Gov. Chris Christie created a stir during a trade trip to London this week when he defended parents' right to decide whether their children should get mandated vaccines -- remarks that a spokesman quickly clarified by saying the governor "believes vaccines are an important public health protection."
Back home in New Jersey, where Christie's health commissioner has been a vocal advocate for vaccinations, parents already have the right to make those decisions if they put in writing that accepting vaccines violates their religious beliefs.
In the 2013-14 school year, nearly 9,000 New Jersey children used a religious exemption to decline immunizations that under state law children must receive in order to attend school. The largest number of exemptions were sought in Hunterdon, Monmouth, Warren and Sussex counties, according to state education department data.
A parent need only submit a signed statement indicating "immunization interferes with the free exercise of the pupil's religious rights," according to the health department website. Parents do not need to produce a letter from a clergy member or cite religious doctrine.
When coupled with the 1,592 children who did not receive the shots for medical reasons last year, about 2 percent of New Jersey's student population is unvaccinated, the state data said.
The standard vaccine regimen provides protection against diphtheria, tetanus and pertussis, polio, measles, mumps and rubella, influenza, hepatitis B and chickenpox.
According to the 2013 National Immunization Survey, New Jersey ranked 22nd in the nation for vaccine compliance, with 72.9 percent of New Jersey children ages 19-35 months receiving the recommended vaccine doses according to the U.S. Centers for Disease Control and Prevention. The national average vaccination rate is 70.4 percent, according to the CDC. Rhode Island scored the highest vaccination rate, with 82.1 percent; Arkansas has the lowest rate, at 57.1 percent.
In a report released last week, the Pew Research Center documented the gulf between the public's and the scientific community's views on vaccine requirements. When asked whether vaccines for measles, mumps, rubella and polio should be required, 86 percent of the members of the American Association for the Advancement of Science said yes, compared with 68 percent of the public polled by Pew.
The issue of parental choice in vaccines is under attack as the number of measles cases has dramatically risen nationwide, but particularly in California among Disneyland visitors.
Christie, an all-but-announced presidential contender, took issue with President Barack Obama's statements during a recent NBC interview about the measles outbreak.
"I understand that there [are] families that, in some cases, are concerned about the effect of vaccinations. The science is, you know, pretty indisputable," Obama said. "You should get your kids vaccinated."
Christie responded by saying there should be "a balance" between the government and a parent's right to choose whether a child is vaccinated. Christie said his four children have all been vaccinated, but he walked a line on the issue of whether others should follow suit.
"That's what we do but I also understand that parents need to have some measure of choice in things as well," Christie said. "So that's the balance that the government has to decide."
A White House senior adviser, Dan Pfeiffer, took to social media to urge Christie to "clarify" his vaccination comments because "it's important that responsible leaders speak with one voice."
"To be clear," Christie spokesman Kevin Roberts wrote in an email shortly after the governor's statements, "the governor believes vaccines are an important public health protection and with a disease like measles there is no question kids should be vaccinated."
Christie was calling for "a balance" because "different states require different degrees of vaccination," Roberts said.
Christie's state health commissioner, Mary O'Dowd, has been a vocal advocate for childhood vaccinations. "Immunization is one of the best ways parents can protect their infants from serious childhood diseases before age two," O'Dowd said in a statement last year.
"Through immunization, we have made great strides in drastically reducing infant death and disability in the United States," she said.
A bill introduced in the New Jersey Legislature several times over the years that would make it tougher to get the religious exemption has failed to gain traction. The legislation called for parents to produce a letter from a clergy member and a detailed explanation from a family on how their religious beliefs conflict with vaccines.
Assemblyman Herb Conaway, D-Burlington, a practicing physician and a sponsor of that failed bill, called Christie's remarks very disappointing and, from a medical point of view, disturbing.
"Gov. Christie's wavering comments are irresponsible and endanger the health of our communities," Conaway said. "Science has shown vaccination to be an extremely effective approach to securing public health. The only thing government has to balance is what's best for the overall public health, and that means unambiguously supporting vaccinations."
Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, said Friday that there were 84 measles cases in January. Although the infected people come from 14 states, most of them are linked by their trip to Disneyland.
"It's only January and we've already had a very large number of measles cases, as many cases as we have all year in typical years."
[NJ Advance Media staff writers Matt Arco and Tim Darragh contributed to this report.]