Mississippi Process For Religious Exemptions From School Vaccination Requirements

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Case 1:22-cv-00233-HSO-BWR Document 82 Filed 07/07/23 Page 1 of 15

UNITED STATES DISTRICT COURT


SOUTHERN DISTRICT OF MISSISSIPPI
SOUTHERN DISTRICT

AMANDA BOSARGE, JAQUELYN


BUTLER, KIMBERLY HARRELL,
WILLIAM MORGAN, PASTOR PAUL
PERKINS, BRANDI RENFROE, and DR.
JEANA STANLEY, individually and on
behalf of their minor children,

Plaintiffs,

v. Civil Action No. 1:22-cv-233-HSO-BWR

DANIEL P. EDNEY, in his official capacity


as the State Health Officer; LYNN FITCH, in
her official capacity as the Attorney General
of Mississippi; ASHLEY BLACKMAN, in her
official Capacity as Principal of East Central
Lower Elementary School; DR. ARCHIE R.
MITCHELL, in his official capacity as Principal
Of Senatobia Elementary School; ALLISON MERIT,
in her official capacity as Principal of North Bay
Elementary School; DR. ASHLEY ALLRED, in her
official capacity as Principal of Vancleave Upper
Elementary School; and DOUGLAS L. TYNES, in
his official capacity as the City Prosecutor for
Ocean Springs, Mississippi,

Defendants.

DEFENDANT DANIEL P. EDNEY’S NOTICE OF


COMPLIANCE WITH PRELIMINARY INJUNCTION ORDER

Defendant Dr. Daniel P. Edney, State Health Officer, submits this Notice of

Compliance with the Court’s preliminary injunction order, ECF No. 77, providing the

Court with the Mississippi Department of Health’s proposed religious exemption

process for Mississippi’s School Vaccination Law, Miss. Code § 41-23-37.

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INTRODUCTION

In April, this Court declared Mississippi’s School Vaccination Law, Miss. Code

§ 41-23-37, unconstitutional because it did not provide a religious exemption process.

The Court directed Dr. Edney, in his capacity as State Health Officer, and the

Mississippi State Department of Health (“MSDH”) to develop and publish a religious

exemption process by July 15, 2023. The Court held that, if no process was provided

by the July 15 deadline, it would enjoin the law in its entirety, so that no vaccination

could be required for any K-12 students. See ECF No. 77 at 1-2, 37-39.

In compliance with the Court’s order, Dr. Edney and MSDH have developed a

religious exemption process, which is attached as Exhibit A. MSDH will publish that

process (and related forms) on its website on July 15, 2023 and begin accepting

religious exemption requests after that date. This notice provides the Court and all

parties with MSDH’s administrative guidance, instructions, and forms for the

exemption process in advance of the publication date.

MSDH’s religious exemption process is modeled on Alabama’s process, adopts

the core components of many religious exemption laws around the country, and is

tailored to match Mississippi’s existing form-based application process for medical

exemptions. The process is meant to respect the beliefs of parents who object to

vaccinating their children on religious grounds, while also protecting the health of

Mississippi’s 440,000 K-12 students and preserving the gains Mississippi has made

in preventing cases of crippling and deadly diseases among school children.

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Case 1:22-cv-00233-HSO-BWR Document 82 Filed 07/07/23 Page 3 of 15

BACKGROUND

I. Procedural Background: The Court orders MSDH to develop a


religious exemption process for the School Vaccination Law.

Mississippi law requires that all children attending K-12 schools be vaccinated

against nine crippling and deadly diseases: chickenpox, measles, mumps, rubella,

diphtheria, pertussis, tetanus, polio, and Hepatitis B. See Miss. Code § 41-23-37 (the

“School Vaccination Law”); see also Miss. Dep’t of Health, Mississippi School

Immunization Requirements (June 3, 2020), available at https://msdh.ms.gov/page/

resources/2029.pdf. These diseases were once common in the United States, causing

thousands of hospitalizations and hundreds of deaths every year. See Centers for

Disease Control and Prevention, Vaccines and Preventable Diseases, available at

https://www.cdc.gov/vaccines/vpd/index.html.

Shortly after the School Vaccination Law was enacted in 1978, a parent

challenged the law as unconstitutional because it did not allow religious exemptions.

The Mississippi Supreme Court rejected the challenge and held unanimously that

“requiring immunization against certain crippling and deadly diseases particularly

dangerous to children before they may be admitted to school, serves an overriding

and compelling public interest . . . .” Brown v. Stone, 378 So. 2d 218, 222 (Miss. 1979).

Today, Mississippi’s school vaccination program is one of the most successful in the

country. 1 Over 99% of the K-12 student population has obtained the necessary

1Mississippi has the highest vaccine coverage of all states for the MMR, DTaP, polio, and
chickenpox vaccines. See Centers for Disease Control and Prevention, Morbidity and
Mortality Weekly Report, Vaccination Coverage with Selected Vaccines and Exemption Rates
Among Children in Kindergarten — United States, 2021–22 School Year (Jan. 13, 2023),
available at https://www.cdc.gov/mmwr/volumes/72/wr/pdfs/mm7202a2-H.pdf.

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Case 1:22-cv-00233-HSO-BWR Document 82 Filed 07/07/23 Page 4 of 15

vaccinations. See Miss. Dep’t of Health, School Immunization Compliance Report

2021-2022, available at https://msdh.ms.gov/page/resources/18773.pdf.

