and the health risks of not vaccinating students. The new certificate should be available soon. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Indiana A school child may not be required to undergo any immunization when the child’s parent objects on religious grounds. A religious objection must be: Made in writing, Signed by the child’s parent, and Delivered to the child’s teacher or to the individual who might order an immunization. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Iowa In order to qualify for a religious exemption, the applicant, or if the applicant is a minor, the applicant’s parent or guardian, must submit a notarized certificate of immunization exemption with the applicant’s or parent’s/guardian’s signature attesting that immunization conflicts with a genuine and sincere religious belief and that the belief is in fact religious and not based merely on philosophical, scientific, moral, personal, or medical opposition to immunizations. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Kansas Submit a written statement signed by a parent that the parent is an adherent of a religious denomination whose teachings are opposed to immunizations. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Kentucky Any child whose parents are opposed to medical immunization against disease, and who object by a written sworn statement to the immunization of such child on religious grounds shall be exempt from immunizations. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Louisiana Medical, religious and philosophic exemptions will be allowed for compliance with regulations concerning day care attendees and school enterers. Only medical and religious exemptions will be allowed for compliance with regulations concerning public assistance recipients. -National Vaccine Information Center	✔	✔	✔
Maine For religious or philosophical exemption written statements by parents, students or healthcare workers stating, “a sincere religious belief that is contrary to the immunization requirement or an opposition to the immunization for philosophical reasons,” are accepted. Medical exemptions are also allowed. -National Vaccine Information Center	✔	✔	✔
Maryland A child whose parent or guardian objects to immunization on the grounds that it conflicts with the parent’s or guardian’s bona fide religious beliefs and practices may not be required to present a physician’s certification of immunization in order to be admitted to school or day care. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Massachusetts No child whose parent or guardian states in writing that vaccination or immunization conflicts with his sincere religious beliefs shall be required to present an immunization certificate in order to be admitted to school. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Michigan A child is exempt from immunization if a parent, guardian, or person in loco parentis of the child presents a written statement to the administrator of the child’s school or operator of the group program to the effect that the requirements of this part cannot be met because of religious convictions or other objection to immunization. Medical exemptions are also allowed. As of Jan. 1, 2015, vaccine education administered and certified (signature on waiver) by local health department is required before the waiver (exemption) will be granted. -National Vaccine Information Center	✔	✔	✔
Minnesota If a notarized statement signed by the minor child’s parent or by the emancipated person is submitted to the person having supervision of the school or child care facility stating that the person has not been immunized as prescribed because of the conscientiously held beliefs of the parent of the minor child or of the emancipated person, the immunizations specified in the statement shall not be required. This statement must also be forwarded to the commissioner of the department of health. Medical exemptions are also allowed. -National Vaccine Information Center	✔	✔	✔
Mississippi Certificate of exemption from vaccination for medical reasons may be offered by a duly licensed physician and may be accepted by the local health officer when, in his opinion, such exemption will not cause undue risk to the community. -National Vaccine Information Center			✔
Missouri Immunization of the person seeking to attend school may not be required prior to attendance at the school, if a notarized affidavit on a prescribed form stating that immunization is contrary to the religious tenets and practices of the signer is submitted to the school administrator. A child in a day care program shall be exempt from immunization requirements if the child’s parent or guardian files a written objection to immunization with the day care administrator. Exemptions shall be accepted by the day care administrator when the necessary information as determined by the department of health and senior services is filed with the day care administrator by the parent or guardian. Exemption forms shall be provided by the department of health and senior services. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Montana When a parent, guardian, or adult who has the responsibility for the care and custody of a minor seeking to attend school or the person seeking to attend school, if an adult, signs and files with the governing authority, prior to the commencement of attendance each school year, a notarized affidavit on a form prescribed by the department stating that immunization is contrary to the religious tenets and practices of the signer, immunization of the person seeking to attend the school may not be required prior to attendance at the school. Religious exemption for child care applies only to Haemophilus influenzae type b (Hib). Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Nebraska Immunization shall not be required for a student’s enrollment if he or she submits to the admitting official an affidavit signed by the student or, if he or she is a minor, by a legally authorized representative of the student, stating that the immunization conflicts with the tenets and practice of a recognized religious denomination of which the student is an adherent or member or that immunization conflicts with the personal and sincerely followed religious beliefs of the student. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Nevada Child is exempt if the parents’ of the child has submitted to governing body of a school or child care facility in which the child has been accepted for enrollment a written statement indicating that their religious belief prohibits immunization of such child or ward. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
