Effective Date:

Revised 7/20/2021; 1/19/2019

Status: Position Statement

Written by: WNA Public Policy Council Adopted by:WNA Board of Directors

 A printable copy of this position statement can be found by clicking here.


Immunizations are a safe and effective intervention to protect the public from highly communicable and deadly diseases (suchas measles, mumps, diphtheria, pertussis, and influenza), and the purpose of this position statement is to present the WNAposition on immunizations and exemptions.


Statement of WNA Position

WNA supports the revised Immunization Position Statement issued by ANA on June 29, 2021, which supports all nurses and other health care workers be immunized against COVID-19 as part of employment in order to protect the patients they care for and themselves. https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/immunizations/

The WNA supports of all individuals being immunized against vaccine-preventable diseases according to the best and most current evidence outlined by the Centers for Disease Control and Prevention (CDC) and the Advisory Committee onImmunization Practices (ACIP) with exemptions from immunization only for medical contraindications. This aligns with the ANA position on immunization exemptions.



The WNA recommends that the state of Wisconsin eliminate both the personal and religious exemptions to immunizations.



The WNA does have a position statement on immunization. Most recently, vaccines have been developed that support protection against COVID-19. c has outbreaks of immunization preventable diseases, such as measles, have occurred, puttingspecific individuals and the population at risk for illness and death.


Current Wisconsin Immunization Law:

As of the fall of 2019 in Wisconsin, children can be waived from immunization requirements for school for three reasons: (1) personal conviction, (2) religious, and (3) medical/health reasons (Wisconsin Department of Health Services, 2018, https://www.dhs.wisconsin.gov/publications/p01438.pdf). In order to qualify for a personal conviction or religious exemption, parents simply fill out a waiver form that is turned into the child’s school. In Wisconsin, the rates of personal conviction exemptions for school age children have increased from 1.2% in 1997 to up to 4.6% in 2018. Moreover, in the 2018-2019 school year, 5.3% of all students had an immunization waiver (Wisconsin Department of Health Services, 2019, https://www.dhs.wisconsin.gov/publications/p01894.pdf). Having a sufficient number of people immunized (92% to 95%) is critical to establishing community immunity and preventing illness and death, especially among those at particular risk, such asinfants or those of all ages who are immunocompromised.

During the 2018-19 school year, 91.9% of students met the minimum immunization requirements, just below the minimum target for community immunity. There are currently a 2019 Assembly Bill 248 and a 2019 Senate Bill 262 to eliminate the personal conviction exemption from immunization (Wisconsin State Legislature,http://docs.legis.wisconsin.gov/2019/proposals/sb262, http://docs.legis.wisconsin.gov/2019/proposals/ab248.1


Immunization exemptions in other states:

Currently only 16 states permit personal conviction-type immunization exemptions; however, the vast majority of states (44), do permit religious exemptions (Sandstrom, 2019, https://www.pewresearch.org/fact- tank/2019/06/28/nearly-all-states-allow-religious-exemptions-for-vaccinations/). As of June 2019, there were five states (California, Mississippi, West Virginia, New York, and Maine) that only permit medical waivers for immunization (Sandstrom, 2019). By removing the personal conviction for immunization, Wisconsin would join the majority of states with such laws. While removing the religious waiver may be more controversial, it is a position the WNA can promote to improve health over time. By removing both the personal conviction and religious exemptions, Wisconsin could increase immunization rates and improve the chancesof achieving community immunity.


ANA position on Immunization Exemptions:

In June of 2019, the American Nurses Association updated their immunization policy statement to exclude religious exemptions for immunization; currently the ANA only supports medical exemptions for immunization(https://www.nursingworld.org/news/news-releases/2019-news-releases/american-nurses-association-takes-action-on- critical-public-health-issues/).


Rates of Immunization in Wisconsin:

While Wisconsin has not had an outbreak of measles, Wisconsin children are very much at risk. The 2018 data show that for 5 and 6 year olds, only 5 out of 72 counties in Wisconsin had MMR (Measles, Mumps, and Rubella) immunization rates of over 85%, with more than half the counties with immunization rates at less than 80% (Wisconsin Department of Health Services, April 2019, https://www.dhs.wisconsin.gov/publications/p02420a.pdf; Johnson, September 2019, in Milwaukee Journal Sentinel, https://www.jsonline.com/story/news/local/wisconsin/2019/09/03/measles-wisconsin-nears-50-000-unvaccinated- children-u-s-copes-outbreak/2152352001/).


Immunization throughout the lifespan:

While adults are not covered under laws for immunization waivers (which only apply to school age children), having laws which support and promote immunizations for school age children could also positively influence immunization rates for people throughout the lifespan. Consider immunization against influenza as an example. The influenza vaccine is safe and has been proven to decrease: (1) rates of influenza, (2) the severity of the illness, (3) the number of hospitalizations, and (4) the number of deaths attributable to influenza (CDC, 2018, https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm). For the 2017-2018 season, the CDC estimates that the influenza vaccine prevented “approximately 7 million flu illnesses, 109, 000 fluhospitalizations, and 8,000 flu deaths” (CDC, 2018, https://www.cdc.gov/flu/vaccines-work/burden-averted.htm). Immunizations are fairly inexpensive in comparison to the resulting improvements in morbidity and mortality. In the Wisconsin 2018-2019 influenza season, only 40% of residents were immunized against influenza, and there were:

  • over 17,000 cases of influenza
  • over 3400 influenza-related hospitalizations
  • 124 deaths (4 pediatric)

(Wisconsin Department of Health Services, October 2019, Respiratory Virus Surveillance Report(https://www.dhs.wisconsin.gov/publications/p02346.pdf).