In this lawsuit, Plaintiffs—parents who have religious objections to

vaccinating their children—challenge the School Vaccination Law on the theory that,

without a religious exemption process, it violates their First Amendment right to the

free exercise of religion. Plaintiffs sought an injunction to prohibit state and local

officials from enforcing the law unless the State were to provide a religious exemption

process. ECF No. 77 at 2-5 (discussing case background). In response to this

challenge, Attorney General Lynn Fitch agreed that a religious exemption was

required. In General Fitch’s view, however, a religious exemption was already

mandated by state law—specifically, the Mississippi Religious Freedom Restoration

Act, Miss. Code § 11-61-1 (“MRFRA”), which prohibits state laws from burdening

religious practices. See ECF No. 42 at 4-8; ECF No. 70 at 5.

After conducting a hearing on Plaintiffs’ motion for a preliminary injunction

and noting that “the Attorney General admits in her briefs that not permitting an

option to request a religious exemption to the vaccination statute is not the least

restrictive means of further a compelling government interest,” ECF No. 77 at 15, the

Court issued a preliminary injunction against enforcement of the law, id. at 1-2, 37-

39. The Court did not adopt the Attorney General’s position that MRFRA provided a

religious exemption. Instead, the Court found that Plaintiffs were likely to succeed in

showing that the School Vaccination Law violates the First Amendment because it

does not provide a religious exemption process. ECF No. 77 at 15-23.

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Case 1:22-cv-00233-HSO-BWR Document 82 Filed 07/07/23 Page 5 of 15

The Court’s preliminary injunction order provided that state and local officials

“will be enjoined from enforcing Mississippi’s school compulsory vaccination law,

Mississippi Code § 41-23-37, unless they provide an option for requesting a religious

exemption from the law’s requirements.” ECF No. 77 at 2 (emphasis added). The

Court noted that MSDH has the duty under Mississippi law “[t]o formulate the policy

of the State Department of Health regarding public health matters within the

jurisdiction of the department” and “is responsible for assuring that all children in

the state are appropriately immunized against vaccine-preventable diseases.” ECF

No. 77 at 35. So the Court ordered Dr. Edney to “develop a process by which persons

may request a religious exemption from the [School Vaccination Law]” and to make

the process available on MSDH’s website by July 15, 2023. Id. at 1-2; 37-39.

II. MSDH has developed a religious exemption process, as required by


the Court’s injunction.

In compliance with the Court’s order, Dr. Edney and MSDH have developed a

form-based religious exemption process for the School Vaccination Law, which aligns

with the State’s medical exemption process. As detailed in the Immunization Manual,

application forms, exemption certificate, and instructional diagram (all attached as

Exhibit A), the religious exemption process has several key components:

• Form-Based Exemption Process: Parents or guardians may request an


exemption by completing a one-page form, which will be available on
MSDH’s website and is modeled on the existing medical-exemption form,
and submit the form to their local health department. Notarization of the
form is not required.

• Educational Component: Parents or guardians requesting an exemption


will be provided educational information on the benefits of childhood
vaccination and the risks of not being vaccinated.

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Case 1:22-cv-00233-HSO-BWR Document 82 Filed 07/07/23 Page 6 of 15

• Centralized Review and Certification: All exemption requests, both medical


and religious, are processed by MSDH’s Office of Immunizations and
approved by the State Epidemiologist, who issues a uniform certificate of
religious exemption that the parent or guardian may provide to their child’s
school for enrollment purposes.

See Exhibit A. These components are common features of religious exemption laws

around the country. See Centers for Disease Control and Prevention, Center for State,

Tribal, Local, and Territorial Support, State School Immunization Requirements and

Vaccine Exemption Laws (Feb. 2022), available at https://www.cdc.gov/phlp/docs/

school-vaccinations.pdf (providing overview of non-medical exemptions to school

vaccination requirements from jurisdictions in the United States).

As shown in MSDH’s informational diagram, the religious exemption process

will proceed as follows:

Religious Exemption Process

Request Religious Health Office of State Process


Exemption Department Immunizations Epidemiologist Completion
Appointment
 Parent/guardian accesses
Religious Exemption  Brings or completes  Rev iews request f or  Rev iews and accepts
Religious Exemption  Exemption is
Request completeness completed religious
Form at Health recorded in MIIX
Form exemption request
www.msdh.ms.gov Department with signature of
 Prepares Certif icate of
 Parent v iews v accine Medical/Religious Medical/Religious  Certif icate of
 Completes Form education v ideo Medical/Religious
Exemption Certif icate Exemption
and packet. Exemption to school
 Nurse counsels
 Schedules Appointment and parent/guardian
parent/guardian on
at Local Health benef its and risk of  Presents religious
Department immunizations exemption to State
 Nurse signs Request Epidemiologist f or
and sends to Of f ice of acceptance
Immunizations

6
Case 1:22-cv-00233-HSO-BWR Document 82 Filed 07/07/23 Page 7 of 15

ARGUMENT

Dr. Edney and MSDH have developed a religious exemption process that

respects the beliefs of parents who have religious objections to vaccinating their

children, as required by the Court’s order, and also promotes Mississippi’s compelling

state interest in protecting its K-12 student population through vaccination against

crippling and deadly diseases. With this religious exemption process in place, Dr.

Edney believes Mississippi’s School Vaccination Law satisfies the strict scrutiny

standard applied in this Court’s preliminary injunction order.

