New Oregon Law for Claiming Vaccine Exemptions Effective March 1st

Sheperd, Adkins, StacyThe state just posted today the links for how to get a vaccine exemption.  Here is the link to the main resource page 

Here is the link to the required video module  


IF YOU WANT TO CLAIM AN EXEMPTION so you don’t have to give your child all the vaccines on the required schedule: Watch the video to the end. This will require constant attention as you must click “Next” and then pick different vaccine modules and click next again and again.  Be prepared to print off as many exemption forms as you have children when you are done. You cannot come back and do this later. Plan for at least 1-2 hours to get through this. Some of the information is great but it is clearly predominantly about benefits and lacking on information about side effects and absolutely does NOT address the aluminum issue, and the immune altering effect of giving so many vaccines when the immune system is immature that first year of life.

While the State has provided a mechanism for a medical exemption, in practical terms this really doesn’t work.  For most educated parents who want an exemption based on their understanding of the risks and benefits or want their doctor to prove that there is a medical condition that makes a medical exemption valid, it will likely require that the State medical officer agrees, and they will only use the CDC and standard information.  All the world literature on aluminum toxicity, vaccine side effects, or genetic risks will likely not sway the establishment.

Humpty Dumpty sat on a wall,
Humpty Dumpty had a great fall.
All the King’s horses, And all the King’s men
Couldn’t put Humpty together again!

 Parents, it is your right to make health care decisions for your child.  We are supposed to give informed consent before doing a procedure.  Vaccines are an invasive procedure and even this video acknowledges many of the risks.  It is your right to look at all the information and make an informed choice about whether or not to vaccinate.  I am not against vaccines. I just wish they didn’t have aluminum and I think the current schedule has major flaws. 

Below, is my response to those aspects of the educational video that I find either misleading or lacking in both sides of the story:


VaccinesThe state module (educational video)


POINT:  “90% of Oregon Kindergartners– were up-to-date on all their required vaccines in 2013.”

COUNTERPOINT: 89% of Oregon Kindergartners’ parents are uninformed or misinformed.  1% of parents educated on the facts about aluminum toxicity and the common sense of waiting to give the Hepatitis B vaccine when their children were closer to teen years when the risk of sex or IV drug use existed, chose NOT to give that vaccine to their newborns/infants in my practice.  Informed consent includes sharing all the information so parents can make an informed decision.  There is no mention of aluminum toxicity in the State module.  There is no mention of the fact that the Hepatitis B vaccine is not providing lasting immunity when given as they are recommending- at birth, 2 months, and 6 months. 

POINT: “Vaccines have reduced dramatically many of the diseases once considered the bane of childhood like smallpox, polio, measles, and tetanus”. They show a graph of dramatic disease reduction.

COUNTERPOINT:  Hygiene and sanitation was largely responsible for the reduction of these diseases. Smallpox has been eradicated, polio is essentially eradicated (the last USA case in 1979), and the risk of measles or tetanus is typically less than 1 in one million.  I applaud the success of hygiene and vaccine programs.  We now live in a world of hundreds of neurotoxins and chronic disease (autism, anxiety, diabetes, asthma, ADHD, etc. are the disorders of the 21st century).  If vaccines were without toxins or immune challenges, when given at the excessive pace we have in the first year of life that affects the immune system, then I’m all for them.  Sadly, the current schedule is part of the problem, overdosing infants with aluminum and shifting the immune system to an allergic state and possibly triggering autoimmune disorders like insulin-dependent diabetes. 

POINT:  “…it’s important that parents have science-based information before immunizing their children or claiming an exemption to school requirements for immunization”.

COUNTERPOINT:   I couldn’t agree more.  Sadly this module that is touting “science-based” information is being very selective about which information they present.  If we are to make an informed and educated decision, we need all the science, not just that which supports the pro-vaccine establishment.  Parents– we are pro-our kids!  Learn all the science, and then make your informed decision. This video gives no references. NONE!  I refer you to my blogs on vaccine issues that are all referenced at:


POINT:  The video link “How vaccines work” will make the statement that vaccines will give you immunity for life.

COUNTERPOINT: Not all vaccines are giving lasting immunity, hence the importance of considering the timing of the vaccine.  The current schedule would have you vaccinate your newborn against Hepatitis B (with it’s 250 micrograms of aluminum) when we now have data that less than 50% of 15 year olds who got the vaccine as newborns and infants still have adequate antibodies.

