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Joanna Pearstein – WIRED

In the past few years California has gained ground in its fight to protect children from infectious diseases. But new data released this week shows that the state’s vaccination rate declined for the second year in a row.

Last fall 94.8 percent of California kindergartners had received all their shots, down from 95.6 in 2016-2017. That drop may look small, but California has about as many kindergartners as Wyoming has people. The most recent figures show that California now falls below the Centers for Disease Control and Prevention’s recommended vaccination rate of 95 percent, considered necessary to protect a community from disease outbreaks through herd immunity. Those numbers also obscure big differences in vaccination rates from one zip code to another, from as low as 19 percent in one community in northern Los Angeles County to as high as 99 percent in Watsonville, a farm town in Santa Cruz County.

Four years ago, following a measles outbreak in Southern California that began at Disneyland, California passed Senate Bill 277, a law that eliminated parents’ ability to opt out of mandated vaccinations for their kids based on personal beliefs. At first, the law seemed to be working. When it was passed, 2.4 percent of kindergartners in California weren’t vaccinated because of a personal belief exemption; today, that figure is zero.

But children can also skip vaccinations if they receive a permanent or temporary medical exemption from a doctor; these are typically given to children who have health conditions, like immune system disorders, that contra-indicate vaccination. Five years ago, just 0.2 percent of California students received a permanent medical exemption, while 2.5 percent claimed a personal belief exemption, or PBE. Since the PBE’s elimination, permanent medical exemption (PME) rates have begun to climb, from 0.7 percent to 0.9 percent for the past year.

California Department of Public Health data suggests that communities in which PBEs were popular in the past may now be obtaining PMEs. As Barbara Feder Ostrov reported in Kaiser Health News earlier this spring, many schools that previously claimed the highest PBE rates now have high PME rates.

New data released this week backs up this analysis. The California schools with the highest exemption rates today—we’re talking rates of 40, 50, even 64 percent of a group of a few dozen kindergartners—had PME rates of zero five years ago. So five years ago, kindergarten classes at these schools had no children whose health was compromised to the degree that they could not medically handle immunizations. At the time, those same schools claimed very high PBE rates—ranging from 35 percent to 87 percent. About half of the schools with the highest PME rates are Waldorf schools. (Waldorf schools follow an educational model developed by Rudolf Steiner and Emil Molt that emphasizes bringing out each child’s individual potential in a way that serves humanity.)

Take Yuba River Charter, a Waldorf-affiliated school in Grass Valley, California. (Grass Valley is northeast of Sacramento, in a county where 10.6 percent of kids have a PME and only 80.3 percent are fully vaccinated.) In 2013, more than two-thirds of Yuba River Charter’s kindergartners claimed personal belief exemptions. Today, that figure is zero. But just 36 percent of students at the school are vaccinated, with the remainder claiming a permanent medical exemption. (Administrators did not respond to a request for comment.)

Private schools have lower immunization rates than public ones: This year 95 percent of children entering public kindergarten had all their shots and 0.7 percent had medical exemptions, while 92.9 percent of private school kindergartners were fully vaccinated and 2.4 percent claimed permanent medical exemptions.

The permanent medical exemption rates don’t tell the whole story, says Leah Russin, executive director of Vaccinate California, a parent group that advocates for vaccination. (WIRED contributor Renee DiResta is a cofounder of Vaccinate California.) Russin explained that the state also reports on the percent of students who enter schools conditionally—meaning they aren’t fully vaccinated but plan to be in the future. Those numbers include students who have received a Temporary Medical Exemption from their physician. “Kids might not receive a permanent exemption because a temporary exemption is all that’s being offered by the doctor they’re working with,” Russin says. “There’s one doctor who will give a 90-day temporary exemption if you call, and then you have to follow up and get one for a longer term.” (Earlier this year Voice of San Diego identified a single physician behind one-third of medical exemptions written for students in the San Diego Unified School District.)

Through a public records request, Russin received data from the California Department of Public Health that breaks out the share of students who received temporary medical exemptions. In the 2018-2019 school year, dozens of schools had TME rates of 10 percent or higher, while their PME rates are low. At Highland Hall Waldorf school, in the Northridge area of Los Angeles, 34 percent of students have a temporary medical exemption, while only 4 percent have a permanent exemption. Thirty miles east in Altadena, it’s a similar story at another Waldorf school. “All members of our association are independent and make decisions in accordance with our membership and accreditation criteria,” says Beverly Amico, executive director for advancement at the Association for Waldorf Schools of North America. “These criteria include the expectation that all schools be compliant with national, state, provincial, and local laws.”

