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Herd Protection v. Vaccine Abstention

Potential Conflict Between School Vaccine Requirements and State Religious Freedom Restoration Acts

Published online by Cambridge University Press:  06 January 2021

Dina Nathanson
Dina Nathanson*
Affiliation:
Boston University 2016
*
Email: [email protected]
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American Journal of Law & Medicine , Volume 42 , Issue 2-3: Global Infectious Diseases: New Challenges and Solutions , May 2016 , pp. 621 - 641
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Copyright © American Society of Law, Medicine and Ethics and Boston University 2016

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References

1 Bloch, Alan B. et al., Health Impact of Measles Vaccination in the United States, 76 Pediatrics 524, 525 (1985)Google Scholar.

2 Id.; Requirements & Laws, Ctrs. for Disease Control & Prevention [CDC] (Jan. 25, 2016), http://www.cdc.gov/vaccines/imz-managers/laws/ [http://perma.cc/B66N-TMFT].

3 Katz, Samuel L. & Hinman, Alan R., Summary and Conclusions: Measles Elimination Meeting, 16-17 March 2000, 189 J. Infectious Diseases S43, S46 (2004)Google Scholar. The process of measles eradication was more complicated than the text suggests; it was a process consisting of multiple rounds of resurgence and attack strategies. See Orenstein, Walter A. et al., Measles Elimination in the United States, 189 J. Infectious Diseases S1, S2 (2004)Google Scholar.

4 Gastanaduy, Paul A. et al., Measles – United States, January 1-May 23, 2014, 63 Morbidity & Mortality Wkly. Rep. 496, 496-97 (2014)Google Scholar.

5 Frank Bruni, The Vaccine Lunacy, N.Y. Times, Feb. 1, 2015, at S3.

6 Cal. Dep’t of Pub. Health, Pertussis Report 1 (2014), http://www.cdph.ca.gov/programs/immunize/Documents/Pertussis_report_10-7-2014.pdf. Pertussis is another name for whooping cough. Further details on the disease can be found infra at the Appendix.

7 Gastanaduy et al., supra note 4, at 496 (stating that almost half of the cases were within the unvaccinated Amish communities of Ohio); Paul A. Offit, Opinion, The Anti-Vaccination Epidemic, Wall St. J., Sept. 25, 2014, at A21 (noting that the area of California with the highest infection rate is also the area with the lowest vaccination rate).

8 Jonathan D. Rockoff, More Parents Seek Vaccine Exemption, Wall St. J., July 6, 2010, at A19.

9 Jacobson v. Massachusetts, 197 U.S. 11, 25 (1905).

10 See Requirements and Laws, supra note 2.

11 See, e.g., In re LePage, 18 P.3d 1177, 1180 (Wyo. 2001) (holding that a religious exemption was wrongfully denied because the court inquired as to the sincerity of the litigant’s religious belief). But see, e.g., Phillips v. City of New York, 775 F.3d 538, 543 (2d Cir. 2015) (upholding the city’s practice of barring unvaccinated children from attending school if a classmate is suffering from a vaccine-preventable disease).

12 See Jacobson, 197 U.S. at 37-38; see also Zucht v. King, 260 U.S. 174, 176 (1922) (upholding ordinance requiring certificate of vaccination before school enrollment).

13 Burwell v. Hobby Lobby Stores, Inc., 134 S. Ct. 2751, 2771 (2014).

14 Religious Freedom Restoration Act of 1993, 42 U.S.C. §§ 2000bb-1 to -3 (2016).

15 See Hobby Lobby, 134 S. Ct. at 2775-85.

16 See id. at 2778 (noting that a federal court has “no business addressing whether the religious belief asserted in a RFRA case is reasonable”) (parentheses omitted).

17 City of Boerne v. Flores, 521 U.S. 507, 534 (1997). I limit this contention to state-level compulsory vaccination laws or judicial denials of requests for vaccine exemptions. I believe that the decision in Hobby Lobby has opened the door for employers to refuse to cover vaccinations through insurance. However, that is not something I will address in this Note.

18 See Lund, Christopher C., Religious Liberty After Gonzales: A Look at State RFRAs, 55 S.D. L. Rev. 466, 477 tbl.1 (2010)Google Scholar (listing the sixteen states that had enacted RFRAs by 2010: Connecticut, Florida, Illinois, Rhode Island, Alabama, Arizona, South Carolina, Texas, Idaho, New Mexico, Oklahoma, Pennsylvania, Missouri, Virginia, Utah, and Tennessee).

