Methodology for Investigating Immunization Exemptions for Universities in the US
Disclaimer
The author of this article is not an attorney and not authorized to practice law in any state. Nothing presented in this document is to be taken as legal advice. Everything presented here is personal opinion derived from research and is for informational purposes only. Please reach out centerforpublictransparency@gmail.com for clarification or recommended revisions or additions. Please consider donating if you found this information useful and want to further the mission.
Related Articles
The Challenge With Obtaining Immunization Exemptions for Healthcare Degrees
Lack of Transparency Regarding University Exemptions at Universities (yet to be published)
Introduction
There is currently no existing reference one can consult to know whether a university in the US has any exemptions for required immunizations. Likewise, the universities themselves often omit any mention of immunizations or how to exercise exemptions or who qualifies if the existence of exemptions can be confirmed. Therefore, The Center conducted an investigation of universities in every state and the District of Columbia (DC) to create such a resource that provides transparency where there is none or to enhance transparency if there is any. The map, table and list that can be found on Immunization Exemptions for College (yet to be publishes) were created as a result of this investigation and they indicate the likelihood of obtaining an exemption from immunizations for non healthcare related degrees at the major public and private universities in every state and DC. Below are details about the methodology used to obtain the data.
The colors on the map represent the following:
Dark blue - All guaranteed
Blue - All but one private guaranteed
Medium Light Blue - All but one public guaranteed
Light Blue - Some private scrutinize
Blue Green - Some public scrutinize
Green - Some public and private scrutinize
Light Green - Most public and private scrutinize
Purple - All scrutinize
Red - Medical only
There are non medical exemptions available in 48 states (and DC) which are represented by any state that is not red and there are guaranteed exemptions available in 44 states (including DC) which are represented by any state that is not red or purple.
Healthcare degrees have additional requirements set by 3rd parties that fall outside of state law so they are not included in this analysis. See The Challenge With Obtaining Immunization Exemptions for Healthcare Degrees for more information.
Objectives
The following were the objectives of the investigation. The goal for each of the objectives was to gather evidence to be used to ultimately determine the degree of certainty of obtaining an exemption at each university along with documenting that fact in order to counter the general lack of transparency provided by many states and universities regarding who is eligible for exemptions, how to exercise them and whether or not they are guaranteed.
Determine Adherence to State Law
If there is a state law that guarantees exemptions at the university level, to determine whether it applies to both public and private universities and to confirm whether or not universities subject to the law are complying with it. Knowing this could assist one in determining the level of confidence one could have that if a state law requires a guaranteed exemption from all immunizations for universities that in fact universities in that state comply with that law despite the fact that the state health department or the university may not be forthcoming about the existence of exemptions, who qualifies or how they are processed.
Determine Voluntary Compliance With K-12 Laws
Whether or not there is a state law controlling public or private universities or both, the objective was to determine to what extent universities also provided guaranteed exemptions if the K-12 exemptions were guaranteed, or scrutinized exemptions if the K-12 exemptions were scrutinized. Knowing this could assist one in determining the level of confidence one could have that the universities are guaranteeing exemptions in the same manner as K-12 despite the lack of transparency.
Evaluate Transparency
To examine the level of transparency universities have regarding both the existence of exemptions and how consistent the representation of the exemption is compared with state law requirements, if there is a state law, and the actual practice of processing the exemption whether there is a state requirement or not. Knowing this could assist one in having confidence that even if a university does not represent that exemptions exist, or if they do and fail to provide any guidance on who qualifies or how to exercise them, that the lack of transparency in and of itself is not a determinative factor that exemptions do not exist and are not available to anyone that wishes to claim them.
Establish Record of Exemptions
To document evidence of the exemption policy at each university by obtaining a form or the written policy itself explaining how the exemption is processed including how to contact the department responsible for processing forms in order to confirm the information presented here. Knowing this provides one a method of combating lack of transparency from the state or the university and most important, makes information about exemptions available to a prospective student prior to going through the admissions process, saving the prospective student whose religious beliefs prevent them from being immunized from applying in vain to a university that they would not choose to attend if there was no likelihood that they would be able to obtain an exemption.