POINT: Vaccine ingredients– you are given a link to a CDC web page and are not given any guidance on which ingredients are in which vaccines. 

COUNTERPOINT:  Since preterm infants should not receive (per FDA parenteral fluid guidelines) more than 4–5 micrograms of aluminum per kilogram of body weight per day, and the adult maximum is 50 micrograms, you would think it would be important to know which vaccines contain aluminum and how much, and then make a plan to minimize the exposure by not giving multiple aluminum containing vaccines at the same time.  Hepatitis B vaccine has 250 micrograms, the Prevnar has 125 micrograms and the Dtap has 170–330 micrograms (more in combination vaccines)!  All three of these are being recommended at the 2 month visit, resulting in a dose of aluminum of at least 545 micrograms (11 times the adult maximum of this neurotoxin).

For research publication reviewing aluminum and autism connection, click here… 

My previous blog on Over Vaccinating and Exposure to Neurotoxins can be seen here… 

Video on Heavy Metal Toxins and How They Affect Your Child can be seen here…


POINT:  “for optimal protection from the diseases, it is important to get them when recommended”.

COUNTERPOINT:  This is not actually true, but rather a judgment call.  For example, by giving the Hepatitis B vaccine to all newborns in the USA, this will prevent a handful of cases of childhood Hepatitis B (those patients whose mom’s were not tested or had recently acquired Hepatitis B and might infect their baby).  We still don’t know the thousands or hundreds of thousands of young adults who will get Hepatitis B when they are sexually active and their immunity has waned.  Timing of vaccines is everything, and there are trade-offs.  In the case of the aluminum vaccines, you have greater toxicity the younger the child since toxicity is often based on the dose of the toxin per Kg of body weight. This statement doesn’t acknowledge that educated and knowledgeable experts don’t agree about the best schedule.  Countries in Europe have less aggressive schedules and good outcomes.

POINT: “babies less than 2 months are at very high risk, but vaccines don’t work well in them” – this is given as the argument to vaccinate everyone to provide herd immunity.

COUNTERPOINT: If the vaccines were completely safe, I could go along with this reasoning.  Actually, babies are born with mom’s antibodies passively transferred by the umbilical cord and these last for 4-6 months. The time babies are at greatest risk is actually after 4 to 6 months, as relates to the diseases that are covered by vaccines, for which 99% of moms have immunity.  The social contract that all parents should vaccinate to protect the community does have some merit.  Unfortunately, many families have genetic risk factors that make the current schedule with its toxic load of aluminum unwise if not outright dangerous.  It is important that the public understand that to make an educated decision to vaccinate slowly or differently is often based on sound science and review of the peer reviewed literature.  It is inappropriate for parents to be judged by schools, the State, or other parents if they exercise their right to refuse vaccinations.

POINT: Dr Jennifer Vines shares her view to do all the vaccines on schedule. She shares the CDC  web site for more information.

COUNTERPOINT: Clearly, her children have not suffered from any vaccine or toxin related chronic disease or disorder.  Those physicians whose children suffer from autism, ADHD, anxiety, diabetes, asthma, mitochondrial defects, etc. often research a little deeper and reach the conclusion that vaccines as scheduled are a risk factor for some of these conditions.


 POINT:    “from 2004 to 2008 111 people in the USA died from pertussis and 83% of the deaths were among children 3 months and younger”.

COUNTERPOINT: Any death is horrible, but our response to such tragedy needs to make sense.  The current response to this statistic is that every pregnant mom in America gets the TDaP with its 170–330 or more micrograms of aluminum.  There has never been a test or study of injecting such a toxic dose into pregnant women or even animals.  No IRB (Institutional Review Board) would ever allow such a study.

Will the government and the “experts” make the connection when the autism rate reaches one in 20 this coming decade?  I think not, as they don’t see the connection now.  Our vaccine schedule just keeps adding more and more toxins to younger and younger children and the experiment is not going well.  What needs to happen is that we give teens and young adults the booster for TDaP, and for newborns, all care providers should have the TDaP so they don’t bring the Pertussis home to the new baby.