19 Zucht v. King, 260 U.S. 174, 176 (1922).

20 State Vaccination Requirements, CDC (Jan. 29, 2016), http://www.cdc.gov/vaccines/imz-managers/laws/state-reqs.html [http://perma.cc/Q85Y-FUJ3]; see also Brown v. Stone, 378 So. 2d 218, 222 (Miss. 1979) (stating that there is a “compelling public interest” in protecting a child and his school community from “certain crippling and deadly diseases”).

21 See Fine, Paul et al., “Herd Immunity”: A Rough Guide, 52 Clinical Infectious Diseases 911, 911 (2011)Google Scholar.

22 Id. at 911-12.

23 Id.

24 Id. at 911, 913.

25 Mariner, Wendy K. et al., Jacobson v. Massachusetts: It’s Not Your Great-Great-Grandfather’s Public Health Law, 95 Am. J. Pub. Health 581, 584 (2005)Google Scholar (noting a change in justification for vaccination given the context).

26 State Vaccination Requirements, supra note 20.

27 State Information: State Mandates on Immunization and Vaccine-Preventable Diseases, Immunization Action Coal. (Mar. 9, 2016), http://www.immunize.org/laws/ [http://perma.cc/8N8J-5EJ7].

28 History and Epidemiology of Global Smallpox Eradication, CDC 17 (Aug. 25, 2014).

29 Id.

30 Id.

31 Id.

32 Id.

33 Johnny Kung, Vaccines and Public Health, Sci. News 20, http://sitn.hms.harvard.edu/wp-content/uploads/2010/09/Lecture_1.2.pdf.

34 Ozaki, Takao, Long-Term Clinical Studies of Varicella Vaccine at a Regional Hospital in Japan and Proposal for a Varicella Vaccination Program, 31 Vaccine 6155, 6160 (2013)Google Scholar. Note that tetanus, which is one of the most frequently required vaccinations, is contracted by puncture infection and so is not spread in the same way as the other diseases discussed. Therefore, there is no herd immunity threshold for tetanus.

35 See Tetanus, CDC at 342, http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf [http://perma.cc/3K4G-FQWM].

36 Oxford Vaccine Grp., Vaccine Knowledge Project, Tetanus (Dec. 15, 2014), http://www.ovg.ox.ac.uk/tetanus [http://perma.cc/CZS2-ECJF].

37 Morbidity and Mortality Weekly Report: Updated Recommendations for Use of Meningococcal Conjugate Vaccines, CDC (Jan. 28, 2011), http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6003a3.htm [http://perma.cc/M9KN-CD4U].

38 Maiden, Martin C. J. et al., Impact of Meningococcal Serogroup C Conjugate Vaccines on Carriage and Herd Immunity, 197 J. Infectious Diseases 737, 737 (2008)Google Scholar (examining the impact of Meningococcal Serogroup C Conjugate vaccines introduced in the United Kingdom).

39 Abebe, A. et al., Seroepidemiology of Hepatits B Virus in Addis Ababa, Ethiopia: Transmission Patterns and Vaccine Control, 131 Epidemiology & Infection 757, 757 (2003)Google Scholar.

40 See Gregg M. Milligan & Alan D. T. Barrett, 312 Vaccinology: An Essential Guide 312 (2014).

41 Id.

42 See Holland, Mary & Zachary, Chase E., Herd Immunity and Compulsory Childhood Vaccination: Does the Theory Justify the Law?, 93 Or. L. Rev. 1, 14 (2014)Google Scholar.

43 Samandari, Taraz et al., Quantifying the Impact of Hepatitis A Immunization in the United States, 1995-2001, 22 Vaccine 4342, 4348 (2004)Google Scholar.

44 Jones, Petre, Measles Targets and Herd Immunity, 63 Brit. J. Gen. Prac. 403, 403 (2013)Google Scholar.

45 Offit, supra note 7.

46 See id. (noting that 57% of the children at the Kabbalah Children’s Academy in Beverly Hills are unvaccinated).

47 This last aspect—available treatment options—will be important when conducting a “least restrictive alternatives” inquiry. Public health experts would likely argue that treatment should not be included in the analysis, however, because public health is generally preventative and treatment alone will not combat the spread of a contagion. See Mariner, Wendy K., Law and Public Health: Beyond Emergency Preparedness, 38 J. Health L. 246, 251-52 (2005)Google Scholar (including prevention within the scope of public health).