Procedure
Determine Adherence to State Law
In order to determine whether state laws, if applicable, were being implemented, depending on the population and number of universities in a state, at least two of the major public universities (or systems if there were multiple universities in the same system), with the goal of three or more, and at least two of the largest private universities were investigated to determine whether or not there was any consistency among the practices of each group with the requirements for state law. The strategy was to account for the largest number of enrolled students using the least amount of universities. In each case, it seems as though some 70-80% of enrolled students are represented by the universities examined.
For example, if state law requires something to the effect that any person that submits in writing an objection to immunization on religious grounds shall be exempted, universities policies were investigated to confirm whether or not exemptions submitted in that way were automatically approved.
In the case where the department of health of a state created a state form for the purpose of exercising a university exemption, each university was evaluated to confirm whether or not they honored the state form, or if they created their own form, whether or not it was similar to the state form and handled in the same manner.
Determine Voluntary Compliance With K-12 Laws
The same criteria were followed for the number of public and private universities examined. But in this case, it was simply to evaluate how closely they followed guaranteeing exemptions in the same manner that most states do for K-12. Based on the number of universities that followed suit, a degree of certainty could be determined in general about the likelihood of obtaining an exemption if one wanted to attend a university in that state for a non healthcare related degree.
Evaluate Transparency
The following points were considered when evaluating transparency:
Could the Existence of an Exemption Be Readily Determined
Was there any mention of an exemption on an immunizations or health requirements page or admissions requirements page if there was no health requirements page?
If not, was there a link on that page to an FAQ page where an exemption was mentioned?
If there was no link to an FAQ page, could any evidence be found in a search about an exemption for required immunizations?
Was there a written policy under the university bylaws?
If no information about exemptions could be found, could a form be found through a search?
If no form could be found, was there any mention of an exemption on the required immunizations or other health record form?
If not, was there any way for a person not yet registered as a student to communicate with the department associated with the health form?
If there was, was anyone in that department willing to provide a copy of the form and otherwise explain the procedure for processing the exemption request?
If they were unwilling or unable to provide a copy of the form to a non student, were they willing to describe the form?
Could the Degree of Certainty of Obtaining the Exemption Be Readily Determined
Was there any definitive statement anywhere that explained that once the form was filled out and turned in the exemption was considered executed?
Could that determination be made by examining the form? For example, did the form only have a place for the student to sign with no requirement to provide a written statement?
Was there any indication in writing that a written statement was required and that it would be reviewed by a committee before being approved or denied?
Was it possible to reach the person or people responsible for receiving and processing the forms or statements to get a sense from them as to whether the forms or statements were automatically approved or whether scrutiny was involved in examining the claim, and if so, were students given the opportunity to revise their claims or provide additional evidence?
Establish Record of Exemptions
University websites were scoured for the existence of forms and or policies, any of which were found were saved and stored. If no policy or form could be found or the university was unwilling to provide one, an oral description of the form was requested and documented if a representative was willing to provide one. In any case where there was any doubt as to how the exemption was processed, the person responsible for processing or otherwise approving or denying the exemption forms was sought and asked for clarification about the process and the degree of scrutiny involved.
Results and Conclusions
Determine Adherence to State Law
In general, if a state law required that universities provide a guaranteed exemption, universities complied. Many of those universities had very little transparency to the effect that they may not have mentioned exemptions on their required immunizations page or had a link to or any mention of an exemption form, but when officials that process the immunization paperwork were contacted regarding exemptions, they confirmed a form did exist or written statements were accepted and that they were processed according to state law or some university policy or procedure. In a few states they accepted a state form if it was generated by the department of health. Others created their own forms based off of the state form. Based on these results, one could be assured with a very high degree of certainty that if a state law requires a guaranteed exemption at the university level that whether or not there is any indication in writing from that university about an exemption, that the school either accepts the state form or has a form of their own that will be provided when demanded.
The map on the Immunization Exemptions for College (yet to be published) page does not currently clarify whether or not state law is a controlling factor (The Center will likely put that information on future state pages). But, on the map, if the state law controlled both public and private universities, that state is likely shaded dark blue indicating that all universities have guaranteed exemptions. If the state law only controlled public universities, the state could be dark blue or a slightly lighter shade of blue or green if some private universities scrutinize. There were no states where the state law was only controlling for private universities.
