Use of Fees to Discourage Nonmedical Exemptions to School Immunization Laws in US States

Am J Public Health. 2016 Feb;106(2):269-70. doi: 10.2105/AJPH.2015.302967. Epub 2015 Dec 21.


Recent outbreaks of vaccine-preventable diseases in the United States have renewed public discourse about state vaccine mandates for children entering schools. With acknowledgment of the challenge of eliminating religious and philosophical exemptions in most states, some have proposed instead to impose additional administrative burdens for parents seeking such exemptions. We review the use of taxes, fines, and fees as financial disincentives in public health. We argue that adding processing fees to a comprehensive set of administrative requirements for obtaining exemptions will avoid the use of taxpayer funding for exemption processing and will help tilt the balance of convenience in favor of vaccination.

MeSH terms

  • Child
  • Fees and Charges / legislation & jurisprudence*
  • Humans
  • Immunization Programs / legislation & jurisprudence*
  • Public Health / legislation & jurisprudence
  • Religion and Medicine
  • Schools / legislation & jurisprudence*
  • State Government*
  • Taxes
  • Treatment Refusal / legislation & jurisprudence*
  • United States
  • Vaccination / legislation & jurisprudence