 POINT: “In 1 of 30 children getting the Dtap, is followed by swelling of the entire arm or leg in which the shot was given lasting 1–7 days”. “Serious allergic reaction occurs in 1 in out of 1 million doses.” 1 in  1 million also see permanent seizures, brain damage”.

COUNTERPOINT: I actually have seen far less of the “entire swelling of the leg or arm”, maybe seeing this once in my career out of thousands of this vaccine being given. This statistic may be left over from when we used to give the whole cell DPT, done until about 1991. That vaccine was very prone to severe side effects, seizures, and deaths.  The Dtap we use should not be feared as much, but it still has the huge dose of aluminum.

 POINT: “In 2012, more than 900 cases of Pertussis were reported in Oregon” … “the highest number since 1953”… “ 25 infants were hospitalized, 24 were 3 months or younger…no infants died..”

COUNTERPOINT: while clearly Pertussis can be horrible and the video shares an audio of an infant coughing that sounds distressing, most infants and people recover completely.  We have not had an infant death in Oregon for over a decade or two.  I believe that using the cocooning method of vaccinating all those around the newborn infant should go a long way in preventing Pertussis in these most vulnerable children. The intelligent, educated parent might choose that miniscule risk of infant death (perhaps less than one in a million) over the certain injection of a large dose of the neurotoxin aluminum while pregnant.  It’s a judgment call.  Who should make that decision?  You, the parent, or the State?  Having said this, you should consider vaccinating your baby on schedule, death from Pertussis is preventable. 


POINT: ‘The last case of polio in the United States was in 1979 and vaccination has eliminated it from South America as well”…”the spread of polio has not stopped in Afghanistan, Nigeria, and Pakistan.”  “Three doses of the polio vaccine IPV provides 99% protection”.

COUNTERPOINT: The eradication of polio from the western hemisphere, and soon the entire world, is indeed a vaccine success story.  Knowing the risk in the USA is zero, I agree that we should continue to provide the protection until world eradication is accomplished, but the timing of that vaccine during the first 6 months when a baby is getting so many other vaccines and the immune system is immature no longer makes sense.  The series of 4 vaccines is also no longer needed since 3 shots gives 99% protection.


POINT:  “..before the vaccination was routinely given, chickenpox infection resulted in over 10,000 hospitalizations and 100 to 150 deaths a year in the United States”.

“Two doses are 98% effective at preventing chickenpox”. 

COUNTERPOINT: Varicella can be serious to pregnant women, those immune-compromised, and very young children. This is a good argument for maintaining herd immunity.  Since the death rate today is near zero, I would argue that we can maintain herd immunity with vaccinating those a bit older.  This is a live virus that likes the nervous system. The virus stays dormant in the nerve roots, and later can cause shingles,  whether you get natural chickenpox or the vaccine, so why not wait until at least age 3 when language is well established and the immune system fully developed?  I do agree that this vaccine is fairly effective and seems to be safe.


POINT: “ most affective for infants, children, and adolescents” … “after receiving 3 doses of Hepatitis B, 95% of children in these age groups have lifetime protection from Hepatitis B disease”.  “Hepatitis B can be spread by sharing items like razors and toothbrushes, and by direct contact with open sores of an infected person”.

COUNTERPOINT: Studies are showing that the antibodies that provide the protection against Hepatitis B are not lasting in the majority of infants who get this series at birth, 2 months, and 6 months. Indeed, most European countries and Canada have figured this out and only give the vaccine to high risk pregnancies (where mom has Hepatitis B, her status is unknown, or she has high risk factors).  Hepatitis B is actually more effective if given to the pre-teen and teenager group before they engage in risky behaviors (sex and IV drug use).  To propose that sharing razors, toothbrushes, and open sore contact is the reason to inject 250 micrograms of the known neurotoxin aluminum into a newborn who is not at risk is simply preposterous!  How many infants and newborns are sharing razors?  Toothbrushes? Rubbing up against open sores of infected people?  In the USA, less than 1% of moms have Hepatitis B and most moms who deliver know their Hepatitis B status.  If they don’t have Hepatitis B, the risk of their newborn getting Hepatitis B is ZERO!!!

Why would you inject 250 micrograms of aluminum into that newborn?  Consider giving this vaccine to school age or pre-teen children.


POINT: “1 in 5 people who get Hepatitis A will require hospitalization”. 