Every university examined did have an exemption and a procedure for processing it, even for the medical only states.
Determine Consistency with the Treatment of K-12 Exemptions
For states where the state law was controlling for public and private and K-12 laws provide for guaranteed exemptions, the majority of states also provided guaranteed exemptions, but there were exceptions. For example, New Jersey has the clearest guidance of all states that no additional proof is required for any parent that turns in a statement claiming a religious exemption (their religious claims are taken at face value and automatically approved), yet all universities scrutinize exemption requests, so they are not automatic or guaranteed. They don’t require any proof either, but they require a written statement that is evaluated and only approved if it meets certain requirements. And in a few other states, some public or some private or a mixture of both scrutinize exemption requests.
For states where the state law was controlling for only public universities, in most cases, at least one major private university scrutinizes exemptions.
For states where there was no law controlling public or private universities, most universities still guaranteed exemptions. New Hampshire was the exception like New Jersey where all universities scrutinize unlike K-12 that is guaranteed. Otherwise, private universities were more likely to scrutinize even though a few public ones do as well.
Evaluate Transparency
In many of those cases, exemptions were not mentioned anywhere on the university’s website. Even in some states like Vermont where a state form is available for universities and all universities accept them, there was no mention of any exemption on some university websites and no form was able to be found through a search. It seemed that the university’s attitude was that anyone applying to the university was well aware that there was a state exemption available to them so there was no need to make any mention of it. Transparency at the university level is just as lacking in many cases, if not worse, than the child care and K-12 levels despite the fact that there are more states with guaranteed exemptions available. See Lack of Transparency Regarding University Exemptions at Universities (yet to be published) for more details.
Since some universities simply will not provide a form to anyone who is not yet enrolled, there were multiple times that our researchers had to resort to requesting immunization compliance personnel to read descriptions of the immunization forms over the phone in order to fully understand all that was involved in the exemption process and to gauge the degree of certainty of obtaining an exemption. This, of course, makes it exceptionally hard for anyone whose religious beliefs prevent them from being immunized to assess ahead of time whether or not there is a high degree of certainty that once accepted they will obtain an immunization and all their efforts spent towards getting accepted along with the cost will not have been done so in vain.
Establish Record of Exemptions
One of the objectives of this project was to create a repository of all exemptions policies, forms and processes for universities nationwide to create transparency where often none exists. Often a form, if one is provided, will indicate whether a statement is required, anything additional is needed or one simply needs to just sign the form and turn it in, shedding light as to the certainty of obtaining the exemption. Some forms are only available to enrolled students making it impossible for one who wishes to exercise an exemption the opportunity to know prior to enrolling what the likelihood of obtaining an exemption would be unless university personnel are willing to verbally clarify the process. The Center was not able to obtain forms (if the university uses forms) from all universities investigated, but it hopes that this investigation will lay the foundation for a collective effort to share additional forms, policies and procedures so that absolute clarity can be obtained regarding immunizations at the university level. Many forms have been collected but it takes time and effort to get them uploaded and made shareable. Please consider donating so that The Center can continue in this effort.
Summary
This investigative effort was an attempt to provide transparency where very little exists. States and universities make very clear what the immunization requirements are (in most cases) yet many provide little if no clarity on whether an exemption exists, how it is processed and who qualifies. So, this investigation attempted to evaluate university compliance with state law, tendency to provide guaranteed exemptions when K-12 set the example, evaluate transparency regarding the existence of and processing of exemptions and obtain and document exemption forms, policies and procedures in order to provide a reference that prospective students can turn to to determine the likelihood of obtaining an exemption from immunizations for non healthcare degrees at any university in the country.
The results found that a guaranteed exemption is available to attend university unimmunized with a non healthcare degree in 44 states and there are non medical exemptions available in 48 states. There are only two states, CT and ME that do not permit any non medical exemptions for any degrees at the university level which makes guaranteed exemptions at universities available in more states than for child care and K-12.