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http://www.nytimes.com/2003/01/14/health/14VACC.html?ex=1043125200&en=6559823e2e10e71c&ei=5062&partner=GOOGLE

Worship Optional: Joining a Church to Evade Vaccine

By DONALD G. McNEIL Jr.

EDFORD, N.J. — "This is to certify that the family of Donald McNeil is enrolled as members of this religious order and is subject to the tenets and beliefs of this order. No member of the Congregation shall have injected, ingested or infused into the body any foreign materials of unhealthy or unnatural composition. No member of the Congregation shall have surgical instruments cutting or piercing the tissues of the body."

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It is not hard to get a religious exemption to the childhood immunization laws. To join the Congregation of Universal Wisdom, all it takes is a letter to this neat house in the Pine Barrens with the "Don't Tread on Me" flag above the mailbox and the sculptured spine on the garage, where Dr. Walter P. Schilling, a chiropractor, runs the congregation from his den.

He replies to inquiries by mailing a copy of the religion's tenets, which emphasize that "Universal Wisdom is the Supreme Master of all levels in creation" and that "laying on of hands to the vertebrae shall be the sole means of maintaining the life force."

Once the families have confirmed that they "will aspire to live by" the tenets and have paid at least $1 of the $75 "customary donation" as a sign of commitment, they receive their membership certificates.

Dr. Schilling does not require that applicants give up other religions, and he is not too exacting about wording: he accepted a vague letter saying an applicant could follow the tenets if he chose to. In New Jersey, where Dr. Schilling says he has 2,988 members, this certificate guarantees a waiver from the state's requirement for vaccinations against polio, measles and a dozen other childhood diseases, no questions asked. Under a 1995 ruling by the state attorney general, a school may not pass judgment on a religious exemption request.

"If they have a deeply held belief, they get the exemption," said Dr. Eddy Bresnitz, New Jersey's chief epidemiologist. "We don't define what a deeply held belief is."

Dr. Schilling's church was founded in 1975 to defend "straight chiropractors" like himself, who regard Western medicine as paganism or Satanism. Now he claims 5,520 members, mostly families wanting to avoid vaccination, in 28 states.

Forty-seven states — all but Arkansas, Mississippi and West Virginia — offer religious exemptions to vaccination; only 17 offer "philosophical" exemptions, available virtually on demand. Parents opposing vaccination often apply for religious exemptions when they cannot get philosophical or medical ones, public health officials say.

Although more than 90 percent of all American children have had their vaccinations, exemptions appear to be increasing, and to concentrate in pockets where higher numbers of parents object.

In Montclair, N.J., for example, less than 1 percent of school-age children have exemptions, but one cooperative school has a much higher rate.

National data do not distinguish between exemption types, said Daniel A. Salmon, a vaccination expert at the Johns Hopkins School of Public Health. But in Massachusetts, which he has studied and which does not offer philosophical exemptions, religious exemptions are on the rise. The American Medical Association opposes both types, saying they increase the risk of epidemics.

In many states, just what constitutes "religious exemption" is hazy. A study in The American Journal of Public Health in 2000 showed that only 21 of the 47 states had ever denied one. "A lot of states call their exemptions religious, but anyone who wants it, gets it," Mr. Salmon said.

The issue has never come before the Supreme Court, but state laws that have listed exempt faiths — Christian Science, for example — have been struck down in courts on the basis of the First Amendment.

Religious exemptions do have public health consequences. The last two American polio outbreaks were in Amish and Mennonite communities in 1979 and in a Christian Science school in Connecticut in 1972. Measles killed 3 students of 125 infected in a Christian Science school in 1985, and a similar-size outbreak among the Amish in 1987 and 1988 killed 2 people. In 1991, 890 cases of rubella, leading to more than a dozen deformed children, hit Amish areas.

Mr. Salmon argues that such religious enclaves do not present much of a public health problem except to their members. "We're unlikely to see a population explosion among the Amish," he said. "And these people came here for religious freedom, came here to be left alone. That's very difficult to take away."

But religious conversions announced just in time to avoid vaccinating children "have the potential to grow," Mr. Salmon said. "If you look on the Internet, you can find what Scripture to quote," he said. "Is that really a religion?"

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One of the toughest places to get an exemption is New York City. City health codes fine principals $2,000 a day for any unvaccinated child in a school, and the Board of Education's lawyers take the position that no established religion formally forbids vaccination, said Dr. Terry Marx, the board's chief physician, so applicants must write letters detailing their personal beliefs.

Many applications are "bogus," she said. She rejects medical ones "if they're based on quackery." Another official, who said her boss had told her not to give an interview, assesses the sincerity of religious ones.

Dr. Marx had never heard of the Congregation for Universal Wisdom, she said, but after reading its tenets on its Web site, said: "If someone were really and truly part of this church and upheld its beliefs, that would pass the test. But only if somebody really obeyed this. That means they wouldn't treat their kid for asthma, wouldn't take their kid for an appendectomy."

At the Montclair Cooperative School, 10 of the 160 students have Dr. Schilling's certificates. That frustrates Elizabeth Tengwall, the school nurse, who feels that some parents are exploiting a legal loophole.

To them, she said, the notion of an outbreak of measles, whooping cough or polio "is so foreign that they think it's not going to happen."

But as a hospital nurse, she has treated a baby with whooping cough. "It was frightening," she said. "It coughed so much it couldn't catch a breath and turned blue. You could just spray oxygen at its face."

The parents usually do not cite religion first, she said, but mention unproven fears. "They say they're worried about the autism link, or that it's just not natural to inject weakened viruses into their kids."

At one time, being helpful, she steered them to other parents in Dr. Schilling's congregation.

"But now I see what's going on," she said. "I hope I wasn't enabling them."

In interviews, Dr. Schilling — Brother Schilling in correspondence — seems a polite, gentle man with pacifist and environmentalist beliefs and a sincere passion for his religion, though the impression is knocked somewhat off kilter by his quick wit and the accent that lingers from his Queens childhood.

He adopts greyhounds facing euthanasia when their dog-track careers are over. He doesn't own a gun and is religiously opposed to war, but joined the National Rifle Association because it fights government restrictions.

He doesn't smoke or drink and, as a chiropractor, even shuns X-rays because he considers them irreligiously invasive. He decorated his Christmas tree with little human spines, which he gives away as key chains. As a minister, he occasionally performs weddings.

He founded the Congregation — which does pay taxes, he said — with three other chiropractors, who have since died. The most radical was Dr. Daniel J. Dalton, who preached that physicians were agents of Satan, pharmacy was witchcraft, and Western medicine evolved from worship of the Greek god Hermes and adopted his symbol, the caduceus, a snake-entwined winged wand.

"I wouldn't say he was a fanatic, but that would give you a sense of him," Dr. Schilling said. "What other people see as Western medicine, we see as a state-imposed pagan religion.

"We're constantly intimidated by the system. Now, when we're intimidated, we intimidate back."

Asked how he would feel if a child with an exemption from him contracted polio, he answered: "If they're clear spinally, if the communication between God and the body is clear and they're working at 100 percent efficiency, then their resistance will be higher. Unless God wants them to leave. God does want people to leave eventually. I wouldn't feel I'd made a mistake. I'd feel it was part of God's will."

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ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.