Illinois has two types of exemptions allowing unvaccinated kids to stay in school: One calls for a doctor's note if, for example, a child is allergic to a certain vaccine. Or, a parent can file a religious objection to the immunizations.
That second method has opened a gateway to forego the shots that more and more parents, such as Elgin's Ashley Focht, are choosing to walk through. She has skipped immunizing her son Gavin, despite not having any actual religious beliefs against vaccines.
"People say to me, 'Gosh, what if he gets whooping cough?'," Focht said. "I tell them I think that we are building his immune system the way it should be. And I totally have faith that it wouldn't be life threatening."
But by "faith," Focht doesn't mean a spiritual higher power or some religious text has guided her decision.
"I'm not religious," Focht said. "My husband and I each have our own idea of spirituality. But at school, as parents, we should just be able to say we don't want to get these shots because we just don't want to. Kids get sick. And guess what? The vaccinated kids get sick, too."
But Illinois law doesn't allow that kind of parenting, at least not in the open. There are 19 states that allow parents to opt out of vaccinations for nonreligious, philosophical reasons. Illinois isn't one of them.
Mary Fergus, a spokeswoman for the Illinois State Board of Education, said philosophical objections tend to get murky. So Illinois provides for a religious exemption because that's protected by the highest law in the country.
"Religious freedom is protected under the Constitution, which provides a clear means for allowing such an exemption," Fergus said. "We tell districts that they should just have parents write a specific letter that clearly states that they are seeking an exemption on religious grounds."
But there is no mandatory check for the veracity of those beliefs. That's a major flaw to people like Annie Boesen, manager of immunization initiatives for the Illinois Chapter of the American Academy of Pediatrics. The group is a strong advocate for school vaccines.
"Parents don't have to get a note on letterhead from a pastor or anything like that," Boesen said. "There is no real process in place. What we are talking about now is tightening the religious exemption process."
The academy envisions something more akin to California's religious exemption. That version requires proof that the parent spoke with a pediatrician about their immunization concerns before deciding to still pursue the exemption. Boesen said that's a great added step because it forces parents to make time and talk to a doctor rather than just cutting and pasting an excuse they found on the Internet.
"It's possible some of these parents don't disagree with vaccines, but they don't have the time or resources to vaccinate," Boesen said. "There is help out there for that."
Juanita Gryfinski is one of the many school nurses who can provide a link to that help. She was recently a nominee for the Illinois Association of School Nurses Nurse Administrator of the Year Award for her work in St. Charles Unit District 303 schools. She reads every religious exemption letter in her district.
"The letter just has to state a religious belief that conflicts with our immunization policy," Gryfinski said. "But they don't have to attach it with a specific religious tenet or church. Some people are very specific and talk about fetal material used in a vaccine. Some just briefly mention 'a creator.' But as soon as it says religious belief it gets very unlikely that I would reject a request because I can't read somebody's heart. What I'm looking for is any indication that they are trying to avoid something else."
That "something else" may be parents not wanting to admit they can't afford the vaccines or a physical exam or that they don't have a pediatrician for their child. In those cases, if Gryfinski can decipher it from the letter, she can direct them to reduced or free ways to get the shots. But even if money is not the problem, Gryfinski doesn't just stamp the letter and walk away.
"I'll talk to the parent about the consequences of their actions," Gryfinski said. "And I tell them their child won't be able to come to school if there is an illness outbreak."
Autism was a major concern for some parents a few years ago when fear spread that vaccinations were the cause for the rise in autism. Sometimes Gryfinski still gets that question.
"The evidence has clearly indicated there is no relation between immunizations and autism developing," she said. "That's what I tell them. That fear is totally unfounded."
Her main battle in recent years has involved explaining changing recommendations and requirements for pertussis vaccinations. Gryfinski said she understands that parents can get frustrated by the changing rules and how that makes it seem as though the medical community isn't always sure of the right course of action.
"And the reality is there are children who get those pertussis shots and still end up getting pertussis," she said.
In part because of that, and also because she believes in the rights of parents, Gryfinski doesn't necessarily have a problem with people asking for religious exemptions even if they don't actually have any spiritual ties.
"I have learned through this that parents always have good intentions for their children, and those intentions are based off their own experiences," Gryfinski said. "Most of the people feel very educated about their choice. It is not a willy-nilly decision."
Ashley Focht matches that description. She goes to every pediatric doctor appointment with Gavin per the same schedule just about every other parent is recommended to follow. She can even recite her pediatrician's phone number by memory. When Gavin came down with a bad croup cough, she had no problem following the doctor's prescription for Albuterol.
"I don't have a problem with medicine," she said. "I don't dislike doctors. I just don't think my son needs to have these shots."