The augmented California data, which Russin shared with WIRED, shows a statewide TME rate of 0.2 percent—that’s on top of the 0.9 percent of students receiving permanent medical exemptions, bringing the state’s total medical exemption rate to 1.1 percent.

Click here for a larger view of this map.

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The rise in medical exemptions has not gone unnoticed. Last month the California Senate passed SB 276, a bill that would set statewide standards for medical exemptions. Authored by California senator Richard Pan, a pediatrician from Sacramento, the bill aims to reduce the rising rate of medical exemptions in the state and is supported by the California branch of the American Academy of Pediatrics and the California Medical Association. The bill now moves to the California State Assembly for consideration; there are questions about whether governor Gavin Newsom will sign the bill should it reach his desk.

The rise in medical exemption rates isn’t entirely a surprise, says Catherine Flores Martin, executive director at the California Immunization Coalition, a Sacramento-based nonprofit that supports immunization. “We knew that after SB 277 passed the medical exemptions would go up, because we thought that some PBEs might really be medical exemptions that weren’t formalized by the parent.” But the rates continue to rise. “Some physicians are writing these exemptions for things that do not fall under established guidelines, and that’s not safe for public health.” Senator Pan’s bill doesn’t mandate immunizations, Flores Martin says; parents who choose not to can, for example, opt to home-school their kids. “Nobody is forced to vaccinate their children.”

No one in California is forced to vaccinate children, but in the wake of a measles outbreak in Brooklyn, the New York City health department recently mandated that people who work or live in four zip codes get the measles, mumps, and rubella vaccine or face a $1,000 fine. (Medical exemptions, however, are permitted.)

Last month a paper in The Lancet Infectious Diseases identified the 25 US counties most at risk of a measles outbreak. Three California counties, Los Angeles, San Mateo, and San Diego, made the researchers’ top 25 list. According to California Department of Public Health data, while 98 percent of San Mateo kindergartners and 96.4 percent of LA kids received the MMR, only 94.3 percent of San Diego kids were fully protected against measles, below the herd immunity level of 95 percent. This year 51 people have contracted measles in the state, with 10 cases in Los Angeles to date.

From doctors to immune-suppressed children, everyone benefits from SB 276 

SACRAMENTO, CA – Vaccinate California, a parent advocacy group working to improve public health across the state, today issued a statement in response to full Senate passage of Senate Bill 276, which was voted off the floor in a 24-10 vote.

“The recurrence of measles and other vaccine preventable disease is too serious a threat to our children to ignore. Vaccinate California and thousands of parents across the state applaud the Senate for passing this important bill that will help protect all California children,” said parent and Vaccinate California Co-Founder Leah Russin.

SB 276, authored by Senator Richard Pan, will enhance the exemption laws preventing students from getting the required immunizations before admittance to a school. Under SB 276, medical exemptions will be reviewed by theCalifornia Department of Public Health (CDPH). Additionally, the CDPH will create and maintain a database of medical exemptions to keep track of fraudulent or inconsistent requests. 

“My daughter will be on immunosuppressants for the rest of her life. We count on others being vaccinated to protect her from measles, whooping cough, and other preventable diseases. This bill will give us peace of mind that she can safely attend school and her dance classes,” said Jenni Balck, a Ladera Ranch resident and mother to an immune-compromised 10-year-old daughter.

San Leandro resident and school nurse Joan Edelstein said lax exemption laws put her daughter’s premature baby in danger. “My daughter just had a 3 ½ pound preterm infant who can’t be vaccinated against measles and is highly vulnerable,” Edelstein said.

“As a pediatrician and the mother of a childhood cancer survivor, I know the importance of vaccines,” said Erin Holsinger, an M.D. from Palo Alto. “No person should have to worry they that will catch one of these potentially fatal diseases in the classroom, doctor’s office or community.”

Kayla Colburn, a mother in Palo Cedro near Redding, said, “The day after my new baby was born in April, Shasta county announced another case of the measles. A week later another local baby too young to be vaccinated was diagnosed, as well. SB 276 will ensure that our community and schools are as safe as possible for these little ones!”