48 Linda Quick, M. et al., Risk Factors for Diphtheria: A Prospective Case-Control Study in the Republic of Georgia, 1995-1996, 181 J. Infectious Diseases S121, S121-22 (2000)Google Scholar.

49 Nat’l Library of Med., Diptheria, MedlinePlus, (Dec. 10, 2015), http://www.nlm.nih.gov/medlineplus/ency/article/001608.htm [http://perma.cc/BW6N-MUV9].

50 Diphtheria, Complications, CDC (Jan. 15, 2016), http://www.cdc.gov/diphtheria/about/complications.html [http://perma.cc/3ZZS-9CMB].

51 Id.

52 Diphtheria, Diagnosis and Treatment, CDC (Jan. 15, 2016), http://www.cdc.gov/diphtheria/about/diagnosis-treatment.html [http://perma.cc/6U6X-C2EC].

53 Hepatitis A, World Health Org. [WHO] (July 2015), http://www.who.int/mediacentre/factsheets/fs328/en/ [http://perma.cc/A5SP-BWUY].

54 Hepatitis A Questions and Answers for the Public, CDC (May 23, 2016), http://www.cdc.gov/hepatitis/A/aFAQ.htm#overview [http://perma.cc/T9AD-WKRM].

55 Id.

56 Diptheria, CDC at 107-08 (Apr. 2015), http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/dip.pdf [http://perma.cc/9PUM-BMKM]; Nat’l Library of Med., Preventing Hepatitis A, MedlinePlus (Aug. 14, 2015), http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000422.htm [http://perma.cc/BM2Q-5NBV].

57 Requirements & Laws, supra note 2.

58 Id.

59 Nat’l Conference of State Legs., States with Religious and Philosophical Exemptions from School Immunization Requirements (Jan. 21, 2016), http://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx [http://perma.cc/8T92-XB5M] [hereinafter NCSL, States with Religious and Philosophical Exemptions].

60 Sheila V. Kumar, Oregon Considers Banning Most Nonmedical Immunization Exemptions, Bos. Globe (Mar. 1, 2015), http://www.bostonglobe.com/news/nation/2015/03/01/oregon-considers-banning-most-vaccine-exemptions/8VQExoiWtXP6Lgr6156CWP/story.html [http://perma.cc/T882-63HF]; The Editorial Board, Op-Ed., California’s Tough Vaccination Law, N.Y. Times (July 13, 2015), http://www.nytimes.com/2015/07/13/opinion/californias-tough-vaccination-law.html?_r=0 [http://perma.cc/2Z79-RZM5].

61 NCSL, States with Religious and Philosophical Exemptions, supra note 59.

62 Michael Specter, Vermont Says No to the Anti-Vaccine Movement, New Yorker (May 29, 2015), http://www.newyorker.com/news/news-desk/vermont-says-no-to-the-anti-vaccine-movement [http://perma.cc/5YG3-8H7M].

63 Ill. Dep’t of Pub. Health, Instructions for Completing Illinois Certificate of Religious Exemption to Required Immunizations and/or Examinations Form, http://www.isbe.net/research/pdfs/immun-exam-gdlns-religious-exempt.pdf [perma.cc/4LES-R24Z] [hereinafter Ill. Dep’t of Pub. Health, Instructions].

64 N.H. Rev. Stat. Ann. § 141-C:20-a, 20-c (2015).

65 Ill. Dep’t of Pub. Health, Instructions, supra note 63.

66 See generally Eve Dubé et al., Vaccine Hesitancy, 9 Hum. Vaccines & Immunotherapeutics 1763, 1768 (2013) (“[R]esults of a large US study indicated that the largest proportion of parents who changed their minds about delaying or not getting a vaccination for their child listed ‘information of assurances from health care provider’ as the main reason.”).

67 See e.g., Boone v. Boozman, 217 F. Supp. 2d 938, 953 (E.D. Ark. 2002) (refusing to apply strict scrutiny to a vaccination law because it is neutral and generally applicable).

68 Miss. Code. Ann. § 11-61-1 (West Supp. 2015).

69 Miss. Code Ann. § 41-23-37 (West 2013).

70 Id.

71 Lantos, John D., et al., Controversies in Vaccine Mandates, 40 Current Probs. Pediatric & Adolescent Health Care 38, 51 (2010)Google Scholar.

72 Maier v. Besser, 341 N.Y.S.2d 411, 414 (N.Y. Sup. Ct. 1972); see also Welsh v. United States, 398 U.S. 333, 341 (1970) (finding an individual’s belief to be religious where individual did not initially state his belief was religious); United States v. Seeger, 380 U.S. 163, 176 (1965) (extending military exemption to those with a “sincere and meaningful belief which occupies in the life of its possessor a place parallel to that filled by the God of those admittedly qualifying for the exemption”).

