Schools Can Exclude Students with Vax Opt-Outs In an Epidemic, TMA Says
By Joey Berlin


If school districts during an epidemic want to exclude students who have declined vaccinations for reasons of conscience, both the law and public health considerations are on their side, the Texas Medical Association has told Texas Attorney General Ken Paxton.

In a brief earlier this month, TMA responded to a request for an attorney general’s opinion filed by state Rep. James White (R-Hillister), chair of the House Committee on Corrections. Although presumably in reaction to the COVID-19 pandemic, Representative White’s request asked about an epidemic.

Representative White requested the opinion on whether state law and regulations allow school districts to exclude students with a conscience-based opt-out on vaccinations “even when such vaccinations are unrelated to the epidemic.” TMA’s Aug. 7 brief first tackled the public health risks, saying, “To reduce the threat of coinfection with other infectious diseases, strain on local health systems, and increased risk to vulnerable individuals, school districts should be allowed to exclude nonimmunized students.”

“Unfortunately, the threat of COVID-19 coinfection with other infectious diseases remains possible. While fighting disease, a weakened immune system can increase susceptibility to further illness,” TMA noted. “The compounding effect of multiple disease outbreaks on community health and local health department resources can be devastating to public health, with the potential to overwhelm health care systems. Additionally, children and adults at risk for more severe outcomes from COVID-19 may include those who are unable to receive necessary vaccinations for medical reasons.”

TMA added that upholding school vaccination requirements reinforces herd immunity for children at higher risk. In addition, interrupting routine vaccination schedules during a pandemic could “disproportionately impact communities with limited health care access.”

“Allowing local officials to consider exclusion of under-vaccinated students from school as a means to mitigate compounding disease outbreaks during a pandemic is in the best interest of public health,” the brief said.

Next, for schools to legally exclude a student with a conscience-based vaccination exemption, TMA looked at whether state law and rule require that the exempt vaccine be for the disease causing the epidemic. The plain language of the relevant rule and law show that the answer is no, TMA said.

While the state’s Education Code lists six diseases for which immunizations are required, TMA said the circumstances allowing the exclusion of a student aren’t limited to those diseases.

The law says a person who hasn’t received those immunizations “may be excluded from school in times of emergency or epidemic declared by the commissioner of public health.” TMA’s brief also noted that the language “times of emergency or epidemic” contains “no limiting language as to the cause of those circumstances,” and that interpretation is consistent with the language of the state Health and Safety Code.

“COVID-19 is a significant enough danger to the well-being of families in Texas on its own,” TMA wrote. “Preventing secondary infectious disease outbreaks should be a leading public health priority.”

Last Updated On

August 20, 2020

Originally Published On

August 20, 2020

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Joey Berlin

Associate Editor

(512) 370-1393

Joey Berlin is associate editor of Texas Medicine. His previous work includes stints as a reporter and editor for various newspapers and publishing companies, and he’s covered everything from hard news to sports to workers’ compensation. Joey grew up in the Kansas City area and attended the University of Kansas. He lives in Austin.

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