This vote comes days after Congresswoman Kim Schrier, M.D., introduced theVaccines Act of 2019, which aims to fund research into effective ways to encourage parents to vaccinate.

“Vaccines were one of the greatest medical accomplishments of the 20th century and have been proven safe and effective at preventing diseases that once killed or greatly harmed people around the world,” said Rep. Schrier in a statement.

“We are very grateful for the leadership of Dr. Pan and the members of the Senate who voted with him,” said Leah Russin. “We look forward to moving the bill through the Assembly.”

Hannah Wiley – The Sacramento Bee

Dr. Richard Pan has fought the vaccine fight before.

First, as a pediatrician in Philadelphia during a deadly measles outbreak. Then, four years ago, as a doctor-turned-lawmaker who battled death threats and a coalition of parents enraged over Pan’s 2015 legislation. The proposal — Senate Bill 277 — cut the personal belief exemption from a list of approved reasons not to immunize a child.

The new law dealt a major blow to anti-vaccine advocates who relied on religion or philosophical convictions to avoid vaccinations. California parents who wanted to send their children to school now had to vaccinate their kids.

Now Pan is taking his defense of California’s vaccination system a step further with a measure that would put the decision to grant any exemptions in the hands of a state public health official.

“Doctors are the only ones who know their patients well enough to make medical decisions such as which vaccines a child should or shouldn’t receive,” said Dr. Shannon Kroner, an educational therapist and co-organizer for the rally. “It should never be up to a third party to make that type of medical decision.”

His idea has an alliance of 1,000 family members, doctors, alternative healthcare practitioners and members of parental rights and religious groups headed to the Capitol in advance of a Wednesday hearing to oppose legislation they consider an “overreaching bill.”

Kroner, who is not authorized to administer medical exemptions, will join representatives from across the anti-vaccine spectrum. They include families who distrust pharmaceutical companies, those who doubt the “government bureaucrats” in the public health department and many who believe vaccines cause irreversible medical injuries.

Two doctors will be testifying against the bill, the rally’s spokesperson Dawna Shuman said. The organizers also have scheduled a demonstration following the hearing.

But in the past few years, Pan says doctors have often faked, exaggerated — or in some instances, sold — medical exemptions to vaccine-skeptical and denying parents.

“I have dedicated my career to keeping children and our communities safe and healthy,” Pan said, whose statement on the issue says some doctors are “monetizing their exemption-granting authority and profiting from the sale of medical exemptions.” 

Since SB 277 passed, medical exemptions are rising in California. The rate of medically exempt kindergarteners rose from 0.5 percent to 0.7 percent in the 2017-2018 school year, and now equals 4,111 kindergarteners. There are nearly 30,000 kindergarteners who are not fully vaccinated, including more than 1,000 attending school in Sacramento.

Doctors are leveraging conditions like “asthma, eczema, food allergies, speech delays, a family history of a variety of things including autism,” said Dean A. Blumberg, associate professor and chief of the Pediatric Infectious Diseases department at the University of California, Davis.

“Parents are basically doctor-shopping,” Blumberg explained. “They are going to physicians that have reportedly been giving exemptions that are far, far outside of routine medical practice guidelines for what traditional, conventional medical doctors would consider as a reasonable underlying condition that should result in a medical exemption.”

Under Pan’s measure, Senate Bill 276, the State Department of Public Health would create a standard form doctors would fill out to seek a medical exemption for students to allow them to enroll in school. The physician would have to send the document to the department to be approved or denied by the state public health officer. The measure also would establish a database to track doctors who are filing for exemptions, and for what reasons.

The California Medical Association, which represents 44,000 doctors statewide, and parents of some of the state’s sickest children support the measure.

Among them is Siobhan Kelley, whose son Miles Page, 4, lives with a congenital heart disease and hypertrophic cardiomyopathy, a condition that compromises heart functioning.

Although Miles is fully vaccinated now, Kelley told The Bee, there were several times his vaccinations were delayed due to surgeries and illness.

During that time, Kelley said she’d have to take diligent care that Miles was not exposed to any communicable disease that could risk his life.

That meant avoiding Santa’s lap during Christmas time. It meant forgoing family dinners at restaurants during flu season and fearing that someone near Miles had “made a choice that is going to cost my kid their health, and potentially their life,” Kelley said.