COUNTERPOINT: This is misleading.  The video mentions that most children don’t have symptoms at all, and that being so, clearly this statistic is referring to adults.  Why not wait and give this aluminum containing vaccine a bit later.  There is just no logic that makes sense for giving this toxic dose of aluminum at the one year visit, right when most pediatricians are also recommending the MMR with it’s three potent live viruses. 

POINT: “No serious adverse reactions have been reported for the Hepatitis A vaccine”

COUNTERPOINT:  To say no adverse reactions have been reported, if true, is a stretch.  I would admit that I have not had side effects to this vaccine be an issue. What is also true is that this vaccine has 250 micrograms of aluminum and this is a neuro-toxic dose.  Perhaps the side effects are not being appreciated since they show up as subtle decreased brain function and decreased immune system response.

POINT:  “2927 cases in Oregon in 1995 before vaccinations and just nine cases in 2012”.

COUNTERPOINT: This is an exciting statistic and I suspect the vaccine program has had something to do with this success.  Knowing this, however, makes it even more logical to give the Hepatitis A vaccine at a later date.  There should be no problem for herd immunity and the success of this program if we delay this vaccine to age 2 or even a bit later. 


POINT:  “MMR does not raise the risk of getting autism”… “Several large studies reviewing hundreds of thousands of vaccinations given have concluded that there is no link between MMR and autism” 

COUNTERPOINT: The studies being referred to here are not referenced.  I suspect these “large studies” are the flawed epidemiological studies, the data of which is no longer available (mysteriously lost in the CDC archives).

That the MMR can cause autism is a fact documented in the medical literature:

  • Bradstreet et. al. “Detection of Measles Virus Genomic RNA in cerebral fluid of Three Autistic Children with Regressive Autism”. Journal of American Physicians and Surgeons. 2004; 9:38-45
  • Weibel RE et. al “Acute encephalopathy followed by permanent brain injury or death associated with further attenuated measles vaccines: A review of claims submitted to the National Vaccine Injury Compensation Program” Paediatrics 1998: 101:383-387
  • Walker-Smith JA et. al. “Ileo-caecal lymphoid nodular hyperplasia non-specific ileo-colitis with regressive behavioral disorder and food intolerance: a case study. “J. Pediartr. Gastroenterol Nutr. 1997;25 (supple 1) S48

 For those familiar with the Andrew Wakefield issue, I would encourage you to read his book “Callous Disregard” before you cast judgment.  He was a gastroenterologist at England’s Royal Free School of Medicine and when presented with several children with both regressive autism and severe gastrointestinal symptoms, he studied these children and published the brilliant work in Lancet:

Wakefield A et. al. “Ileal lymphoid nodular hyperplasia, non-specific colitis and pervasive developmental disorder in children” The Lancet 1998;351:637-641 [retracted].   He presented 12 case studies of which 9 parents claimed their children’s  regression into autism started with the MMR vaccine.  I have heard this same statement over 100 times in my own practice.  Should we ignore this?

At the end of his paper he summarized that there might be an association between the MMR and autism regression.  For this he ultimately lost his license to practice medicine.  Is it any wonder physicians are not eager to research the topic of vaccines and health problems that might be a result of vaccines?

While this important research has been removed from the world literature for “ethical violations”, the findings of this important research have been replicated many times:

  • Gonzalez L et. al “Endoscopic and Histological Characteristics of the Digestive Mucosa in Autistic Children with Gastro-Intestinal Symptoms. Arch Venez Pueric Pediar 2005;69:19-25
  • Balzola F et. al. “Panenteric IBD-like disease in a patient with regressive autism shown for the first time by wireless capsule enteroscopy: Anothr piece in the jigsaw of gut-brain syndrome?” American Journal of Gastroenterology, 2005. 100(4);979-981.
  • Krigsman A et. al. “Clinical Presentation and Histologic Findings of Ileocolonoscopy in Children with Autism Spectrum Disorder and Chronic Gastrointestinal Symptoms.  Autism Insights. 2009;1:1-11
  • Chen B et. al. “Childhood autism and eosinophilic colitis.”  Digestion 2010;81:127-9
  • Valicenti-McDermott M et. al. “Frequency of gastrointestinal symptoms in children with autistic spectrum disorders and association with family history of autoimmune disease.  J. Dev Behav Pediatr  2006, 27 (2suppl): S128-136.
  • Ming X et. al. “Autism spectrum disorders: concurrent disorders” J Child Neurol 2008  23: 6-13.
  • Buie T et. al. (Evaluation, diagnosis and treatment of gastrointestinal disorders in individuals with ASD’s: a consensus report” Pediatrics 125 Suppl 1S, 1-18

 POINT: “In the US, from January 2013 to August 2013, there were 159 cases of measles reported. 17 of those cases were hospitalized.

