Types of Vaccine Exemptions

Medically Reviewed By William C. Lloyd III, MD, FACS
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cropped image of woman checking Covid-19 vaccine passport and international certificate of vaccination with QR code on smartphone and holding a suitcase

Vaccine mandates are nothing new. In fact, all 50 states, Washington, D.C., and U.S. territories have legislation requiring specific vaccines for students attending school or staying in childcare facilities. In addition, many businesses and federal institutions have mandatory vaccine requirements for a variety of diseases. In tandem with these requirements, all states, and Washington, D.C., also permit medical exemptions for students, while 44 states and Washington, D.C., permit religious exemptions, and 15 states permit philosophical exemptions from these immunization requirements.

COVID-19 vaccine mandates for workplaces, schools and businesses are placing a renewed focus on vaccine requirements—and how to get around them. Learn about different types of vaccine exemptions.

Medical exemptions from vaccination are limited in scope. 

Medical exemptions for vaccines are limited to those who have a medical condition that prevents them from receiving the vaccine. This could refer to specific conditions or to an allergy to ingredients in the vaccine.

While each state has specific requirements for applying for a medical exemption, most require that a physician write the exemption. In some states, you also may obtain a medical vaccine exemption from specific state-designated healthcare workers.

That being said, obtaining a medical vaccine exemption is not as easy as calling your doctor and requesting one. If your doctor can find no medical reason to provide the exemption, he can decline to give you one. If you receive an exemption, your state may require you to submit your medical exemption request to state public health officials for their review and approval.

Religious exemptions from vaccination could be difficult to obtain. 

Although a person has a constitutional right to freedom of religion, each state has its own requirements for a religious exemption. States must prove it has a “compelling state interest” to enforce a vaccine mandate. Limiting the spread of serious communicable diseases was deemed as such by the U.S. Supreme Court in 1905 in Jacobson v. Massachusetts, in reference to a smallpox vaccine mandate.

While most states accept a religious exemption from vaccines, they are not readily available. You do not have to belong to an organized religion to receive a religious exemption. However, some states require you to show proof that you belong to an organized religion with written tenets that prohibit invasive medical procedures. Other states may require you to provide a signed affidavit from your pastor or spiritual advisor.

Philosophical exemptions vary from state to state.

Philosophical exemptions—also called personal belief or conscientious exemptions—are available for anyone who conscientiously objects to vaccines. Only 15 states permit this type of vaccine exemption, and the requirements vary widely by state.

In some states, a person cannot pick and choose which vaccines they object to; you have to object to all vaccines. Also, certain states limit philosophical exemptions to specific situations. For instance, Missouri only allows philosophical exemptions to daycare centers.

You may get a vaccine exemption if you can prove you are immune to the disease. 

Some states allow an exemption if the individual can provide a blood titer test showing they have enough naturally acquired or vaccine acquired antibodies to provide immunity to the disease in question. These blood titer tests are not routinely available at your doctor’s office. Oftentimes, a private medical laboratory must perform the test. The test results would be submitted with the request for a vaccine exemption.

For more information about school vaccination requirements and exemptions, refer to the list of states at the Centers for Disease Control and Prevention website. You may find more general information about vaccination and exemption requirements by contacting the public health department of the state or territory in which you live.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Nov 19
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. States With Religious and Philosophical Exemptions from School Immunization Requirements. National Conference of State Legislatures. https://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx
  2. What Is An Exemption and What Does It Mean? Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/imz-managers/coverage/schoolvaxview/requirements/exemption.html
  3. Frequently Asked Questions About Vaccine Exemption Information. National Vaccine Information Center. https://www.nvic.org/faqs/vaccine-exemptions.aspx