Tennessee was once a leader in childhood vaccines, but a Tennessee House bill would make required vaccines unconstitutional. (Photo: John Partipilo)
Since 1967, Tennessee has protected students, faculty, staff, and communities by requiring certain vaccinations for children to attend school but House Joint Resolution 28, by Rep. Gino Bulso, a Brentwood Republican, threatens to make these requirements unconstitutional.
School vaccination requirements play a vital role in keeping diseases at bay. Measles eradication is a shining example of the success of such laws and the return of outbreaks like the current one in Texas is a chilling reminder of their importance.
The first measles vaccine was approved in 1963, and the first national vaccination campaign followed in 1966. Within two years, measles incidence had decreased by more than 90% compared with pre vaccine-era levels.
In 1967, the Tennessee General Assembly enacted the state’s first school vaccine requirements for kindergartners entering school. Physicians could grant medical exemptions when necessary. Unless there was an epidemic or immediate threat, parents could request a medical exemption if they were members of a “well-recognized religious denomination whose teachings include reliance on prayer or spiritual means alone for healing.”
The law was incredibly effective, and Tennessee saw a large drop in yearly measles cases. In the textbook, “Law in Public Health Practice,” Kevin Malone and Alan Hinman write, “states that had school vaccination laws for measles vaccine had measles incidence rates 40% to 51% lower than states without such laws.” Tennessee was a proud leader in the campaign to eradicate disease.
By 1977, vaccination rates were declining and. President Jimmy Carter began the national Childhood Immunization Program. The goal of the initiative was for at least 90% of American children to be immunized by 1979. Many states reviewed their immunization laws and began finding better ways to enforce them.
After much discussion and deliberation, Tennessee legislators decided that the 1967 law “was inadequate because it lacked sufficient sanction.” In 1978, almost 10 years after first requiring school vaccinations, the Tennessee General Assembly unanimously passed “one of the most compulsory school immunization laws in the nation.”
The new law extended the requirement to all children in grades K-12 and imposed a penalty for non-compliance. Unvaccinated children were not counted in the school’s average daily attendance, which meant they would not be counted for state funding. The state department of public health determined children would be required to receive vaccines for iphtheria, tetanus, pertussis, poliomyelitis, measles, and rubella to begin school in 1978.
Ensuring 840,000 Tennessee K-12 students were vaccinated was a monumental task. The health departments, schools, media outlets, the Red Cross, the State PTA, and others helped get the word out to parents.
Parents and children stood in long lines to get immunized in time for the school year to begin. State Health Commissioner, E.W. Fowinkle, reported that though they had a difficult mountain to climb, “the campaign received strong support from the public, physicians, and the health and education personnel.” He admitted that the departments of health and education were not always aligned. They agreed about the importance of the immunization program, but it wasn’t always easy to manage.
Naturally, the health department’s main focus was the immunization program. They needed the education department to help with enforcement. The education department sometimes resented the disruption the immunization program caused. Despite these difficulties, an audit at the end of the 1978–1979 school year showed that 95.3% of all K-12 students in public schools were immunized. Only 0.2% of parents requested medical or religious exemptions. According to Malone and Hinman, “an analysis of states with the highest and lowest incidences of measles in 1979–1980 found that states with the lowest incidence rates were significantly more likely to have laws covering the entire school population … and more likely to be strictly enforcing the laws.”
In 1981, Commissioner Fowinkle wrote, “outbreaks … are not as devastating now as outbreaks of earlier years, but they are viewed as unnecessary because today they are preventable. The infrequent incidences of physical impairment and death that result from these diseases are even more tragic because they are unnecessary.” Forty five years later, his words are still true, perhaps even more so.
The laws enacted in 1978 have largely remained intact over the last several decades. Religious exemptions have broadened to any “conflicts with the parent’s or guardian’s religious tenets and practices.” Though immunization rates have steadily declined over the last several years, (Figure 2), Tennessee has a measles immunization rate of 94.9%. In 2000, the United States declared measles eradicated. Tennessee continues to have less than a handful of measles cases each year.
Parents want to keep their children safe and healthy. They understand the importance of school vaccine requirements. According to a 2024 Centers for Disease Control parent survey, “the majority (76.6%) of parents/guardians somewhat or strongly agreed that school and daycare vaccination requirements are important and necessary.”
In Tennessee, despite the broad exemption policy, more than 90% of school children are vaccinated. Tennessee once proudly led the rest of the country in preventing disease. HJR0028 threatens to make us a leader in increased illnesses, hospitalizations, long-lasting impairments, and even deaths. Our general assembly has the opportunity to choose the kind of example we want to be to the rest of the country. It is my sincere hope that they choose the health and safety of our children and communities by rejecting Bulso’s bill.
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