To be clear, Dr. Edney does not endorse Plaintiffs’ views on vaccination or their

arguments that the School Vaccination Law is unconstitutional. Nor does Dr. Edney

agree with the Attorney General’s position that MRFRA provides a religious

exemption to the School Vaccination Law, though he respects her authority to opine

on questions of Mississippi law. 2 In Dr. Edney’s view, the School Vaccination Law is

constitutional as enacted by the Mississippi Legislature without a religious

exemption. As the Mississippi Supreme Court has held, the law serves the “overriding

and compelling public interest” of protecting school children against “crippling and

deadly diseases by immunization, and to the extent that [compelling public interest]

may conflict with the religious beliefs of a parent, however sincerely entertained, the

interests of the school children must prevail.” Brown, 378 So. 2d at 223.

2 See Miss. Code § 7-5-25 (authorizing Attorney General to issue written legal opinions);
Kennington-Saenger Theatres v. State ex rel. Dist. Atty., 18 So. 2d 483, 487 (Miss. 1944)
(“[T]he Attorney General, who is the responsible head of the legal department of the state,
shall have initial jurisdiction over those important legal questions which affect the general
interests or policy of the state.”).

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Case 1:22-cv-00233-HSO-BWR Document 82 Filed 07/07/23 Page 8 of 15

Dr. Edney respects this Court’s order, of course, and MSDH has worked

diligently to comply with it. By complying with the Court’s order, however, Dr. Edney

does not waive his, MSDH’s, or any other party’s right to request further relief from

this Court, including vacatur or modification of the preliminary injunction order,

should a change in law or factual circumstances support such relief. 3

I. The State of Mississippi has a compelling public interest in protecting


school children from crippling and deadly diseases.

The State of Mississippi, like all other states, has a compelling interest in

requiring that K-12 students be vaccinated against crippling and deadly childhood

diseases. The Mississippi Supreme Court recognized this “overriding and compelling

public interest” in Brown v. Stone:

[W]e have concluded that requiring immunization against certain


crippling and deadly diseases particularly dangerous to children before
they may be admitted to school, serves an overriding and compelling
public interest and that such interest extends to the exclusion of a child
until such immunization has been effected, not only as a protection of
that child but as a protection of the large number of other children
comprising the school community and with whom he will be daily in
close contact in the school room.

3 Just yesterday, the Fifth Circuit dismissed as moot plaintiffs’ First Amendment free-
exercise challenge to the Navy’s now-rescinded Covid-19 vaccine mandate. See U.S. Navy
Seals 1-26 v. Biden, 2023 WL 4362355 (5th Cir. July 6, 2023). Although the Court declined
to vacate its prior opinion denying a stay pending appeal, U.S Navy Seals 1-26 v. Biden, 27
F.4th 336 (5th Cir. 2022), that decision was not unanimous, see 2023 WL 4362355 at *7
(Graves, J., dissenting in part). That litigation will return to the district court, and
subsequent developments in the district court or on another appeal could impact the Court’s
analysis of the School Vaccination Law’s constitutionality. Two other circuits have recently
held that Covid-19 vaccine mandates—which allowed medical exemptions but not religious
ones—were generally applicable, subject to rational basis review, and did not violate the Free
Exercise Clause of the First Amendment. See We The Patriots USA, Inc. v. Hochul, 17 F.4th
266 (2d Cir.), opinion clarified, 17 F.4th 368 (2d Cir. 2021), and cert. denied sub nom. 142 S.
Ct. 2569 (2022); Does 1-6 v. Mills, 16 F.4th 20 (1st Cir. 2021), cert. denied sub nom., 142 S.
Ct. 1112 (2022).

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Case 1:22-cv-00233-HSO-BWR Document 82 Filed 07/07/23 Page 9 of 15

378 So. 2d at 222-23. The School Vaccination Law furthers that compelling interest

by protecting “the great body of school children attending the public schools in

Mississippi against the horrors of crippling and death resulting from poliomyelitis or

smallpox or from one of the other diseases against which means of immunization are

known and have long been practiced successfully . . . .” Id. at 223.

Other courts have recognized this compelling interest. “[A] state’s wish to

prevent the spread of communicable diseases clearly constitutes a compelling

interest.” Workman v. Mingo Cnty. Bd. of Educ., 419 F. App’x 348 (4th Cir. 2011)

(citing authorities). As one federal district court noted:

There is no question that society has a compelling interest in fighting


the spread of contagious diseases through mandatory vaccination of
school-aged children. All courts, state and federal, have so held either
explicitly or implicitly for over a century.

Whitlow v. California, 203 F. Supp. 3d 1079, 1089–90 (S.D. Cal. 2016); see also Does

1-6 v. Mills, 16 F.4th 20, 32 (1st Cir. 2021) (“Few interests are more compelling than

protecting public health against a deadly virus.”); Murray v. Cuomo, 460 F. Supp. 3d

430, 446 (S.D.N.Y. 2020) (“Controlling the spread of the disease in order to . . .

minimize deaths, and prevent a larger public health catastrophe . . . is a powerful

compelling government interest.”). 4

Accordingly, all 50 states have enacted mandatory childhood vaccination laws.

See Centers for Disease Control and Prevention, Center for State, Tribal, Local, and

4 In its preliminary injunction order, this Court did not disagree that Mississippi has a
compelling interest in requiring vaccinations to protect school children. Instead, applying
strict scrutiny, the Court considered only whether the School Vaccination Law—without a
religious exemption—was “narrowly tailored” or “the least restrictive means” of furthering
that compelling interest. ECF No. 77 at 23.

