The History of the Personal Belief Exemption.

Abstract

California’s 2015 elimination of personal belief exemptions to required childhood vaccinations may have set off a trend. In 2019, in response to record-breaking measles outbreaks, lawmakers in at least 10 states attempted to eliminate or restrict the exemption. The moves suggest a possible end for the legal tool, which has a long yet little-examined history. The term “personal belief exemption” first came into popular use in the 1990s, but the idea of granting exemption from compulsory vaccination on the basis of secular convictions dates to the late 19th century. Since then, the exemption has evolved through 4 stages, each prompted by new vaccines or vaccine laws. In each stage, the exemptions reflected political compromise in the lawmaking process and broader struggles over liberties and rights. Smallpox prompted the earliest vaccination mandates, and by the late 19th century, those laws inspired the first personal belief exemptions. California passed its first law requiring smallpox vaccination for school admission in 1889, a time when compulsory schooling and rising smallpox rates had been prompting such laws nationwide.1 The law included a medical exemption, but other states’ laws often omitted exemptions, and the unvaccinated could generally be fined, quarantined, or suspended. On the other side of the Atlantic, meanwhile, England’s 1853 compulsory vaccination law triggered decades of widespread noncompliance and openly hostile antivaccinationism.2 In 1898, the British government responded by adding a “conscience clause” to the law.2 US antivaccinationists and … Address correspondence to Elena Conis, Graduate School of Journalism and Center for Science, Technology, Medicine, and Society, University of California, Berkeley, 121 North Gate Hall, Berkeley, CA 94720. E-mail: econis{at}berkeley.edu