73 Emp’t Div., Dep’t of Human Res. v. Smith, 494 U.S. 872, 887 (1990)

74 See Rockoff, supra note 8.

75 Vaccination: Using the First Amendment to Opt Out of This Potentially Damaging Procedure, Mercola (Dec. 27, 2011), http://articles.mercola.com/sites/articles/archive/2011/12/27/legal-vaccine-exemptions.aspx [http://perma.cc/D7M9-4ULN]; Internet Search on How to Get a Vaccine Exemption, Google, http://google.com (search “how to get a vaccine exemption”; then follow the link to the first result, which should read, “How to Legally Get a Vaccine Exemption”).

76 Vaccination, Using the First Amendment, supra note 75.

77 Jack Healy & Michael Paulson, Vaccine Critics Turn Defensive Over Measles, N.Y. Times (Jan. 30, 2015), http://www.nytimes.com/2015/01/31/us/vaccine-critics-turn-defen\sive-over-measles.html?action=click&contentCollection=U.S.&module=RelatedCoverage&region=Marginalia&pgtype=article [http://perma.cc/RS9K-5HZN].

78 Id.

79 United States v. Seeger, 380 U.S. 163, 185 (1965).

80 See, e.g., Idaho v. Cordingley, 302 P.3d 730, 736 (Idaho Ct. App. 2013); Idaho v. White, 271 P.3d 1217 (Idaho Ct. App. 2011).

81 See Cordingley, 302 P.3d at 736; see also White, 271 P.3d at 1227.

82 Cordingley, 302 P.3d at 736.

83 Id. (comparing the Supreme Court’s instruction in Thomas v. Review Board of Indiana Employment Security Division to err on the side of freedom when questioning religious beliefs against its statement in Wisconsin v. Yoder that personal definitions of religion might actually fall more in the realm of philosophy than religion).

84 Id. (citing Malnak v. Yogi, 592 F.2d 197, 209 (3d Cir. 1979)).

85 Id. at 737 (citing United States v. Meyers, 95 F.3d 1475, 1502-03 (10th Cir. 1996)).

86 Friedman v. S. Cal. Permanente Med. Grp., 125 Cal. Rptr. 2d 663, 685 (Cal. 2002). While the case did not contain a RFRA claim, the court utilized a relevant analysis, stating: “While veganism compels plaintiff to live in accord with strict dictates of behavior, it reflects a moral and secular, rather than religious, philosophy.” Id.

87 Africa v. Pennsylvania, 662 F.2d 1025, 1037 (3d Cir. 1981).

88 Strayhorn v. Ethical Soc’y of Austin, 110 S.W.3d 458, 466 (Tex. App. 2003). The court’s reasoning here can be narrowed, however, as it recognized Ethical Culture as a religion largely due to its overarching principles, body of literature, and extensive history. See id. at 470.

89 Usman, Jeffrey O., Defining Religion: The Struggle to Define Religion Under the First Amendment and the Contributions and Insights of Other Disciplines of Study Including Theology, Psychology, Sociology, the Arts, and Anthropology, 38 N.D. L. Rev. 123, 174 (2007)Google Scholar (quoting Founding Church of Scientology v. United States, 409 F.2d 1146, 1160 (D.C. Cir. 1969)).

90 Id. at 175 (quoting Ford v. McGinnis, 352 F.3d 582, 588 (2d Cir. 2003)).

91 Id. at 176 (quoting Kaufman v. McCaughtry, 419 F.3d 678, 681-82 (7th Cir. 2004)).

92 Id. at 176-87.

93 Clyde Haberman, A Discredited Vaccine Study’s Continuing Impact on Public Health, N.Y. Times (Feb. 1, 2015), http://www.nytimes.com/2015/02/02/us/a-discredited-vaccine-studys-continuing-impact-on-public-health.html?hp&action=click&pgtype=Homepage&module=second-column-region&region=top-news&WT.nav=top-news&_r=0 (explaining the reasoning of many parents who are seeking exemptions).

94 Eileen Wang et al., Nonmedical Exemptions from School Immunization Requirements: A Systematic Review, 104 Am. J. Pub. Health e62, e79 (2014).

95 Id.; see also Clint Rainey, Immune to Logic: Some New York City Private Schools Have Dismal Vaccination Rates, N.Y. Mag. (Mar. 30, 2014, 9:07 PM), http://nymag.com/daily/intelligencer/2014/03/some-nyc-schools-show-dismal-vaccination-rates.html.