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Case 1:22-cv-00233-HSO-BWR Document 82 Filed 07/07/23 Page 10 of 15

Territorial Support, State School Immunization Requirements and Vaccine

Exemption Laws (Feb. 2022), available at https://www.cdc.gov/phlp/docs/school-

vaccinations.pdf. These school-based vaccination laws are critical to disease control

efforts in the United States, and they “have made a major contribution to the

elimination of many vaccine-preventable disease and significantly reduced the

incidence of others.” Sandra W. Roush & Trudy V. Murphy, Historical Comparisons

of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States, 298

J. Am. Med. Ass’n 2155, 2155 (2007).

Since it was enacted by the Mississippi Legislature in 1978 and affirmed by

the Mississippi Supreme Court in 1979, Mississippi’s school vaccination program has

become one of the most successful in the nation. For the last twenty years, Mississippi

“has been a national leader in immunization coverage, with over 99% of children who

enter kindergarten being protected.” See Miss. Dep’t of Health, Immunizations, What

Parents Should Know about Childhood Immunizations, available at

https://msdh.ms.gov/page/41,15556,71.html. Due to these efforts and results,

“Mississippi children now have an excellent chance of growing up without the damage

that childhood diseases can cause, and are less likely to die from them than ever

before.” Id. According to the latest data published by the CDC, Mississippi had the

highest vaccine coverage of all states for the MMR, DTaP, polio, and chickenpox

vaccines in the 2021-2022 school year. See Centers for Disease Control and

Prevention, Morbidity and Mortality Weekly Report, Vaccination Coverage with

Selected Vaccines and Exemption Rates Among Children in Kindergarten — United

10
Case 1:22-cv-00233-HSO-BWR Document 82 Filed 07/07/23 Page 11 of 15

States, 2021–22 School Year (Jan. 13, 2023), available at https://www.cdc.gov/mmwr/

volumes/72/wr/pdfs/mm7202a2-H.pdf.

Despite the success of childhood vaccination programs, concerns over

outbreaks and risks to school children remain, particularly in states or localities

where vaccine coverage dips below target levels. In recent years, health authorities

have confirmed cases of measles and chickenpox—both of which are deadly for

children—and warned the public about the risk of outbreaks. 5 Maintaining high

vaccine coverage levels is important so that the population at large can maintain herd

immunity, which can prevent outbreaks of dangerous diseases. See Dina Nathanson,

Herd Protection v. Vaccine Abstention: Potential Conflict Between School Vaccine

Requirements and State Religious Freedom Restoration Acts, 42 Am. J. L. & Med. 621,

624 (2016). “When too many individuals are unvaccinated in a given population, . . .

the chance of encountering the targeted pathogen increases and one can no longer

rely on herd immunity for protection.” Id. (citation omitted).

5 See, e.g., https://www.cdc.gov/media/releases/2022/p1123-measles-threat.html (detailing


increased risk of measles outbreak due to declining measles vaccination coverage since the
beginning of the COVID-19 pandemic); https://emergency.cdc.gov/han/2023/han00488.asp
(warning relating to confirmed case of measles in an unvaccinated individual who attended
a large religious gathering in Kentucky); https://governor.hawaii.gov/newsroom/doh-news-
release-department-of-health-announces-second-oahu-measles-case/ (April 2023 press
release advising of confirmed case of measles and detailing the highly contagious nature of
the disease, which can spread easily to unprotected persons); https://www.kdhe.ks.gov/
DocumentCenter/View/27476/03-15-23-PDF (vaccine-preventable chicken pox outbreak
consisting of 20 confirmed cases between November 2022 and February 2023);
https://www.health.state.mn.us/news/pressrel/2022/measles092922.html (Minnesota press
release describing recent measles outbreak among several families with unvaccinated
children); https://www.cdc.gov/mmwr/volumes/68/wr/mm6819a4.htm (CDC report detailing
measles outbreaks in New York and New Jersey orthodox Jewish communities with low
vaccination rates).

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Case 1:22-cv-00233-HSO-BWR Document 82 Filed 07/07/23 Page 12 of 15

When the Mississippi Supreme Court decided Brown in 1979, the “horrors of

crippling and death resulting from poliomyelitis or smallpox or from one of the other

diseases against which means of immunization are known and have long been

practiced successfully,” 378 So. 2d at 222, were quite real and still recent. While those

horrors may seem like a distant memory today, that is only because Mississippi’s

childhood vaccination program has been so successful in preventing infections and

outbreaks. Maintaining high vaccination rates in Mississippi is essential to

preventing the return of those deadly diseases, which continue to infect and kill

thousands of people around the world.

II. With MSDH’s religious exemption process, the School Vaccination


Law will be narrowly tailored to comply with the First Amendment.

In Dr. Edney’s view, once Mississippi’s religious exemption process is

implemented, the School Vaccination Law will satisfy strict scrutiny review under

the First Amendment. With the religious exemption, the law will no longer burden

any parent’s religious practices or beliefs, and it will be narrowly tailored to achieve

Mississippi’s compelling interest of protecting its K-12 population from crippling and

deadly diseases. 6 This is so for several reasons.

First, MSDH has designed the religious exemption process to match, as closely

as possible, the existing medical exemption process. All exemption requests, both

6 For the avoidance of doubt, Dr. Edney reiterates that he does not agree that the School
Vaccination Law is subject to strict scrutiny under the First Amendment or, even if it is, that
it could not satisfy strict scrutiny even without a religious exemption. See We The Patriots
USA, Inc., 17 F.4th at 280-290; Does 1-6, 16 F.4th at 29-35. Dr. Edney reserves, and does not
waive, his or MSDH’s right to request relief from or modification of the preliminary injunction
order if warranted by changes in law or circumstances.