 COUNTERPOINT: In the entire country, 159 cases of measles last year, 17 hospitalizations and no deaths.  We had 4 cases in Oregon last year (2013).  The chance of getting measles in the USA is 1 in 1,000,000 (one in a million).  The chance of dying is 1 in 2000 in the literature.  Our medical care is so much better that it is certainly less than that.  So, your chance of dying from measles is one in a billion.  You are far more likely to be struck by lightening.  Given my experience of multiple cases 1 in 100 to 1 in 200 of normal children at age 1 regressing into autism by age 2 prior to 2008, about 100 cases in my practice where the families have no doubt that it was the MMR that triggered autism regression, and the evidence presented, along with my experience of 1 new regression out of 1000 cases when the MMR is delayed until age 3 …

I would propose parents consider waiting to age 3 unless there is an epidemic in your community.  If you have one autistic child, I would not give this vaccine at all. 

POINT: “Encephalitis occurs in about 2 out of every 100,000 mumps cases”. 

COUNTERPOINT: I grew up in Africa and had mumps as did all my friends. No one died and no-one was sterile or otherwise affected.  Encephalitis is still worth avoiding.  Given the rare cases of mumps (I’ve seen none in private practice for 20 years) this vaccine can certainly be given at age 3 or later.  In the USA, the individual Measles, Mumps, and Rubella vaccines have not been available since 2008.  It is not clear why, but we are stuck giving the full MMR. 

POINT: “Rubella [vaccine] is most important in preventing congenital rubella syndrome.” 

COUNTERPOINT:  I took care of a rubella syndrome baby in the 1980’s.  It is devastating. While rubella is now rare, you do not want to catch this disease while pregnant.  At least get the protection before the fertile years. 

POINT:  “MMR…at least two injections are required to provide maximum immunity” 

COUNTERPOINT:  This is actually not true.  One MMR gives 95% protection and the second vaccine is recommended to try to get closer to 100%.  It makes a tiny difference.  I measure IGG-measles titers in my practice and about 95% have very high IGG-measles titers after one MMR shot.   This will be life-long protection.  Most children do not need a second MMR.  I have seen a case where the first MMR seemed to have caused some neurological delays but the symptoms resolved by age 4 when a second MMR was given.  In that child, full autism was the result.  Some families have genetic risk factors that make them vulnerable to damage from the MMR.  Most doctors are not aware of which tests can be ordered and which genetic factors put your child at risk.  This field of knowledge is growing rapidly.  We will soon be able to predict if you have risks that might make the MMR vaccine or other vaccines more risky for your child. 

 POINT: “very rarely deafness, long term seizures, coma, and permanent brain damage…” 

COUNTERPOINT: I agree and here is the point:  this vaccine (MMR) can cause serious damage (in my opinion, especially if given at a year of age, and it is much safer when give after age 3).


POINT: “Before vaccines against Hib were developed, about 12,000 children, most of them younger than 5 years old, got Hib meningitis in the United states each year”…”20,000 developed some form of Hib disease and 1000 died each year”

Now  …”fewer than 55 cases a year are reported in this age group” 

COUNTERPOINT: Hib is my favorite vaccine.  I absolutely did see what is expressed above. It has few harmful ingredients (no aluminum, no mercury, no animal products). The ActHib is the brand I use which is perfect except for a trace 0.5 micrograms of formaldehyde. (PedVaxHIB has 225 micrograms of aluminum, I would not recommend this brand.)

As with all vaccines, you are balancing risks and benefits.  While the chance of getting Hib these days is rare, this bacteria is in the noses and pharynx of your babies family and loved-ones, who, when coughing, sneezing, or kissing your baby, may be transferring this bacteria.  Since the Acthib is so safe, I vote give this one on schedule. 



In general, avoid vaccines while pregnant.  The Tdap has 170–330 or more micrograms of aluminum.  There is no safe dose for the unborn child.  Premies should not get more than 10–15 micrograms. 

