Tangled in History: Race, Religion, and Vaccines
The development of vaccines has all but eradicated infectious diseases such as polio, measles, and tetanus, and by 1979 completely eradicated smallpox, which killed 300-500 million people in the 20th century alone. Herd immunity generated by vaccines is second only to clean water as the most effective way to prevent the spread of infectious disease, leading to mandatory vaccination laws in every state, especially in healthcare facilities where risk of transmission is high. However, a small subset of the population argue against mandatory vaccinations for reasons that range from ideological to safety concerns. Title VII requires employers to reasonably accommodate religious practices or beliefs unless doing so would constitute an undue burden.
In a recent resolution to a 2011 case, a federal court in Massachusetts concluded that Children’s Hospital Boston adequately accommodated an employee with religious objections to an influenza vaccination requirement by offering a vegan vaccine, encouraging her to seek a medical exemption, granting her a temporary exemption, aiding in a search for an alternative employment position, offering an additional two weeks for the search, and ultimately terminating her in a way that would allow her to re-apply in the future.
Leontine Robinson was an administrative employee at the hospital who “was typically one of the first Hospital employees to interact with patients and their family members when they arrived in the emergency department” and who thus had to be in “close physical proximity” to patients. In July 2011, the hospital established a policy requiring all hospital staff who had access to patient-care areas to be vaccinated against the influenza virus. Exemptions were only allowed for individuals for whom vaccines presented a medical risk. Robinson sought an exemption from the requirement due to being a proponent of The Nation of Islam, a religion opposed to vaccinations over both philosophical and safety concerns. Ideologically, members of the Nation of Islam do not consume pork or pork products. Since the standard influenza vaccine uses pork-based gelatin as a stabilizer, the hospital offered Robinson along with other employees who do not consume pork on religious grounds a gelatin-free vaccine. The hospital also informed Robinson that if she found another position at the hospital where she would not have to interact with patients then she would not need to be vaccinated.
Robinson declined the gelatin-free vaccine, stating that she believed many vaccines were contaminated, and that she did not feel comfortable receiving it. In December of 2011 on the day of the deadline to receive the vaccine, Robinson informed the hospital that she had had an allergic reaction to a flu vaccine in 2007. She was granted a temporary medical exemption pending review of her medical records. The review concluded that Robinson’s medical history did not qualify her for an exemption. Robinson used her earned time off to look for another position in the hospital that did not require her to come into contact with patients, and the hospital assisted her search. She interviewed for a medical records position but was not offered the job. After granting her another two weeks of leave, the hospital terminated Robinson as a voluntary resignation, leaving her eligible to re-apply for other Hospital positions in the future. Robinson filed a lawsuit in February 2014 accusing the hospital of religious discrimination.
The court concluded that the hospital had reasonably attempted to accommodate Robinson by offering her a gelatin-free vaccine, aiding in her search to find an alternate position, and offering her an extra two weeks to look for another position. The court noted that
Had the Hospital permitted [Robinson] to forgo the vaccine but keep her patient-care job, the Hospital could have put the health of vulnerable patients at risk. To allow Robinson to avoid relatively more vulnerable patients and not others would have been unworkable as well. It would have forced the Hospital to arrange its work flow around uncertain factors. On this record, accommodating Robinson’s desire to be vaccine-free in her role would have been an undue hardship because it would have imposed more than a de minimis cost.
An interesting aspect of this case is that while the hospital has procedures in place to attempt to alleviate dietary concerns over vaccines, safety concerns are much more difficult to accommodate due to the historical and psychological context of such fear. The Nation of Islam’s Western Regional Minister Tony Muhammad has expressed concern that vaccines disproportionately negatively affect young black males, citing a widely rejected study by one researcher who indicated that there might be a higher incidence of autism in African-American boys who receive the MMR vaccination against measles, mumps and rubella. Muhammad goes on to compare vaccination requirements to the Tuskegee syphilis study where federal researchers withheld treatment for syphilis without informed consent to 600 black men. The study lasted for 40 years, ending in a $10 million out-of-court settlement in 1974 and a promise of lifetime health and medical benefits and burial services to all living participants and their families.
Prominent associations serving black communities, such as the NAACP, National Coalition of 100 Black Women, the Charles R. Drew Medical Society, the California Black Health Network and the Network of Ethnic Physician Organizations, have all denounced the comparison, stating: “We condemn the targeting of our communities with dangerous misinformation about vaccine safety. We are incredulous that this is being painted as a civil rights issue.” Indeed, vaccination as a public health measure benefits low-income communities and communities of color by drastically reducing incidences of deadly and costly illnesses. However, collective fears around vaccine safety are difficult to dismiss outright when they are based in real historical events (such as the Tuskagee syphillis study) and spurred by institutional racism. When government agencies (such as Public Health Service) meant to protect vulnerable citizens disregard their well-being with such callous ease, rebuilding trust can take a long time and a considerable amount of work. An important part of this work includes deeply engaging supervisors and employees on issues like race and religion through thoughtful, well-researched diversity programs.