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Case 1:22-cv-00233-HSO-BWR Document 82 Filed 07/07/23 Page 13 of 15

medical and religious, will be made to, reviewed, and granted by the State

Epidemiologist. Parents may request a religious or medical exemption by submitting

a one-page form, after consultation with a physician or nurse about the benefits and

risks of immunization and being advised by that healthcare professional that their

child may be excluded from school if a vaccine-preventable disease (for which the child

is not vaccinated) is occurring or threatened in the community. If the medical or

religious exemption is granted, MSDH will issue the parent a Certificate of

Medical/Religious Exemption Form (Form 122) that can be used to enroll their child

in school without the vaccinations that would otherwise be required.

Second, the religious exemption request does not require notarization,

verification, or any other form of “under oath” statements by a parent about his or

her religious beliefs or those of the child.

Third, the religious exemption does not permit state or local officials to inquire

into the sincerity of a parent’s religious beliefs. Instead, as set forth in Section 7.4 of

the Immunization Manual, the religious exemption will be granted so long as the

application process is properly completed:

Any requested religious exemption will be accepted by MSDH, and a


Certificate of Medical/Religious Exemption issued if following guidelines
are met . . . .”

Exhibit A (Immunization Manual, Section 7.4 – Requesting a Religious Exemption).

Fourth, Mississippi’s religious exemption process is modeled on neighboring

Alabama’s process, which Plaintiffs are familiar with and have identified as an

acceptable exemption process. See ECF No. 5 at 26-27 (Plaintiffs’ summary judgment

13
Case 1:22-cv-00233-HSO-BWR Document 82 Filed 07/07/23 Page 14 of 15

brief describing Alabama as having “a religious exemption to vaccination that is easy

to obtain”). Under Alabama’s established process, a parent seeking a religious

exemption for her child must submit a written objection to a county health

department, receive education on the risks of not being immunized, and obtain a

Certificate of Religious Exemption on a form approved by the Alabama Department

of Public Health. See Ala. Code § 16-30-3(1); Ala. Admin. Code § 420-6-1-.02(4); Ala.

Dep’t of Public Health, Bureau of Communicable Disease, Immunization Division

Home Page, available at https://www.alabamapublichealth.gov/immunization/.

CONCLUSION

Dr. Edney and MSDH will publish the religious exemption process on MSDH’s

website on July 15, 2023, consistent with this Court’s preliminary injunction, and will

be prepared to accept and process exemption requests immediately after that date.

s/ Michael J. Bentley
Michael J. Bentley [MBN 102631]
Erin Saltaformaggio [MBN 103999]
mbentley@bradley.com
esaltaformaggio@bradley.com
BRADLEY ARANT BOULT
CUMMINGS, LLP
Suite 1000, One Jackson Place
188 East Capitol Street
Post Office Box 1789
Jackson, MS 39215-1789
Telephone: (601) 948-8000
Facsimile: (601) 948-3000

Attorneys for Dr. Daniel P. Edney,


State Health Officer

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CERTIFICATE OF SERVICE

I hereby certify that on July 7, 2023, I filed the foregoing using the Court’s ECF

filing system which sends notice to all counsel of record.

s/Michael J. Bentley
Attorney for Dr. Daniel P. Edney,
State Health Officer

15
Case 1:22-cv-00233-HSO-BWR Document 82-1 Filed 07/07/23 Page 1 of 10

Religious Exemption Process


EXHIBIT
A

Request Religious Health Office of State Process


Exemption Department Immunizations Epidemiologist Completion
Appointment
 Parent/guardian accesses
Religious Exemption  Brings or completes  Reviews request for  Reviews and accepts
Religious Exemption  Exemption is
Request completeness completed religious
Form at Health recorded in MIIX
Form exemption request
www.msdh.ms.gov Department with signature of
 Prepares Certificate of
 Parent views vaccine Medical/Religious Medical/Religious  Certificate of
 Completes Form education video Medical/Religious
Exemption Certificate Exemption
and packet. Exemption to school
 Nurse counsels
 Schedules Appointment and parent/guardian
parent/guardian on
at Local Health benefits and risk of  Presents religious
Department immunizations exemption to State
 Nurse signs Request Epidemiologist for
and sends to Office of acceptance
Immunizations
Case 1:22-cv-00233-HSO-BWR Document 82-1 Filed 07/07/23 Page 2 of 10

Mississippi State Department of Health TOPIC: Laws Regulations


IMMUNIZATION MANUAL M-201 Requirements

Issue Date May 2, 1997 Process Owner: Immunizations


Revision
Revision Date: June 19, 2023 Section 7.0
Number: 7

Last Review Date: June 19, 2023 Page 1 of 11

7.1 MS School Immunization Laws


MS School Entry Requirements
In order to enroll in any public or private kindergarten, elementary, or secondary school in
Mississippi, a student must provide the school with a:

Certificate of Immunization Compliance (Form 121) – MUST be signed by the Regional


Health Officer, a physician, nurse or MIIX validated.
or a
Certificate of Medical/Religious Exemption (Form 122) - is not computer generated.
This form MUST be signed by the State Epidemiologist or Deputy State Epidemiologist
(refer to the Medical and/or Religious Exemption sections for specific information.)

The list of required immunizations is specified by the State Health Officer and is promulgated at
least annually as directed by state statute. All vaccines are to be given at the appropriate age and
intervals according to ACIP recommendations.

