The American Academy of Pediatrics has recently joined the American Medical Association and the American College of Physicians in calling for the elimination of nonmedical exemptions from state school-entry immunization laws. Although these calls have merit and are appealing from a public health perspective, the reality of such regulations are subject to political influence and also face substantial challenges on both legislative and judicial fronts.

There has been a vocal backlash against removing nonmedical exemptions, and some states have even attempted to add exemptions to law. One such state is New York, which introduced a bill to add philosophical exemptions in January 2015. Arkansas succeeded in broadening its vaccine exemption policy by adding philosophical exemptions to the state in 2003. As expected, there has been an increase in vaccination exemptions since that time; fortunately, there has not been the corresponding increase in vaccine-preventable diseases.

Three US Supreme Court cases...

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