See You Tube videos:  


You are to be respected.  The State, schools, your pediatrician, and other parents should respect your decisions also.  See my blog on this topic here… 

IOM (Institute of Medicine) Report that Vaccines are Safe.
Read my blog to get the real story! Click Here…  

I encourage you to subscribe to my blogs and videos so you can get all the updates.  New blogs daily and videos weekly:


Dr. Paul



  • I had an infant death from pertussis in 2012, just a little over two years ago. In Wisconsin. Amish family, older kids unvaccinated. Baby was 17 days old, completely breastfed, eating home cooked and mostly home grown food. Young healthy parents.

    It was a terrible experience. Breast feeding is very important, but it doesn’t protect from pertussis.

    I see that autism rates are rising, but I don’t see that avoiding vaccines makes a difference. I think that we are all unwilling (and mostly unknowing) participants in an experiment on chemical exposures.

    • I am so sorry for your loss. It is for exactly your situation that I continue to recommend the DTaP for infants. For most families I think the small risk of the aluminum in that vaccine is probably worth it not to have to go through what you have had to go through. Thank-you for sharing with the world and for your bravery.

      • Anonymous

        CDC recommends DTaP at 2 months for a newborn baby.

        So even following the CDC schedule this baby wouldn’t have been vaccinated and this still would have happened.

    • tami berman

      A quick search revealed a study that showed if the mother had naturally acquired pertussis infection, her immunity lasts possibly up to 30 years and that she does pass antibodies through the placenta and the breast milk to her baby. Perhaps the Amish mother had not experienced pertussis and therefore had no protection to pass to her baby, however, if she was exposed while breast feeding, she should pass antibodies to her baby, which normally would provide some protection. Your experience seems like a very rare occurrence.

  • All infant deaths are tragic. You do realize that this infant was too young to have been vaccinated anyway. The first vaccine for pertussis is done at 2 months and I do support that – even with it’s known toxic dose of aluminum. I do not however think the idea of injecting every pregnant mom with a huge dose of a neurotoxin (aluminum) while pregnant it wise. It is beyond reckless, as there have been no studies to show safety of injecting aluminum during pregnancy. FIRST DO NO HARM.
    When there is a death from a vaccine preventable disease it makes it especially difficult. How do you avoid thinking you made a mistake by not vaccinating? The challenge is that life is full of decisions that involve risks and benefits. A look at the autism rates for the Amish have shown it to be nonexistent for those who don’t vaccinate. With autism rates now at 1/50 to 1/100, how does a parent decide if they want to take that 1 in a million chance of a pertussis infant death or the 1/100 risk of giving all the vaccines and ending up with an autistic child. You see it’s even more complicated than that, as we cannot prove vaccines cause autism, and we can prove that it was the pertussis in this case that caused the death. How do you balance known risks with unknown ones? Does injecting 330 micrograms with the DTaP, 250 micrograms with the Hep B and 125 micrograms with the prevnar at the 2 month visit, cause harm? You can almost certainly guess it does.
    Driving cars is far more dangerous than not vaccinating. The Amish have reduced mortality and morbidity to a huge extent just by using the horse and buggy. Let’s not judge them for their choices in balancing the risks of this modern world.
    Thanks for your input. I do worry about pertussis mortality in the infant age group and that is why I continue to recommend giving that vaccine on schedule for most families (not those at very high risk for vaccine damage – either due to genetic vulnerability or having an autistic child already).

  • Brooke

    Hi Dr. Paul,

    I have a question regarding vaccination of family members against pertussis when a new baby is born. in light of the information the FDA Recently released about the vaccine effectively protecting against the disease but not the infection (i will paste a link with more info below), would you still recommend cocooning?

    • Brooke

      I couldn’t paste the link, but if you google “FDA 376937” the FDA’s.article should be the first hit you get.

    • YES- most infants still do catch the infection from adolescents or adults in their lives. Why not do what you can (the vaccine is far from perfect but it helps) to reduce the chances that the caregivers and family members would bring the infection home to an unprotected and vulnerable baby?

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  • Elaine

    I keep wondering if the more you research this subject Dr. the more you will be against all vaccines. I don’t see how a person (doctor or not) can’t. And I used to be pro-vaccine. Do you know resources for other states’ vaccine exemptions??

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