The American Academy of Pediatrics (AAP) today called for an end to religious and philosophical vaccine exemptions for children attending daycare and school in the U.S.
In an updated policy statement published in Pediatrics, the AAP said universal immunization is necessary to keep children and employees safe. The organization said there is a place for “legitimate” medical exemptions, but nonmedical exemptions are “problematic.”
“We recommend that vaccination is required for participation in certain public activities, such as school and daycare, and if you choose not to vaccinate, you’re essentially choosing to exclude yourself from those settings,” lead author Dr. Jesse Hackell told MedPage Today.
He added:
“We recognize that excluding a child from public education does have problems, and yet, we reach the conclusion that, on balance, assuring the safety of the school and daycare environment outweighs that risk because there are other educational opportunities available.”
According to the AAP statement, all 50 states, the District of Columbia and Puerto Rico require proof of immunization to attend daycare and school, and all of them grant medical exemptions. However, 45 of those also have religious exemptions, and 15 allow personal belief, philosophical or conscientious objection exemptions.
Only California, Connecticut, Maine, New York and West Virginia don’t allow nonmedical exemptions. Massachusetts is debating a law that would eliminate religious exemptions there.
The AAP statement said reasons for granting medical exemptions can vary, but typically require a demonstrated allergy to a vaccine component, previous serious adverse reaction to a vaccine or its components, or serious underlying immunosuppression.
Some states, including New York, have been tightening their medical exemption requirements in recent years. Some state medical boards, including in California, have sanctioned or targeted the medical licenses of doctors who write medical exemptions.
“Medically indicated exemptions, when granted appropriately, typically do not have a significant impact on overall community vaccination coverage,” the statement’s authors wrote, but allowing other types of exemptions does, and immunization rates have been dropping in recent years.
Kim Mack Rosenberg, general counsel for Children’s Health Defense, told The Defender that religious freedom is a “hot-button” issue nationwide. She said:
“The AAP’s statement calling for an end to religious exemptions to immunization ignores constitutionally protected rights regarding religious freedom and potentially is in violation of other laws as well. AAP blatantly suggests that schools discriminate against families with faith-based reasons to not take some or all vaccines.
“To claim otherwise is to play word games — just as AAP suggests that families are not forced to take vaccines that conflict with their religious beliefs but instead that families simply must choose, in those instances, between attending school and staying true to their religious values.”
Dr. Michelle Perro, author of “What’s Making Our Children Sick?: How Industrial Food Is Causing an Epidemic of Chronic Illness, and What Parents (and Doctors) Can Do About It,” criticized the move by the AAP.
“As a pediatrician committed to informed consent and patient rights based on non-biased science, I strongly support the continued access to medical, religious and philosophical vaccine exemptions,” she said.
Perro said many vaccines are produced using cell lines originally derived from aborted fetal tissue. This poses a moral and ethical conflict for some families. She added:
“In addition, vaccines contain adjuvants and excipients such as aluminum salts, polysorbate 80 and formaldehyde that create neurotoxicity and immune dysregulation in some children. Compounding these issues is the National Vaccine Injury Compensation Program [VICP], which grants vaccine manufacturers legal immunity, leaving families with no recourse when vaccine injuries occur.
“In a system that removes liability from Pharma while simultaneously mandating their products, preserving exemptions is essential to protect not only parental choice, medical ethics, and the fundamental right to informed consent, but protecting the health of our children.”
In an X post today, U.S. Health Secretary Robert F. Kennedy Jr. criticized the VICP and vowed to fix it.
“The VICP is broken, and I intend to fix it,” Kennedy said. “I will not allow the VICP to continue to ignore its mandate and fail its mission of quickly and fairly compensating vaccine-injured individuals.”