The MS Immunization Requirement and Schedules can be found on the MSDH website: at
https://msdh.ms.gov/msdhsite/_static/resources/2029.pdf

7.2 Immunization Requirements for Out-of-State Students


All out-of-state students and foreign students attending childcare or K-12 school (public or
private) in Mississippi must adhere to the following immunization requirements.

• Students are required to be age appropriately immunized with all required vaccines per
Mississippi School Immunization Law and Child Care requirements. All appropriate
immunizations must be documented on the Form 121 or Medical or Religious Exemptions as
documented on Form 122 and be presented upon admission.

For example: a child entering the 8th grade will be required to meet all kindergarten and
7th grade entry requirements.
The standard immunization schedule is available at all health department clinics and the catch- up
schedule for those children who are not current is available in the Epidemiology and Prevention of
Vaccine-Preventable Diseases - (“Pink Book”).
Case 1:22-cv-00233-HSO-BWR Document 82-1 Filed 07/07/23 Page 3 of 10

Mississippi State Department of Health TOPIC: Laws Regulations


IMMUNIZATION MANUAL M-201 Requirements

Issue Date May 2, 1997 Process Owner: Immunizations


Revision
Revision Date: June 19, 2023 Section 7.0
Number: 7

Last Review Date: June 19, 2023 Page 2 of 11

7.3 Medical Exemptions

General Instructions

To request a medical exemption from one or more required vaccinations, the MSDH Medical
Exemption Request (Form 139-M) must be completed and signed by the child’s physician
(pediatrician, family practitioner, or internist) who is duly licensed in Mississippi. Children
receiving specialized or tertiary care outside of the state may have medical exemption requests
completed and signed by their out of state tertiary or specialty care physician, as indicated

All medical exemption requests submitted by a child’s Mississippi licensed primary care physician
(pediatrician, family practitioner, in state tertiary care specialist or internist) that are fully
complete, including indication of the medical reason and designation of the exempted vaccines,
and signed by the child’s physician will be accepted by MSDH. Medical exemption requests
completed and signed by an out of state tertiary care physician will be reviewed individually.

All medical exemption requests are submitted to the MSDH Office of Immunizations by the provider,
reviewed for completeness, and signed by the State Epidemiologist or Deputy State Epidemiologist.

Once the medical exemption request is signed by the State Epidemiologist or Deputy State
Epidemiologist, a Certificate of Medical/Religious Exemption (Form 122) will be issued. Only the
Certificate of Medical/Religious Exemption (Form 122) signed and dated by the State
Epidemiologist or Deputy State Epidemiologist provides official, documented proof that a child has
been issued a medical exemption by MSDH. The original Certificate of Medical/Religious
Exemption (Form 122) will be housed at MSDH with a copy mailed to the parent and the
requesting physician.

Follow up and requests for additional information will be conducted by the State Epidemiologist or
Deputy State Epidemiologist for out-of-state medical exemption requests if needed. The parent and the
requesting physician will be contacted in the event that the out-of-state medical exemption request is
not accepted.
Case 1:22-cv-00233-HSO-BWR Document 82-1 Filed 07/07/23 Page 4 of 10

Mississippi State Department of Health TOPIC: Laws Regulations


IMMUNIZATION MANUAL M-201 Requirements

Issue Date May 2, 1997 Process Owner: Immunizations


Revision
Revision Date: June 19, 2023 Section 7.0
Number 2

Last Review Date: June 19, 2023 Page 3 of 11

Requesting a Medical Exemption

Any requested medical exemption will be accepted if it meets the following criteria.

The MSDH Medical Exemption Request (Form 139-M) must be completed and signed by the
child’s physician (pediatrician, family practitioner, in state tertiary care specialist or internist) who
is duly licensed in Mississippi.
Medical exemption requests completed and signed by an out of state tertiary care physician will be
reviewed individually.

The same requesting physician (pediatrician, family practitioner, internist, or tertiary care
physician) must indicate on Form 139-M the medical condition of the child seeking exemption and
indicate the exemption status for each of the listed vaccines.

Form 139-M must be submitted to the Mississippi State Department of Health, Office of
Immunizations.

The State Epidemiologist or Deputy State Epidemiologist will review, accept, and sign the
completed medical exemption request and MSDH mail a copy of the Certificate of
Medical/Religious Exemption (Form 122) to the parent and the pediatrician, family practitioner,
internist, or tertiary care physician who submitted the Medical Exemption Request. The original
Certificate of Medical/ Religious Exemption (Form 122) will be housed at MSDH.

Data regarding medical exemptions will be maintained on the MSDH website at


Vaccine Exemptions - Mississippi State Department of Health (ms.gov)
The exemption expiration date will be based on the circumstances for the exemption and will be no
less than one school year unless otherwise indicated on the request.
Case 1:22-cv-00233-HSO-BWR Document 82-1 Filed 07/07/23 Page 5 of 10

Mississippi State Department of Health TOPIC: Laws Regulations


IMMUNIZATION MANUAL M-201 Requirements

Issue Date May 2, 1997 Process Owner: Immunizations


Revision
Revision Date: June 19, 2023 Section 7.0
Number: 7
Last Review Date: June 19, 2023 Page 4 of 11

This policy will not amend the school law Section 41-23-37, Mississippi Code of 1972. Children
with a Certificate of Medical/Religious Exemption who are not adequately immunized will be
excluded from school if there is a threat of vaccine preventable diseases occurring in the community.
The child will be excluded until the infectious disease is no longer present or is no longer a threat to
the safety and welfare of the child or other children in the school.

Questions regarding the medical exemption process or the medical exemption request form should
be directed to the Office of Immunizations (601) 576-7751.