New Hampshire If a parent objects to immunization because of religious beliefs, the parent or legal guardian shall sign a notarized form stating that the child has not been immunized because of religious beliefs. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
New Jersey A written statement should be submitted by the student, or the student’s parent or guardian if the student is a minor, stating that “immunization interferes with the free exercise of the pupil’s religious rights”. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
New Mexico Any minor child through his parent or guardian may file with the health authority either an: Affidavits or written affirmation from an officer of a recognized religious denomination that such child’s parents or guardians are bona fide members of a denomination whose religious teaching requires reliance upon prayer or spiritual means alone for healing; or Affidavits or written affirmation from his parent or legal guardian that his religious beliefs, held either individually or jointly with others, do not permit the administration of vaccine or other immunizing agent. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
New York Immunization requirements shall not apply to children whose parent, parents, or guardian hold genuine and sincere religious beliefs which are contrary to the practices herein required, and no certificate shall be required as a prerequisite to such children being admitted or received into school or attending school. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
North Carolina If the bona fide religious beliefs of an adult or the parent, guardian or person in loco parentis of a child are contrary to the immunization requirements, the adult or the child shall be exempt from the requirements. Upon submission of a written statement of the bona fide religious beliefs and opposition to the immunization requirements, the person may attend the college, university, school or facility without presenting a certificate of immunization. No child shall be exempt from the requirements of immunizations for the case of a personal belief or philosophy of a parent or guardian not founded upon a religious belief. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
North Dakota Any minor child, through the child’s parent or guardian, may submit to the institution authorities either a certificate from a licensed physician stating that the physical condition of the child is such that immunization would endanger the life or health of the child or a certificate signed by the child’s parent or guardian whose religious, philosophical, or moral beliefs are opposed to such immunization. The minor child is then exempt from the provisions of this section. -National Vaccine Information Center	✔	✔	✔
Ohio A pupil who presents a written statement of the pupil’s parent or guardian in which the parent or guardian declines to have the pupil immunized for reasons of conscience, including religious convictions, is not required to be immunized. Medical exemptions are also allowed. -National Vaccine Information Center	✔	✔	✔
Oklahoma Any minor child, through his or her parent or guardian, may submit to the health authority charged with the enforcement of the immunization laws, a certificate of a licensed physician stating that the physical condition of the child is such that immunization would endanger the life or health of the child; or upon receipt of a written statement by the parent or guardian objecting to such immunizations because of religious or other reasons, then such child shall be exempt from the provisions of this act. -National Vaccine Information Center	✔	✔	✔
Oregon Oregon’s vaccine laws allow for medical and non-medical vaccine exemptions, which in effect allow for medical, religious and philosophical vaccine exemptions. Oregon’s non-medical exemption law also mandates education and state and/or vaccine provider approval of parents exercising their human and informed consent right to exempt their child(ren) from one or more state required vaccines. Individuals utilizing Oregon’s non-medical exemption are not required to give a reason (religious or philosophical) for taking the exemption, i.e. declarative non-medical exemption statements are optional. -National Vaccine Information Center	✔	✔	✔
Pennsylvania Children need not be immunized if the parent, guardian or emancipated child objects in writing to the immunization on religious grounds or on the basis of a strong moral or ethical conviction similar to a religious belief. Medical exemptions are also allowed. -National Vaccine Information Center	✔	✔	✔
Rhode Island A parent, guardian or pupil (if over 18 years of age) completes and signs the “Religious Immunization Exemption Certificate” attesting that immunization is contrary to their religious beliefs. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
South Carolina A South Carolina Certificate of Religious Exemption may be granted to any student whose parent or guardian signs the appropriate section of the South Carolina Certificate of Religious Exemption stating they are members of a recognized religious denomination in which the tenets and practices of the religious denomination conflict with immunizations. The South Carolina Certificate of Religious Exemption may only be obtained from the Department of Health and Environmental Control. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
