BOSTON — Democrats on Beacon Hill are pushing for tighter immunization rules that would require state health officials to sign off on all exemptions for schoolchildren.

A proposal filed by Rep. Paul Donato, D-Medford, and Sen. Becca Rausch, D-Needham, would require the state Department of Public Health to set standards for medical and religious exemptions to vaccines required of children attending public and private schools, and take over the processing of applications to opt-out.

Parents would no longer be allowed to request exemptions from local school districts under the plan, but would instead apply directly to the state health department.

Donato, the House's second assistant majority leader, said the plan balances religious and medical exemptions with the need to boost declining immunization rates.

"The goal is to keep children safe and make informed decisions about their health while also respecting the rights of families seeking exemptions," he said.

The proposal is touted by supporters as a less controversial alternative to an earlier one filed by Rep. Andy Vargas, D-Haverhill, which would eliminate religious exemptions.

Vargas' plan won support from the influential Massachusetts Medical Society, which in May adopted a policy opposing exemptions for school-age children for non-medical reasons. It also picked up more than 30 co-sponsors including Sen. Brendan Crighton, D-Lynn, and Reps. Linda Campbell, D-Methuen, and Lori Ehrlich, D-Marblehead.

House Minority Leader Brad Jones, a North Reading Republican, also signed on to Vargas' proposal.

Parental rights, religious liberties

But Vargas' plan prompted a backlash from many conservative and faith groups, which argue the move violates religious liberties.

Vargas defends his proposal, saying he's focused on improving public health and that "the science is clear" about the benefits of vaccinating school-age children.

"I certainly think the intent of the new bill is great, to standardize the process and make things a little clearer for folks," he said. "But ultimately my goal is to get rid of the religious exemption, since that is the main driver of increased rates of kids not getting vaccinated."

Donato and Rausch's legislation is expected to face less opposition, though it has yet to be scheduled for a committee hearing.

Even the Massachusetts Family Institute, which strongly opposes the medical society's stance on religious exemptions, doesn't have a problem with the new proposal, as currently written.

"It seems the intent of this bill is not eliminating an important example of parental rights and religious freedom, but rather emphasizing awareness of the potential health risks of vaccine exemptions and better data collection," Andrew Beckwith, the institute's president, said in a statement. "To that extent, it is consistent with the fundamental right of parents to direct the health care of their children."

He said immunization rules "should continue to balance public health concerns with these parental rights and religious freedom for the relative few that seek exemptions."

Massachusetts, like most states, requires students to be vaccinated to attend school, though parents may cite religious reasons, in addition to medical ones, for opting out of the requirements. Those rules apply to private school students as well.

Those who object for non-medical reasons must notify their child's school in writing.

Parents’ religious views were cited for 837 children who attended kindergarten in the 2018-19 school year without the required vaccines, according to the state Department of Public Health. Non-medical reasons were cited for 277 children enrolled that year in state-funded child care and preschool programs.

What's more, the percentage of unvaccinated kindergartners entering school this fall was the highest since the late 1980s, according to DPH.

Measles on the rise

The vaccination proposals come amid a renewed national debate over the thorny issue prompted by measles outbreaks in two-dozen states that were attributed to unvaccinated children.

Measles was once common but gradually became rare after vaccination campaigns began in the 1960s. It was declared eliminated in the U.S. by 2000.

But more than 1,241 cases of the disease, spread by an airborne virus, have been reported this year, according to the U.S. Centers for Disease Control and Prevention. That's a more than 200% increase over last year.

Massachusetts, New Hampshire and Connecticut are among 26 states that have reported measles cases in 2019, but none have met the threshold of three or more cases required to be considered an outbreak.

Physicians say the anti-vaccination movement, driven in part by debunked scientific studies linking vaccines to autism, has played a role in parents choosing not to get their kids vaccinated.

While all states have laws requiring vaccinations for children enrolled in school or day care programs, only California, Mississippi and West Virginia do not consider exemptions based on religious or other non-medical reasons.

At least 10 other states are considering stricter laws in response to the spike in measles cases, according to the National Conference of State Legislatures.

New York recently ended religious exemptions to vaccinations for children in all schools and child care centers. Beginning this school year, all children must begin getting their vaccines within the first two weeks of classes and complete them by the end of the school year.

Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group’s newspapers and websites. Email him at cwade@cnhi.com.

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