The medical exemption request form should be sent to the Mississippi State Department of Health
to the attention of the Office of Immunizations.

Mississippi State Department of Health


Office of Immunizations
570 E. Woodrow Wilson, O-420
Post Office Box 1700
Jackson, MS 39215-1700
Telephone: (601) 576-7725
Fax: (601) 576-7497

The State Epidemiologist or Deputy State Epidemiologist can also be reached at


(601) 576-7725.
Case 1:22-cv-00233-HSO-BWR Document 82-1 Filed 07/07/23 Page 6 of 10

Mississippi State Department of Health TOPIC: Laws Regulations


IMMUNIZATION MANUAL M-201 Requirements

Issue Date May 2, 1997 Process Owner: Immunizations


Revision
Revision Date: June 19, 2023 Section 7.0
Number: 7
Last Review Date: June 19, 2023 Page 5 of 11

7.4 Religious Exemptions

General Instructions

To request a religious exemption from one or more required vaccinations for Mississippi school entry,
the parent or guardian must complete the MSDH Religious Exemption Request (Form 139-R) and
submit to the County Health Department (appointment is required).

A review of all religious exemption requests for completeness will be conducted at the Mississippi State
Department of Health. Complete Religious exemption requests submitted per MSDH policy will be
accepted and signed by the State Epidemiologist or Deputy State Epidemiologist. Once the request is
reviewed and accepted, a Certificate of Medical/Religious Exemption (Form 122) will be issued. Only
the Certificate of Medical/Religious Exemption (Form 122) signed and dated by the State
Epidemiologist or Deputy State Epidemiologist provides official, documented proof that a child has
been issued a medical/religious exemption by MSDH. The original Certificate of Medical/Religious
Exemption (Form 122) will be housed at MSDH with a copy mailed to the parent and the daycare or
school indicated on the Religious Exemption Request Form.

Requesting a Religious Exemption

Any requested religious exemption will be accepted by MSDH, and a Certificate of Medical/Religious
Exemption issued if following guidelines are met.

▪ The MSDH Religious Exemption Request (Form 139-R) must be completed signed and submitted to the
County Health Department (appointment is required) by the child’s parent or guardian.

▪ The parent/guardian will review the Vaccine Education video and will be given the opportunity to ask
questions.

▪ The Public Health Nurse will discuss the benefits and risks of immunizations with the parent/guardian.

▪ The Public Health Nurse will inform the parent/guardian that if any vaccine-preventable diseases for
which the child has not been adequately immunized are occurring in or threatening to occur in the
Case 1:22-cv-00233-HSO-BWR Document 82-1 Filed 07/07/23 Page 7 of 10

community, the child will, for the safety and benefit of him/herself and other children, be excluded from
day care/school until the infectious disease is no longer present or is no longer a threat to the safety and
welfare of the child or other children in the day care/school.

▪ The form 139-R must be submitted by the County Health Department to the Mississippi State
Department of Health, Office of Immunizations through intraoffice mail.

▪ The State Epidemiologist or Deputy State Epidemiologist will accept and sign any Religious Exemption
request that includes all the required components. MSDH will mail a copy of the signed Certificate of
Medical/Religious Exemption (Form 122) to the parent and the daycare or school indicated on the
Religious Exemption Request. The original Certificate of Medical/Religious Exemption (Form 122) will
be housed at MSDH.

Data regarding medical/religious exemptions will be posted annually and will be maintained on the
MSDH website at Vaccine Exemptions - Mississippi State Department of Health (ms.gov) .

This policy will not amend the school law Section 41-23-37, Mississippi Code of 1972. Children with a
Certificate of Medical/Religious Exemption who are not adequately immunized will be excluded from
school if there is a threat of vaccine preventable diseases occurring in the community. The child will be
excluded until the infectious disease is no longer present or is no longer a threat to the safety and
welfare of the child or other children in the school.

Questions regarding the religious exemption process or the religious exemption request form should be
directed to the Office of Immunizations at (601) 576-7751.
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Medical Exemption Request


INSTRUCTIONS
• The child’s pediatrician, family physician, or internist licensed in Mississippi must complete and submit this form to the State
Epidemiologist or Deputy State Epidemiologist. Forms completed by a child’s out-of-state tertiary care physician will be
reviewed on a case-by-case basis. See Vaccine Exemptions - Mississippi State Department of Health (ms.gov) for additional
details.
• Once the Medical Exemption is accepted and signed by the State Epidemiologist or Deputy State Epidemiologist, a copy is sent
by mail to the physician and the parent at the addresses indicated below.

Date of Request: _______________ Name of School/Child Care Facility: ___________________ City/County: ______________

Name of Child: Date of Birth: ________________________


Last First MI

Name of Parent: _______________________________________________________ Phone Number: ______________________


Last First MI

Address:
Street City State Zip

Indicate the exemption status for each vaccine in the table below (an exemption status is required for each vaccine):
Indicate the exemption status for each vaccine by checking the correct box in the table
below (an exemption status is required for each vaccine):
Vaccine Permanent Temporary No Vaccine Permanent Temporary No
(Include Exemption (Include Exemption
Date) Date)
DTaP MMR
Hepatitis B Pneumococcal
Hib* Tdap**
IPV Varicella
*For childcare only **For 7th grade entry
Indicate reason for medical exemption (use additional sheets if needed)

Print name of child’s pediatrician, family physician, or internist licensed in Mississippi (or out-of-state tertiary care physician)