South Dakota Submit a written statement signed by one parent or guardian that the child is an adherent to a religious doctrine whose teachings are opposed to such immunization. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Tennessee Requirements do not apply to any child whose parent or guardian files with school authorities a signed, written statement that the immunization and other preventive measures conflict with the parent’s or guardian’s religious tenets and practices, affirmed under the penalties of perjury. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Texas A signed affidavit must be presented by the child’s parent or legal guardian, stating that the child’s parent or legal guardian declines vaccinations for reasons of conscience, including because of the person’s religious beliefs. The affidavit will be valid for a two-year period. The child, who has not received the required immunizations for reasons of conscience, including religious beliefs, may be excluded from school in times of emergency or epidemic declared by the commissioner of public health. Medical exemptions are allowed as are exemptions for active duty members of the United States armed forces. -National Vaccine Information Center	✔	✔	✔
Utah To receive a personal exemption form, the legally responsible individual who claims the exemption for the student must complete the online immunization education module. If the legally responsible individual who claims the exemption for the student declines to take the online education module, he/she can obtain a vaccination exemption form from a local health department and receive an in-person consultation. Medical exemptions are also available. -National Vaccine Information Center	✔	✔	✔
Vermont A person is exempt from immunizations if the person, or in the case of a minor the person’s parent or guardian, presents a Department of Health-supplied form, indicating that the person, parent or guardian has religious beliefs or philosophical convictions opposed to immunizations. This form shall be maintained by the child care facility or school as part of the student’s immunization record. -National Vaccine Information Center		✔	✔
Virginia No certificate of immunization is required for admission if student or his parent submits an affidavit to the admitting official stating that the administration of immunizing agents conflicts with the student’s religious tenets or practices. Additionally, because the human papillomavirus is not communicable in a school setting, a parent or guardian, at the parent’s or guardian’s sole discretion, may elect for the parent’s or guardian’s child not to receive the human papillomavirus vaccine, after having reviewed materials describing the link between the human papillomavirus and cervical cancer approved for such use by the Board. Medical exemptions are also allowed. -National Vaccine Information Center		✔	✔
Washington A child shall be exempt in whole or in part from immunization requirements upon the presentation of any one or more of the following certifications on a form prescribed by the department of health: A written certification signed by any parent or legal guardian of the child or any adult in loco parentis to the child that the religious beliefs of the signator are contrary to the required immunization measures, or A written certification signed by any parent or legal guardian of the child or any adult in loco parentis to the child that the signator has either a philosophical or personal objection to the immunization of the child. The form must include a statement to be signed by a health care practitioner stating that he or she provided the signator with information about the benefits and risks of immunization to the child. Any parent or legal guardian of the child or any adult in loco parentis to the child who exempts the child due to religious beliefs is not required to have the form signed by a health care practitioner if the parent or legal guardian demonstrates membership in a religious body or a church in which the religious beliefs or teachings of the church preclude a health care practitioner from providing medical treatment to the child. Medical exemptions are also allowed. -National Vaccine Information Center	✔	✔	✔
West Virginia To obtain a medical exemption the child’s parent or guardian shall present a written request for an exemption from a physician who has treated or examined the child to the local health officer in the county where the child attends school. The physician’s request for exemption from immunization shall state specifically which vaccine or vaccines the child should be exempt from receiving, an explanation of the medical contraindication or precaution relied upon to make the request, and whether the reason for the exemption is permanent or temporary. If the medical exemption is temporary, the request shall also provide the future date or time when the exemption should be reevaluated. Requests for medical exemption from vaccine requirements shall be reviewed and approved or denied initially by the local health officer in the county where the requestor attends school. Approval or denial of a request shall be in writing and a copy of the response shall be sent to the State Health Officer. -National Vaccine Information Center			✔
Wisconsin The immunization requirement is waived if the student, if an adult, or the student’s parent, guardian, or legal custodian submits a written statement to the school, child care center, or nursery school objecting to the immunization for reasons of health, religion, or personal conviction. At the time any school, child care center, or nursery school notifies a student, parent, guardian, or legal custodian of the immunization requirements, it shall inform the person in writing of the person’s right to a waiver. -National Vaccine Information Center	✔	✔	✔
Wyoming Waivers shall be authorized by the state or county health officer upon submission of written evidence of religious objection or medical contraindication to the administration of any vaccine. -National Vaccine Information Center		✔	✔