96 Lisa Aliferis, Childhood Vaccination Rates Climb in California, NPR, http://www.npr.org/sections/health-shots/2016/01/21/461395411/childhood-vaccination-rates-climb-in-california?sc=17&f=1001&utm_source=iosnewsapp&utm_medium=Email&utm_campaign=app [http://perma.cc/HNW6-FGGL].

97 See Jones, supra note 44; Offit, supra note 7.

98 See supra text accompanying notes 17-18.

99 Blaesser & Weinstein, Federal Land Use Law & Litigation § 7:6 (2015 ed.). Utah is included on this list, but its statute is really a Religious Land Use and Institutionalized Persons Act (RLUIPA), which applies to land use.

100 Erik Eckholm, Religious Protection Laws, Once Called Shields, Are Now Seen as Cudgels, N.Y. Times (Mar. 30, 2015), http://www.nytimes.com/2015/03/31/us/politics/religious-protection-laws-once-called-shields-are-now-seen-as-cudgels.html?_r=0.

101 Richard Pérez-Peña & Ashley Southall, Indiana Legislators Say They’ll Clarify Beliefs Law, N.Y. Times (Mar. 30, 2015), http://www.nytimes.com/2015/03/31/us/indiana-legislators-say-theyll-clarify-beliefs-law.html.

102 Campbell Robertson, Arkansas Moves to Revise Legislation as Concerns of Religion and Gay Rights Intensify, N.Y. Times (Apr. 1, 2015), http://www.nytimes.com/2015/04/02/us/arkansas-moves-to-revise-legislation-as-concerns-of-religion-and-gay-rights-intensify.html.

103 Ark. Code Ann. § 16-123-401 (1987).

104 See Eckholm, supra note 100.

105 42 U.S.C. § 2000bb-1 (2012).

106 Id.

107 Ala. Const. art. I § 3.01.

108 Id.; see also Emp’t Div., Dep’t of Human Res. v. Smith, 494 U.S. 872, 885-89 (1990).

109 Smith, 494 U.S. at 882-83; see also Fuller, Gregory H., Constitutional Law – Free Exercise of Religion – Strict Scrutiny and the Religious Freedom Restoration Act, 73 Tenn. L. Rev. 129, 131-37 (2006)Google Scholar (providing a brief history of Supreme Court cases involving State impositions on religious freedoms).

110 See 42 U.S.C. § 2000bb (2012).

111 Ala. Const. art. I § 3.01.

112 Ariz. Rev. Stat. Ann. § 41-1493.01 (2011); Ark. Code Ann. § 16-123-401 (2006); Fla. Stat. Ann. § 761.03 (West 2010); Idaho Code § 73-402 (2016); Ind. Code Ann. § 34-13-9-8 (West 2011); Kan. Stat. Ann. § 60-5301 (2005); Ky. Rev. Stat. Ann. § 446.350 (Lexis 2012); La. Rev. Stat. Ann. § 13:5233 (2012); Miss. Code. Ann. § 11-61-1 (West 1972); Okla. Stat. Ann. tit. 51, § 253 (West 2008); 71 Pa. Stat. & Cons. Stat. Ann. § 2404 (West 2012); S.C. Code Ann. § 1-32-40 (2005); Tenn. Code Ann. § 4-1-407 (2015); Tex. Civ. Prac. & Rem. Code Ann. § 110.003 (West 2011).

113 775 Ill. Comp. Stat. Ann. 35/1 (West 1993).

114 Id.

115 Conn. Gen. Stat. Ann. § 52-571b (West 2013); N.M. Stat. Ann. § 28-22-3 (West 2011); 1956 R.I. Gen. Laws § 42-80.1-3 (2006).

116 Mo. Ann. Stat. § 1.302 (West 2010).

117 See, e.g., Kan. Stat. Ann. § 60-5301 (2005); La. Stat. Ann. § 13:5233 (2012); Okla. Stat. Ann. tit. 51, § 253 (West 2008).

118 See e.g., Church of the Lukumi Babalu Aye, Inc. v. City of Hialeah, 508 U.S. 520, 534 (1993) (finding law aimed at “protecting the public health” was not generally applicable where its terms were so under inclusive that they only impeded on Santerian rituals).