Address
Street City State Zip

Telephone Number Fax Number

I declare that:
• In my medical opinion, the named individual has a medical reason for exemption from the above vaccines and that the physical condition of
this child to be such that the vaccination(s) specified on this form would endanger their life or health and outweighs the risk of death or
disability from the vaccine preventable disease.
• I have discussed the benefits and risks of immunizations with the parent/guardian as a condition for exemption.
• I have informed the parent/guardian that if any vaccine-preventable diseases for which the child has not been adequately immunized are
occurring in or threatening to occur in the community, the child will, for the safety and benefit of him/herself and other children, be excluded
from day care/school until the infectious disease is no longer present or is no longer a threat to the safety and welfare of the child or other
children in the day care/school.
Signature of child’s pediatrician/family physician/internist licensed in Mississippi:
(Or out-of-state tertiary care physician)

Mississippi Medical License Number NPI#:


(Or out-of-state tertiary care physician)
This document should be submitted to the State Epidemiologist or Deputy State Epidemiologist at MSDH in Jackson, Mississippi.
Mail to: MSDH Epidemiology Office, Post Office Box 1700, Jackson, Mississippi, 39215, or fax to (601) 576-7686

Mississippi State Department of Health Form 139-M


Revised: 05/15/2023
Case 1:22-cv-00233-HSO-BWR Document 82-1 Filed 07/07/23 Page 9 of 10

Religious Exemption Request

INSTRUCTIONS
• The child’s parent or guardian must complete and sign the Religious Exemption Request Form indicating the vaccines for which the child
will be exempted.
• Submit the completed form to the County Health Department (appointment is required). For information regarding County Health
Department hours of operation go to www.msdh.ms.gov and to schedule an appointment call 855-767-0170.
• Additional steps will be completed at the County Health Department. For more about the process visit www.msdh.ms.gov .
• The completed Religious Exemption Request is submitted to the State Epidemiologist or Deputy State Epidemiologist for signature, and a
copy is sent by mail to the school and the parent/guardian at the addresses indicated below.

Date of Request __________ Name of School/Child Care Facility: ____________________ City and County: ______________

Name of Child Date of Birth: _________________________


Last First MI

Name of Parent/Guardian: _______________________________________________Phone Number: _______________________


Last First MI

Address: _________________________________________________________________________________________________
Street City State Zip

Indicate the exemption status for each vaccine by checking the correct box in the table
below (an exemption status is required for each vaccine):
Vaccine Permanent No Exemption Vaccine Permanent No Exemption
DTaP MMR
Hepatitis B Pneumococcal
Hib* Tdap**
IPV Varicella
*For childcare only. **For 7th grade entry only.

I, ____________________, am requesting a religious exemption from the above vaccines for my child, _________________________.

• I understand that not vaccinating my child with the vaccination(s) specified above can endanger their life or health, and the life or
health of other children; and that the religious reasons for not vaccinating my child outweigh the risk of death or disability to my
child or other children from the vaccine preventable disease.
• I understand that if any vaccine-preventable diseases for which my child has not been adequately immunized are occurring in or
threatening to occur in the community, my child will, for the safety and benefit of him/herself and other children, be excluded from
day care/school until the infectious disease is no longer present or is no longer a threat to the safety and welfare of my child or other
children in the day care/school.

Parent/Guardian signature: _______________________________________________Date________________________

Location of County Health Department: ________________________________________________________________

Verification of Process:
• Religious Exemption Request completed and signed by parent/guardian.
• Parent/guardian has viewed Vaccine Education video and has been given the chance to ask questions.
• I have discussed the benefits and risks of immunizations with the parent/guardian as a condition for exemption.
• I have informed the parent/guardian that if any vaccine-preventable diseases for which the child has not been adequately immunized are
occurring in or threatening to occur in the community, the child will, for the safety and benefit of him/herself and other children, be excluded
from day care/school until the infectious disease is no longer present or is no longer a threat to the safety and welfare of the child or other
children in the day care/school.
Signature of Health Department Nurse____________________________________ Date:
Printed Name of Health Department Nurse________________________________
County of Health Department: __________________________________________ Phone: _________________
This document should be submitted through intraoffice mail to: Office of Immunizations MSDH Central Office in Jackson, Mississippi

Mississippi State Department of Health Form 139- R


05/15/2023
Case 1:22-cv-00233-HSO-BWR Document 82-1 Filed 07/07/23 Page 10 of 10

Certificate of Medical/Religious Exemption

Name of Student: _____________________________ Birthdate: _______________

Name of Parent: _______________________________________________________________________________

Address: _________________________________ _____________ ___________ _______________


Street City State Zip

Medical Exemption – A medical exemption from the required vaccinations for the above-named individual is
hereby issued on the basis of a specific medical condition initiated by the child’s pediatrician, family physician, or
internist.

Religious Exemption - A religious exemption from the required vaccinations for the above-named individual is
hereby issued on the basis of religious reasons requested by the guardian/parent.

Vaccines Exempted
DTaP DT-Ped Tdap Td-Adult IPV Measles
Permanently
Temporarily Until: Date

Mumps Rubella Hep B VAR Hib Pneumococcal


Permanently
Temporarily Until: Date

Physician/Health Provider/HD: _____________________________________________________________________

Address:
______________________________________________________________________________________________
Street City State Zip

Telephone Number: ________________________

Accepted by State Epidemiologist or Deputy State Epidemiologist:

Signature Date

School Officials: Do Not File this form in cumulative folder. The form must be maintained in a separate file and
reviewed periodically to ensure validity
This form may be used for Day Care or K -12 Exemptions.

Mississippi State Department of Health Form 122


Revised 05/15/2023

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