What a ride! And now that you’ve read through each state’s exemption requirements, how do you feel? Overburdened with information? Yeah, me too. Basically, seventeen out of fifty states allow a parent to forego vaccines if they simply don’t agree with them. That’s what we call a “Philosophical” reason. Thirty of the states allow the parent to refuse vaccinations based on religious beliefs (so much for separation of church and state). Only three states allow for medical exemptions only.

What’s the deal with anti-vaxxers?

Susan Senator can shed some light on why some Americans are severely anti-vaccinations.

Essentially, when a child is diagnosed with autism, the parents aren’t prepared for this scary concept. They tend to panic and not know what to do. Having a anti-vaxxer in my own (extended) family, I’ve seen this panic, anger and frustration first hand. No, it’s not fair that people who want to be parents have to deal with a disability we don’t fully understand.

And that’s where my point lies. It’s not fair. To the parents. The child suffers from isolation and sensory overload. But the parents suffer with lack of sleep, money woes, schooling issues and many other things. It’s only natural that once someone “identifies” a source, these parents will often grab hold of it. Because humans just can’t not know things. A lot of us have to have someone or something to blame when things go wrong.

No, we don’t know what causes autism. But we can determine that parents over a certain age when they conceive are more likely to have a child with the disease. In the year 2000 (babies born in 1992), only 1 in 150 children were diagnosed with autism. But in 2014 (babies born in 2006), it jumped to 1 in 59 (CDC).

Why autism numbers have increased

In 1992, 4,084,000 babies were born in the United States. That number didn’t increase much in 2006 with 4,131,019 live-birthed children (Infoplease). Obviously, more children being born means more diagnoses will be made. But 1990 had a higher birth rate of 4,179,000, so it can’t be that, right?

Right. When autism was first observed in 1943 by Dr. Leo Kanner, he labeled it as a psychiatric disorder. He studied children who exhibited detachment from reality or an obsessive need for sameness, giving the disorder its powerful name. But in the 50’s and 60’s, Bruno Bettelheim said autism was caused by cold, unemotional mothers.

In 1980, the definition of autism was broken down even further. The Diagnostic and Statistical Manual of Mental Disorders defined the disorder as having three distinct features: lack of interest in people, impairments of communication and strange responses to their environment. These developments had to happen within the first 30 months to be diagnosed as autism.

In 1987, the criteria was expanded even more. No longer did a child have to be under 30 months to be diagnosed. There were 16 different conditions, 8 of which were required to give a diagnosis.

In 2000, Asperger’s disorder, childhood disintegrative disorder and Rett syndrome were added to the list of criteria (CORRECTION: Asperger’s disorder, CDD and Rett syndrome were listed under Pervasive developmental disorders in separate classifications). It was determined that autism found its root in genetics.

In 2003, the Human Genome Project brought hope to medical professionals. Perhaps we could get more information on how this disorder forms. Unfortunately, the genes pertaining to autism were in the hundreds, with no hope for isolation. This led to the characterization of autism as a spectrum disorder.

In 2013, Asperger’s, childhood disintegrative disorder and Rett syndrome were removed from the Pervasive developmental disorders list. Two groups of features were proposed for autism. “Persistent impairment in reciprocal social communication and social interaction” and “restricted, repetitive patterns of behavior,” were included along with social communication disorders, thus creating a spectrum for “shy” or “reserved” children (Zeldovich).

To me, it seems obvious that the recent influx of autism diagnoses is caused by not only a confusion over what criteria meets the disorder, but the characteristics have also changed. It seems that almost anyone with a fear of talking to crowds or loud noises could be added to the list.

What’s up with the 20-state hesitation?

Before we dive into what the issue is, let’s look at what these bills are actually saying.