119 Mo. Ann. Stat. § 1.302, 1.307 (West 2010)

120 Id.

121 Id.

122 Tex. Civ. Prac. & Rem. Code Ann. § 110.003 (West 2011).

123 See Lupu, Ira C., Hobby Lobby and the Dubious Enterprise of Religious Exemptions, 38 Harv. J. L. & Gender 35, 69 (2015)Google Scholar.

124 Tex. Civ. Prac. & Rem. Code Ann. § 110.006 (West 2011).

125 Id. The relevant part of the statute reads:

  • (c) A governmental agency that receives a notice under Subsection (a) may remedy the substantial burden on the person’s free exercise of religion.

  • (d) A remedy implemented by a government agency under this section:

    • (1) may be designed to reasonably remove the substantial burden on the person’s free exercise of religion;

    • (2) need not be implemented in a manner that results in an exercise of governmental authority that is the least restrictive means of furthering the governmental interest, notwithstanding any other provision of this chapter; and

    • (3) must be narrowly tailored to remove the particular burden for which the remedy is implemented.

  • (e) A person with respect to whom a substantial burden on the person’s free exercise of religion has been cured by a remedy implemented under this section may not bring an action under Section 110.005.

126 Tex. Educ. Code Ann. § 38.001 (West 2013). Additionally, Texas’s exemption only requires a signed affidavit from the applicant, unlike Illinois, which also requires certification from a physician. See Ill. Dep’t of Pub. Health, Instructions, supra note 63. Therefore, there is minimal chance of success for a vaccine-based RFRA claim in Texas.

127 While no one has pursued such a claim using a state RFRA, someone recently failed to apply the federal RFRA to a vaccine requirement. See George v. Kankakee Cmty. Coll., No. 14-CV-2160, 2014 WL 6434152, at *5 (C.D. Ill. Nov. 17, 2014) (dismissing the plaintiff’s claim because the federal RFRA cannot be applied to the states).

128 See supra notes 77-91 and accompanying text.

129 See, e.g., Idaho v. Cordingley, 302 P.3d 730, 733 (Idaho Ct. App. 2013).

130 See, e.g., A.A. ex rel. Betenbaugh v. Needville Indep. Sch. Dist., 611 F.3d 248, 272 (5th Cir. 2010) (“[W]hile a school may set grooming standards for its students, when those standards substantially burden the free exercise of religion, they must accomplish something … that something is a compelling interest.”).

131 See, e.g., Arizona v. Hardesty, 214 P.3d 1004, 1008-10 (Ariz. 2009).

132 Lund, supra note 18, at 479-80.

133 See Lupu, supra note 123, at 69 (identifying nine cases in the past five years).

134 Id. at 70.

135 Idaho Code § 73-401 (2016).

136 Idaho v. Cordingley, 302 P.3d 730, 733 (Idaho Ct. App. 2013). The meaning of “substantial burden” under the federal RFRA is still developing. In Hobby Lobby, while the Supreme Court did not discuss a test for determining whether the burden was substantial, the Tenth Circuit, which was affirmed, applied its test, which states that a law imposes a substantial burden if it “(1) requires participation in an activity prohibited by a sincerely held religious belief, (2) prevents participation in conduct motivated by a sincerely held religious belief, or (3) places substantial pressure on an adherent … to engage in conduct contrary to a sincerely held religious belief.” Hobby Lobby Stores, Inc. v. Sebelius, 723 F.3d 1114, 1138 (10th Cir. 2013), aff'd sub nom. Burwell v. Hobby Lobby Stores, Inc., 134 S. Ct. 2751 (2014) (citing Abdulhaseeb v. Calbone, 600 F.3d 1301, 1315 (10th Cir. 2010) (internal quotations omitted). This issue is currently before the Supreme Court. See Little Sisters of the Poor Home for the Aged, Denver, Colo. v. Burwell, 136 S. Ct. 446 (2015) (cert. granted).

137 Freeman v. State, No. 2002-CA-2828, 2003 WL 21338619, at *4-5 (Fla. Cir. Ct. June 6, 2003).

138 Id.

139 See A.A. ex rel. Betenbaugh v. Needville Indep. Sch. Dist., 611 F.3d 248, 268 (5th Cir. 2010).

140 Arizona v. Hardesty, 214 P.3d 1004, 1010 (Ariz. 2009).

141 Id. at 1006.

142 See id. at 1008.

143 Westlaw search as of June 6, 2016, “citing references” for “Mississippi RFRA.”

144 Brown v. Stone, 378 So. 2d 218, 223 (Miss. 1979).

145 See 42 U.S.C. § 2000bb (2012).

146 Be the Voice of Vaccine Choice, Miss. Parents for Vaccine Rts., http://bethevoice.typepad.com/my-blog/.

147 Mississippi Parents For Vaccine Rights, Facebook, http://www.facebook.com/MSParentsForVaccineRights/timeline (last visited May 30, 2016).

