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N.Y.'s Narrow School Vaccine Medical Exemption Is Constitutional

Aug. 1, 2022, 2:30 PM

A group of parents of school-aged children in New York lost their fight against narrower medical exemptions for school immunizations because the state’s new regulations are rationally related to legitimate state interests, under a Second Circuit ruling.

New York’s health department requires children to be immunized against certain diseases before starting school. In 2019, in response to a state-wide measles outbreak, the state repealed a religious exemption and tightened the rules for medical exemptions.

The new rules require heightened proof to medically exempt children. Rather than simply relying on a doctor’s “say-so” that a vaccine may be detrimental to a child’s health, exemption applications must now include information identifying a medical contraindication to a specific immunization that’s consistent with guidelines issued by the Advisory Committee on Immunization Practices or another “nationally recognized evidence-based standard of care.”

A group of parents were denied exemptions for their “medically fragile children,” because they were told their requests lacked sufficient detail, didn’t meet ACIP guidelines, or were submitted on the wrong form. They brought a proposed class action against the health department and certain school systems alleging the new rules are unconstitutional.

The US Court of Appeals for the Second Circuit affirmed the suit’s dismissal July 29.

The court determined that the case was subject to rational basis review. Strict scrutiny review, a more exacting standard for a regulation to clear, applies only when the alleged infringement involves “fundamental” rights, and there is no fundamental constitutional right to an education, the court said. Additionally, no court appears to have ever held that strict scrutiny applies to vaccine mandates, it said.

The new rules clear the rational basis standard, the court said. The health department had a legitimate state objective for adopting the new rules, namely protecting the community from serious, vaccine-preventable diseases, the court said.

Additionally, the rules are reasonably related to obtaining that objective, as the state was concerned that parents would request unwarranted medical exemptions due to the elimination of the religious exemption, the court said. By narrowing the medical exemption, state regulators sought to ensure that the risk of harm from a vaccination was legitimate, Judge Denny Chin said.

The court also affirmed the dismissal of the parents’ Rehabilitation Act claims.

Judges Pierre N. Leval and José A. Cabranes joined.

Sujata Gibson of Ithaca, N.Y., Sussman & Associates, and Children’s Health Defense represent the parents. The New York Attorney General’s Office represents the state health department. Sokoloff Stern LLP, Johnson & Laws LLC, Cullen & Dykman LLP, and Biedermann Hoenig Semprevivo PC represent the school districts and officials.

The case is Goe v. Zucker, 2022 BL 263904, 2d Cir., No. 21-537, 7/29/22.

To contact the reporter on this story: Mary Anne Pazanowski in Washington at

To contact the editors responsible for this story: Rob Tricchinelli at; Brian Flood at