Iannelli, 2019

	Changes Proposed	Bill No.	Status
Arizona	Changes their non-medical exemptions from personal to religious.	HB2505	Presented
Connecticut	Will permit ordained, commissioned and licensed members of the clergy to acknowledge parental statements concerning religious objections to vaccinations required for enrollment in public and nonpublic schools, instead of school nurses.	HB7005	Presented
Delaware	No changes presented		N/A
Georgia	No changes presented		N/A
Hawaii	No changes presented		N/A
Idaho	At the time notification required by this section is provided, the person giving such notification and the parent or guardian shall sign verification that notification has in fact been provided.	HB 494	Presented
Illinois	HPV vaccine added to the list of childhood vaccines that kids receive before starting 6th grade.	SB 1659	Presented
Iowa	Eliminated the religious vaccine exemption.	HF 206	Presented
Maine	Proposal to remove non-medical vaccine exemptions.	LD 798	Presented
Mississippi	No changes presented		N/A
Missouri	No changes presented		N/A
New Jersey	Clarifies the religious exemption to vaccination, so that a general philosophical or moral objection to getting vaccinated will no longer count as a true religious exemption.	AB 3818	Presented
Oklahoma	Requires school districts to report exemption rates.	SB 925	Presented
Oregon	Requires parents to submit a form signed by a health care practitioner if they are not going to vaccinate their kids and a signed certificate verifying that they completed a vaccine educational module.	HB 2783	Presented
Pennsylvania	No changes presented		N/A
Rhode Island	No changes presented		N/A
Texas	Requires schools to post how many kids are claiming vaccine exemptions.	SB 329M	Presented
Vermont	Eliminated religious exemptions.	HB 238	Presented
Washington	Will remove personal or philosophical exemptions for all vaccines.	SB 5841	Presented
West Virginia	No changes presented		N/A

As we can plainly see, Iowa, Maine, New Jersey, Vermont and Washington have opted to present bills that will eliminate every exemption except medical. Furthermore, it doesn’t seem like any of these bills are making it easier to not vaccinate your child.

Sites such as CNN and Tech Times are not reporting correctly, or even offering sources for the information. I’ve seen countless forums today where people are freaking out, thinking these states are creating more loopholes for anti-vaxxers. But before you jump to conclusions, just do some research!

I hope my analysis of these articles is helping you in any way. My aim is to help people understand each other better, so we can have civil conversations.

Thanks for reading!

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Sources

Carlos, N. (March 7, 2019). At Least 20 US States Propose Anti-Vaccination Bills Amid Measles Outbreaks. Retrieved from https://www.techtimes.com/articles/239215/20190307/at-least-20-us-states-propose-anti-vaccination-bills-amid-measles-outbreaks.htm

CDC. (November 15, 2018). Data & Statistics on Autism Spectrum Disorder. Retrieved from https://www.cdc.gov/ncbddd/autism/data.html

Griggs, B. & Lou, M. (March 6, 2019). Even with measles outbreaks across the US, at least 20 states have proposed anti-vaccination bills. Retrieved from https://www.cnn.com/2019/03/06/health/vaccine-exemption-bills-across-us-trnd/index.html

Iannelli, V. (February 20, 2019). New Vaccine Bills and Laws in 2019. Retrieved from https://vaxopedia.org/2019/02/20/new-vaccine-bills-and-laws-in-2019/

Infoplease. (n.d.). Live Births and Birth Rates, by Year. Retrieved from https://www.infoplease.com/us/births/live-births-and-birth-rates-year

National Vaccine Information Center. (2019). State Law & Vaccine Requirements. Retrieved from https://www.nvic.org/vaccine-laws/state-vaccine-requirements.aspx

Senator, S. (August 24, 2018). Why I Was an Anti-Vaxxer. Retrieved from https://www.psychologytoday.com/us/blog/all-families-are-not-alike/201808/why-i-was-anti-vaxxer

Zeldovich, L. (May 9, 2018). The evolution of ‘autism’ as a diagnosis, explained. Retrieved from https://www.spectrumnews.org/news/evolution-autism-diagnosis-explained/