Vaccine Advocacy

After a long and contentious public debate, the Connecticut Legislature enacted a law in April that eliminated religious exemptions to required school-entry vaccines.

The overwhelming scientific evidence behind the removal of the exemption, and the significant benefit to public health, prompted Yale School of Public Health experts to step up to the microphone, and out of their comfort zones, to speak up in support of the legislation.

The legislation, Public Act 21-6, addresses the serious concerns of public health experts and others in the community that an increase in unvaccinated children in schools puts children who cannot be vaccinated for medical reasons, or who are immunocompromised, at greater risk of measles and other infectious diseases. In enacting the legislation, Connecticut became one of just six states that allow exemptions to vaccines only for medical reasons, and not due to religion or personal belief. As a researcher whose work focuses on vaccines, Professor Linda Niccolai, Ph.D., testified before the state Public Health Committee in February 2020.

“People do have the freedom to practice their own religion in this country, however with vaccines, it is more complicated,” Niccolai said in an interview. “Your right to practice your religion does not include the right to harm other people. But it is such a personal issue, and people feel very strongly about it on both sides.”

The legislation garnered bipartisan support. “With an increasing number of children not being vaccinated, the threat of diseases that have been nearly eradicated is surfacing once again,” said state Sen. Christine Cohen, a Democrat from Guilford who supported the legislation. “It is our job to protect the youth of Connecticut and ensure that only those instances where it is medically necessary not to be immunized are honored. It really came down to science and safeguarding the health of our communities.”

According to the Connecticut Department of Public Health’s School Immunization Survey, religious exemptions have been on the rise for several years. In 1999, only 0.2% of schoolchildren claimed religious exemptions to vaccines, with the share rising to 2.1% in the most recent school year. These figures do not include the COVID-19 vaccine and reflect only school-required vaccines, including those for diphtheria, measles, tetanus and other infectious diseases.

“Our elected officials are not epidemiologists, and I felt a real obligation to shed some light on the science for them so they could do what in my opinion was the right thing. Which they did,” said Niccolai, a professor in the Department of Epidemiology of Microbial Diseases.

Saad Omer, M.B.B.S., M.P.H., Ph.D., Susan Dwight Bliss Professor of Epidemiology of Microbial Diseases and director of the Yale Institute for Global Health, was one of the first researchers to testify in favor of the legislation.

“One direct way of improving people’s lives is through evidence-informed legislation,” he said. “It is our responsibility to do the best research possible and synthesize it in a way that is policy relevant, then share it persistently and proactively with policymakers.”

Still, getting the legislation passed was difficult. According to The Associated Press, nearly 2,000 protesters descended on the Capitol building in Hartford during the public hearings for the legislation. “It was packed,” Niccolai recalled. “There were lines around the building to get in. Most of those people did not support this legislation. I saw only one person carrying a sign that was pro-vaccine.”

In her testimony, Niccolai emphasized the scientific evidence that supports immunization, and its safety (disclosure: Niccolai is a scientific adviser for vaccine manufacturers Merck and Moderna). Her assertions met with an audible negative reaction from the crowd. “When I said the vaccines were safe, there was an outburst, like laughing, or chortling,” she said. Putting herself in such a hostile, public environment made Niccolai uncomfortable, she said, and well out of her comfort zone. “People confronted me and asked me hard questions. In the bathroom, outside the building, wherever I was. People were very critical of my work, and my testimony and my reasons for being there.”

Nevertheless, she knew she had an important reason for being there. “I have this internal driving force that I have science on my side,” she said. “That gives me reassurance. And this is for the common good. This is what we do in public health.”

Many of the people who opposed elimination of the religious exemption were at the Capitol to protest the requirement of vaccines beyond the scope of religion and rejected what they saw was an infringement on their individual rights. “The thing they repeatedly say is, ‘My child, my choice,’” said Niccolai. “But I am not swayed by that argument. We do things every day with our children so that they can be healthy, contributing members of society.” She cited laws mandating seat belts and bike helmets as examples. “There are children out there who can’t medically get vaccines, and they have as much of a right to go to school as anyone else.”

Many of the protesters also rejected the general safety of vaccines.

“To be clear, no vaccine is without side effects,” Niccolai responded. “But people have to do a risk/benefit calculation. Parents in their head say, ‘Getting the vaccine is riskier than not getting the vaccine.’ And that is true. But the proper risk/benefit calculation is the risk of the vaccine versus the risk of the infection. The risk from a vaccine is very, very small, in contrast to the risk of infectious diseases.”

While Niccolai might feel relieved to get back to her research, and away from the podium, she realizes that the discoveries she makes do not end with her. “Doing the science is one thing, but for it to make a difference, we need to communicate—to lay people, legislators, the press,” she said. “Otherwise it’s all for naught.”