148 Legislative Newsletter 1, Miss. Parents for Vaccine Rts., http://madmimi.com/s/4d6495 [http://perma.cc/W83W-8LBB].

149 Legislative Newsletter 13, Miss. Parents for Vaccine Rts., http://madmimi.com/s/4666c5 [http://perma.cc/ZT2X-ZAXY].

150 See Wadman, Meredith, Cell Division, 498 Nature 422, 422-23 (2013)Google Scholar.

151 See Burwell v. Hobby Lobby Stores, Inc., 134 S. Ct. 2751, 2779 (2014) (accepting that certain birth control could be considered abortive based on a sincerely held religious belief, despite scientific rationale stating otherwise).

152 See supra notes 79-93 and accompanying text.

153 The Fifth Circuit ruled on a related matter in Brown v. Dade Christian Schools, Incorporated, 556 F.2d 310 (5th Cir. 1977), in which the dissent laid out a weak test for determining whether an individual’s belief is truly religious by stringing together pieces of other Fifth Circuit and Supreme Court cases. The dissent’s test stated that “the ‘religious’ nature of a belief depends on (1) whether the belief is based on a theory ‘of man's nature or his place in the Universe,’ (2) which is not merely a personal preference but has an institutional quality about it, and (3) which is sincere.” Id. at 324. This was not widely cited, but apparently was the basis for one unpublished opinion in the 1970s. See Sandrik, Karen, Toward a Modern Definition of Religion, 85 U. Det. Mercy L. Rev. 561, 584 (2008)Google Scholar.

154 Strayhorn v. Ethical Soc’y of Austin, 110 S.W.3d 458, 469 (Tex. App. 2003).

155 Malnak v. Yogi, 592 F.2d 197, 208-09 (3d Cir. 1979).

156 Legislative Newsletter 13, supra note 149.

157 See Malnak, 592 F.2d at 209.

158 See, e.g., Brown v. Stone, 378 So. 2d 218, 222 (Miss. 1980).

159 See Malone, Kevin M. & Hinman, Alan R., Vaccination Mandates: The Public Health Imperative and Individual Rights, in Law in Public Health Practice 262, 275 (Goodman, Richard A. et al. eds., 2007)Google Scholar (“[D]icta in both Sherbert and Yoder referring to the Jacobson and Prince decisions clearly indicate that on both parens patriae and police power grounds the U.S. Supreme Court sees a compelling state interest in mandating vaccination of children because of the health threat to the community and to the children themselves.”).

160 See Mariner, supra note 25, at 584.

161 See Appendix, infra.

162 See, e.g., Brown, 378 So. 2d at 218. Also, it is important to note that Mississippi is one of only three states without a religious exemption.

163 See Ill. Dep’t of Pub. Health, Instructions, supra note 63.

164 Zubik v. Burwell, 136 S. Ct. 1557, 1560 (2016) (“The Court expresses no view on the merits of the cases. In particular, the Court does not decide whether petitioners’ religious exercise has been substantially burdened, whether the Government has a compelling interest, or whether the current regulations are the least restrictive means of serving that interest.”).

165 Id. at 1559.

166 N.M. v. Hebrew Acad. Long Beach, No. 15-CV-7004(ADS)(AYS), 2016 WL 105950, at *11 (E.D.N.Y. Jan. 9, 2016).

167 Id. at *10.

168 Burwell v. Hobby Lobby Stores, Inc., 134 S. Ct. 2751 (2014).

169 See Thomas v. Review Bd. of Ind. Emp’t Sec. Div., 450 U.S. 707, 715 (1981) (noting, albeit in a non-RFRA setting, that the practices of other Jehovah’s Witnesses should not matter because courts are “singularly ill equipped to resolve such [intrafaith differences]”). The Court in Thomas also stated: “One can, of course, imagine an asserted claim so bizarre, so clearly nonreligious in motivation, as not to be entitled to protection …” Id. at 714. The case of the Orthodox Jewish woman seeking vaccine exemptions, however, is not so bizarre, as some vaccines are developed from animal products that might be troublesome to someone who is very observant. See Vaccine Excipient & Media Summary, CDC (Apr. 2015), http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/excipient-table-2.pdf [http://perma.cc/YN5N-RYXG] (noting that many vaccines include gelatin, which is often made from pigs). Perhaps the District Court just got this recent case wrong.

