Requiring vaccination for school attendance protects kids and communities from disease spread, but the courts may interfere.
Photo by FatCamera, courtesy iStockphoto
The ability of states to reject school vaccination exemptions for non-medical reasons could be on the line this year.
Several court cases may reach the U.S. Supreme Court in coming months addressing the issue of vaccine requirements and religious exemptions. One case stands out for its potential to rewrite case law.
Miller v. McDonald, which grew out of school vaccination requirements in New York, could see the conservative-leaning court rethink the constitutional status of vaccine mandates. Such a decision could increase religious exemptions for routine vaccination for adults and children, eroding protection in schools and communities.
“I think you would see large swaths of people who would be allowed to not vaccinate their children, which would be a radical departure from 100 years of Supreme Court precedent,” Zalman Rothschild, PhD, JD, an assistant law professor at Yeshiva University's Cardozo School of Law, told The Nation's Health.
All U.S. states have some vaccination requirements in place for school attendance, though states vary on whether they allow non-medical exemptions, which can be based on religious or personal beliefs.
For decades, the limit case of courts granting religious exemptions was vaccination. The Supreme Court repeatedly held that religious liberty did not override the dangers of exposing a school or community to a person unvaccinated from an infectious disease.
But the softening of that approach began in 2020, the first year of the COVID-19 pandemic and the year the court achieved a conservative majority. The court, made up of three justices President Donald Trump appointed in his first term, has since ruled in support of a variety of religious liberty claims. Also, even as the court upheld school and workplace vaccine requirements during the pandemic, dissenting opinions supporting religious exemptions were written by conservative justices, said Wendy Parmet, JD, co-director of the Center for Health Policy and Law at Northeastern University School of Law.
Miller's path to Supreme Court consideration began in 2024, when families in a New York Amish community challenged the state's 2019 repeal of religious exemptions following a months-long measles outbreak in the state. The plaintiffs argued that vaccines were counter to their religious beliefs and the ban impeded communal schooling. An appeals court dismissed the case in March 2025.
A few months later, in June, the Supreme Court ruled on a different case: Mahmoud v. Taylor, on children's education, parental rights and religious freedom. At issue was whether a Maryland public school violated parents' constitutional right to exercise their religion by not allowing them to opt out their children from attending an LGBTQ-themed storybook reading. The court sided with the parents.
In December, the court revisited Miller, instructing the appeals court to rethink its ruling in light of the Mahmoud decision.
In Mahmoud, the court ruled “that parents have a right to object to state law or policy action when it involves their children,” Rothschild said. Mahmoud is “a parental rights argument combined with a freedom of religion argument.”
But justices could have made that ruling in Miller without sending the case back to the circuit court, which as of late June had not responded to the remand.
The justices may be avoiding a definitive decision on the matter, something they have done previously, some experts say. In recent years, two states with vaccine requirements were sued for not granting religious exemptions to healthcare workers. The court sided with the states.
Rather than upset 100 years of precedent, the Supreme Court may be working around the debate through the Miller case, Parmet said.
“They just want to smuggle in the idea that if you go to a school and say, ‘My religion doesn't allow it,' the school is going to have to give you the exemption,” said Parmet, an APHA member. “It's not so much about having religious exemptions. It's about making it way easier to get them. But there is a public health danger.”
For a guide to non-medical exemptions by state, visit www.ncsl.org.
- Copyright The Nation’s Health, American Public Health Association
