![]() ![]() Roe v Wade prompted state lawmakers to transfer conscience rights from the military context to health care. Court decisions concerning conscientious objection to war detached conscience from the religious connection it had legally required since World War I. The language in these exemptions reflected the influence of legal battles and rights movements of the 1970s that blurred the line between religious and moral beliefs, popularized health care rights, and promoted the idea of informed consent. But the more defining feature of this stage is evident in states that included broad exemptions when adopting school mandates for the first time, or the first time since smallpox mandates. Others, like Louisiana’s and Minnesota’s, were modifications of religious exemptions in earlier laws. As these mandates were passed, some exemptions, like California’s, were carried over from preexisting laws. 11 The later measles mandates, introduced mostly in the 1970s, were a response to measles’ persistence in urban, impoverished areas despite mass eradication campaigns and to new evidence demonstrating that school mandates prevented outbreaks. The first measles vaccine was approved in 1963, and early mandates were inspired by enthusiasm for its potential to prevent “mental retardation” and reduce health care spending. The third stage of belief exemptions came in tandem with a wave of laws, passed from the mid-1960s through the 1970s, that largely focused on requiring measles vaccination for school enrollment. 7, 8 The solution was an exemption allowing parents to submit a “written statement…objecting to immunization.” 9 A 1961 polio mandate introduced in California originally allowed exemptions based on “religious beliefs,” but objections from constituents, mostly alternative-health adherents, convinced bill sponsors to strike the word “religious.” 10 The move secured California a broad exemption clause that would be applied to each vaccine added to the state code for the next 50 years. Michigan lawmakers introduced a mandate in 1959 in response to 1958 polio outbreaks, but the bill did not pass until 1960, with an exemption allowing “religious or other objection.” 6 A 1959 Ohio bill was held up for weeks by Democrats opposed to its destruction of “the right of freedom of choice” and by school districts opposed to a law overriding their jurisdiction. They responded with new mandates, but several of the laws passed only after political negotiations that introduced a second wave of belief exemptions. Polio plummeted, but some states soon saw the declines reverse, especially in poor, urban areas. Persuasion was initially applied to the first polio vaccine, which was approved in 1955. In the interim, health departments relied on persuasion to encourage the use of new vaccines against diphtheria, tetanus, and pertussis. ![]() The second phase of personal belief exemptions, which introduced their contemporary moniker, came in response to polio vaccine mandates 50 years later.
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