170 See, e.g., Mallory v. Hartford Roman Catholic Diocesan Corp., No. X10-UWY-CV075007642S, 2009 WL 765488, at *2 (Conn. Super. Ct. Feb. 24, 2009) (holding that no RFRA protection was available to a church for employing priest who had sexually abused plaintiff).

171 A potential arena for this is the Satanic Temple’s recently initiated case against Missouri’s abortion waiting period law. See Jenny Kutner, Satanists Sue Missouri for Religious Exemption to Antiabortion Law: “Religious Liberty Isn’t Theirs Alone,” Salon (May 11, 2015 4:25 PM), http://www.salon.com/2015/05/11/satanists_sue_missouri_for_religious_exemption_to_antiabortion_law_religious_liberty_isn%E2%80%99t_theirs_alone/ [http://perma.cc/DB58-8AVK].

172 See NCSL, States with Religious and Philosophical Exemptions, supra note 59.

173 See Lupu, supra note 123, at 68.

174 See Eckholm, supra note 100.

175 See Lupu, supra note 123, at 68-70.

176 See generally Moss, William J. & Griffin, Diane E., Measles, 379 Lancet 153 (2012)Google Scholar; Complications of Measles, CDC (Feb. 17, 2015), http://www.cdc.gov/measles/about/complications.html [http://perma.cc/9CAQ-LZRY]; Measles – Treatment, Nat’l Health Serv. [NHS] (Nov. 9, 2015), http://www.nhs.uk/Conditions/Measles/Pages/Treatment.aspx [http://perma.cc/EKE8-DX2H].

177 Mumps, CDC (May 29, 2015), http://www.cdc.gov/mumps/index.html [http://perma.cc/VN75-7JF9]; Marilyn R. Shahan, Mumps, 13 Nursing 43 (1983); Mumps – Treatment, NHS (July 8, 2015), http://www.nhs.uk/conditions/mumps/pages/treatment.aspx [http://perma.cc/3LZ7-SRGW].

178 Rubella – The Disease, WHO, http://www.who.int/immunization/topics/rubella/en/index1.html [http://perma.cc/DR4J-R47N]; Rubella, CDC (Mar. 21, 2016), http://www.cdc.gov/rubella/about/index.htm [http://perma.cc/L4BE-H7AN].

179 See generally Quick et al., supra note 48, at S121; Nat’l Library of Med., Diptheria, supra note 49; About Diphtheria, CDC (Jan. 15, 2016), http://www.cdc.gov/diphtheria/about/ [http://perma.cc/TX2C-P5CG].

180 Pertussis (Whopping Cough), CDC (Jan. 26, 2016), http://www.cdc.gov/pertussis/ [http://perma.cc/3GM9-GWZ2]; Pertussis, N.Y. Dep’t of Health (Mar. 2016), http://www.health.ny.gov/diseases/communicable/pertussis/fact_sheet.htm.

181 See generally Tetanus, supra note 35; Morbidity and Mortality Weekly Report, Tetanus Surveillance – United States, 2001 – 2008, CDC (Apr. 1, 2011), http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6012a1.htm [http://perma.cc/W344-5WV9].

182 Poliomyelitis, WHO, http://www.who.int/ith/diseases/polio/en/ [http://perma.cc/Q3BK-73DW]; Polio and Prevention, Polio Global Eradication Initiative, http://www.polioeradication.org/Polioandprevention.aspx [http://perma.cc/N8LF-AURE].

183 Chickenpox (Varicella), CDC (Apr. 11, 2016), http://www.cdc.gov/chickenpox/index.html [http://perma.cc/AU4Z-LARV]; Shingles (Herpes Zoster) Transmission, CDC (Sept. 17, 2014), http://www.cdc.gov/shingles/about/transmission.html [http://perma.cc/YD4B-XE8N].

184 Meningococcal Disease, CDC (Mar. 4, 2016), http://www.cdc.gov/meningococcal/ [http://perma.cc/RVV4-RXUU].

185 Hepatitis A, supra note 53; Hepatitis A Questions and Answers for the Public, supra note 54.

186 Hepatitis B, WHO (July 2015) http://www.who.int/mediacentre/factsheets/fs204/en/ [http://perma.cc/S692-TTU3]; Hepatitis B FAQs for the Public, CDC (May 23, 2016), http://www.cdc.gov/hepatitis/B/bFAQ.htm#overview [http://perma.cc/VS3C-23N8].