‘Fundamental right’ of parents addressed in Supreme Court ruling this year
Legally requiring immunization is key to high immunization rates, the authors said, highlighting court rulings from 1905, 1922 and 1944 as “legal justification” for their stance. Mack Rosenberg said:
“AAP is relying on old case law to support its argument, and that case law is being challenged and questioned, and new case law upholding First Amendment religious freedom and also parental rights in a variety of contexts has recently been issued.”
New York civil rights attorney Sujata Gibson, who has represented numerous plaintiffs challenging denials of their vaccine exemptions, said the AAP’s argument disregarded the U.S. Supreme Court’s 2025 ruling in the Mahmoud v. Taylor case. Gibson said:
“The Court reaffirmed that parents have a fundamental right to raise their children according to their religious beliefs, and any government policy infringing on this right faces strict scrutiny — the highest legal standard. Blanket bans on religious exemptions, as the AAP proposes, fail this test. …
“Forcing families to choose between their faith and their children’s education is unnecessary. Forty-five states already balance public health with religious accommodations, proving it’s possible to protect both. States can no longer rely on vague claims of ‘public health’ to justify mandatory medical interventions. Under strict scrutiny, they must provide concrete evidence — something the AAP’s proposal lacks.
“The Supreme Court’s message is clear: a child’s access to public education cannot be conditioned on a family violating their deeply held religious convictions.”
Public support for religious exemptions is growing
A survey conducted by the Annenberg Public Policy Center at the University of Pennsylvania, published in January, found public support for religious exemptions from school vaccine requirements doubled, from 20% in 2019 to 39% in 2025.
The survey also showed that only 52% of U.S. adults support having their state require vaccination as a condition of school attendance.
The study authors said school-entry vaccination rates have fallen, while exemptions have gone up. They reported that states with nonmedical vaccine exemptions have had “steady increases,” although that number only reached 3% in the 2022-2023 school year.
“The ease of requirements to obtain nonmedical exemptions can have a significant impact on the rate of exemptions and immunizations,” the authors said.
In its statement, the AAP appeared to question the legitimacy of people’s religious beliefs. It said no major world religious traditions “include scriptural or doctrinal guidelines that preclude adherents from being vaccinated.”
The organization noted that some people develop beliefs drawn from independent religious traditions or diverse denominational perspectives within major religions. Those perspectives are “nonetheless, thought of as ‘religious’ commitments by those who hold them,” but they are too complicated for effective interpretation, the AAP said.
While legislatures are “reticent” to interfere with the free exercise of religion, allowing for exemptions based on such beliefs can substantially affect public health, the organization said.
‘AAP and many of its members benefit from high vaccine uptake’
The AAP is a professional organization representing 67,000 pediatricians in the U.S. However, it is also a lobbying organization that has spent between $748,000 and $1,180,000 annually advocating for its members over the previous six years, according to the government website Open Secrets.
The organization’s funding for that work comes, in part, from annual contributions from corporate sponsors, including vaccine manufacturers Moderna, Merck, Sanofi, Abbott Laboratories, GSK and CSL Seqirus.
In today’s statement, the AAP said none of the authors have relevant financial conflicts of interest to disclose and that any conflicts “have been resolved through a process approved by the Board of Directors.”
However, the government Open Payments database shows that lead author Hackell has taken money from Merck, Pfizer, Seqirus and GSK since 2018. Author Dr. Lisa M. Kafer has received payments from the same companies, as well as others. Most other authors are university researchers and are not listed in the database.
The thousands of dollars worth of payments to the authors indicate a relationship between the Big Pharma companies that make the vaccines and the AAP members working to make sure vaccine exemptions are scaled back.
“AAP and many of its members benefit from high vaccine uptake, and this conflict of interest should not be ignored,” said Mack Rosenberg.
Related articles in The Defender
- Public Support for Religious Exemptions Nearly Doubled Over Past 6 Years
- Hawaii, Religious Exemptions and Measles: Will the Playbook Work Again?
- New York’s Attack on Medical Exemptions Gives School Officials Power to Override Doctors on Vaccines
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