Role of Nursing in Immunization:

Nurses are ideally situated to promote immunization through active involvement in developing immunization policy, planning immunization campaigns, providing immunization education, directly immunizing individuals, and by being role models in obtaining immunization for themselves. Nurses are often the frontline health care provider asking patients about immunization status, offering immunization, and educating patients about the importance of immunization to protect themselves, their infants, their older family members, and their immunocompromised neighbors.


Supporting Material

2019 Assembly Bill 248: http://docs.legis.wisconsin.gov/2019/proposals/ab248


2019 Senate Bill 262: http://docs.legis.wisconsin.gov/2019/proposals/sb262


American Nurses Association Position Statement on Immunization (July 21, 2015):https://www.nursingworld.org/~49041c/globalassets/practiceandpolicy/nursing-excellence/ana-position-statements/nursing-practice/immunizations.pdf

American Nurses Association no longer supports religious exemptions to vaccination: (June 22,2019):https://www.nursingworld.org/news/news-releases/2019-news-releases/american-nurses-association-takes- action-on-critical-public-health-issues/

Wisconsin Immunization Exemptions: https://www.dhs.wisconsin.gov/publications/p01438.pdf

Wisconsin Immunization Rates 2018 to 2019: https://www.dhs.wisconsin.gov/publications/p01894.pdf

Wisconsin Influenza Immunization Data: https://www.dhs.wisconsin.gov/publications/p02346.pdf

Wisconsin MMR Immunization Data for 5-6 year olds: https://www.dhs.wisconsin.gov/publications/p02420a.pdf

Wisconsin Immunization Rates: https://www.dhs.wisconsin.gov/immunization/data.htm

Article about religious, personal, and medical exemptions for all states: https://www.pewresearch.org/fact-tank/2019/06/28/nearly-all-states-allow-religious-exemptions-for-vaccinations/

Article from the Milwaukee Journal Sentinel about MMR vaccination rates in Wisconsin:https://www.jsonline.com/story/news/local/wisconsin/2019/09/03/measles-wisconsin-nears-50-000-unvaccinated- children-u-s-copes-outbreak/2152352001/


Sandstrom, Aleksandra (June 28, 2019). Amid Measles Outbreak, New York closes religious exemption forvaccinations-but most states retain it. Pew Research Center. Accessed October 28, 2019 athttps://www.pewresearch.org/fact-tank/2019/06/28/nearly-all-states-allow-religious-exemptions-for- vaccinations/


Wisconsin Department of Health Services. (June 2018). Immunization Law Clarification. Accessed September1, 2019 at https://www.dhs.wisconsin.gov/publications/p01438.pdf


American Nurses Association. (July 21, 2015). American Nurses Association Position Statement on Immunizations. Accessed September 1, 2019 at https://www.nursingworld.org/~49041c/globalassets/practiceandpolicy/nursing-excellence/ana-position-statements/nursing-practice/immunizations.pdf


American Nurses Association. (June 22, 2019). American Nurses Association Takes Action on Critical Public Health Issues. Accessed September 1, 2019 at https://www.nursingworld.org/news/news- releases/2019-news-releases/american-nurses-association-takes-action-on-critical-public-health-issues/


Centers for Disease Control and Prevention. Vaccine Effectiveness: How Well Do the Flu Vaccines Work? AccessedSeptember 1, 2019 at https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm


Centers for Disease Control and Prevention. Estimated Influenza Illnesses, Medical Visits, and Hospitalizations Averted by Vaccination. Accessed September 1, 2019 at https://www.cdc.gov/flu/vaccines- work/burden-averted.htm


Wisconsin Department of Health Services, Division of Public Health Bureau of Communicable Diseases,Communicable Diseases Epidemiology Section. Respiratory Virus Surveillance Report Week 20: Ending May 18,2019. Accessed September 1, 2019 at https://www.dhs.wisconsin.gov/publications/p02346.pdf


Wisconsin Department of Health Services, Wisconsin Immunization Program (April 2019). WisconsinImmunization Rates 2018-2019 School Year. Accessed 10/28/2019 athttps://www.dhs.wisconsin.gov/publications/p01894.pdf


Wisconsin Department of Health Services. (April 2019).

Percent of 5‐and 6‐year‐olds with at least two doses of MMR, 2018. Accessed 10/28/2019 athttps://www.dhs.wisconsin.gov/publications/p02420a.pdf


Johnson, Mark. (September 3, 2019). 50,000 unvaccinated children head to Wisconsin schools as the U.S. copes withworst measles outbreak in 27 years. Milwaukee Journal Sentinel. Accessed October 28, 2019 athttps://www.jsonline.com/story/news/local/wisconsin/2019/09/03/measles-wisconsin-nears-50-000-unvaccinated- children-u-s-copes-outbreak/2152352001/).


Wisconsin State Legislature. (2019-2020). 2019 Assembly Bill 248: http://docs.legis.wisconsin.gov/2019/proposals/ab248


Wisconsin State Legislature. (2019-2020). 2019 Senate Bill 262:http://docs.legis.wisconsin.gov/2019/proposals/sb262