“That’s just the reality of life for a lot of families that have kids with special medical conditions,” Kelley said. “These are the kinds of restrictions on everyday life that we live with.”

She said she’d come to the Capitol in defense of the bill herself, if she could. But Miles, who had part of his skull removed after he recently fell due to complications from a stroke, has a procedure scheduled on Tuesday.

“I don’t have the luxury of rejecting science and medicine. I just want my kid to be able to go to school,” she said. ”To see people buy fraudulent (exemptions) as a way of deliberately not vaccinating a child who could be vaccinated…I think if they had gone through what families like mine have gone through, they would make a different choice.”

Denise Dador – ABC 7

The measles outbreak is still active, and while the word is getting out about the importance of vaccines, public health experts are voicing another concern: the rate of medical exemptions is on the rise.

The measles outbreak weighs heavy on new mom Brady McTear’s mind.

“It feels like its just scary times, you know? I don’t want my baby to get the measles,” she said.

Her two sons, 7-month-old Oliver and 3-year-old Remy, recently received their measles vaccine slightly ahead of schedule.

“We’re going on vacation,” McTear said. “We might be going out of the country, so we decided to vaccinate early.”

McTear is also a school teacher who knows firsthand about California’s strict vaccination law that doesn’t allow personal belief exemptions. A new booster bill, SB 276, is aimed at closing another loop hole: excessive medical exemptions.

“This law is now being undermined by a small handful of unethical doctors that are putting children at risk for disease while profiting from selling inappropriate medical exemptions to misinformed patients,” the bill’s author, State Senator Dr. Richard Pan, said.

Since 2015, Pan said the number of medical exemptions has tripled. The new bill would strengthen oversight.

“The schools will certainly be informed that they should not accept any medical exemption that was not approved by the department of public health,” he said.

Pediatrician Dr. John Rodarte of Descanso Pediatrics welcomes the added review.

“There are some doctors who are willing to write medical exemptions for reasons that really are probably not very legitimate,” he said.

Rodarte hopes it will eliminate the market for fraudulent exemptions and encourage education.

“A big part of my job is educating on what is the safety of vaccines; why it’s important to get those and why we don’t give out medical exemptions unless they’re truly needed,” he said.

Groups who oppose the bill argue a child’s own doctor should be more knowledgeable about their patient’s personal health needs than the state. McTear hopes the proposed bill won’t jeopardize parents who need the exemptions.

“It should be a streamlined and easy process,” McTear said.

The extra layer of review is going to cost more money, but legislators say not as much as a measles outbreak.

“That cost is much less than what we’re experiencing right now,” Pan said.

The bill is awaiting approval from the State Senate Appropriations Committee.

ROBIN ABCARIAN – Los Angeles Times

I thought the vaccination wars in California pretty much fizzled out in 2015 after we outlawed religious and “personal belief” exemptions for children whose parents don’t want to immunize them against diseases like pertussis, measles and mumps.

Silly me.

Lack of faith in scientific consensus is a sad but permanent feature of our social media-driven world. Paranoia is an effective business model.

Parents who oppose vaccines are not stupid; in fact, they are often surprisingly well-educated, considering the pseudoscience and unfounded claims they are willing to embrace.

It should come as no surprise, then, that many have found a way around the law, which still allows for medically necessary exemptions.

They have turned to physicians willing to provide bogus medical exemptions, which is why Democratic state Sen. Richard Pan, a pediatrician, is pushing for the passage of a law that would require health officials to sign off on medical exemptions to ensure their validity.

The law, co-sponsored by Democratic Assemblywoman Lorena Gonzalez of San Diego, makes good sense.

Predictably, it has aroused a tremendous amount of anxiety among parents who believe their children have been “vaccine injured” or are “medically fragile,” or those who simply don’t think the government has the right to stick its nose into the patient-doctor relationship.

Carrying babies, pushing strollers, holding the hands of their youngsters, angry parents turned out by the hundreds in Sacramento on Wednesday at a Senate Health Committee hearing to protest the bill. One by one, for more than four hours, they stated their objections.

Some took a moment to vilify Pan, who also led the 2015 battle to end religious exemptions.

“They’re my kids, they’re not your guinea pigs,” said one father.

“Shame on you,” said a mom holding a “Pan lies” sign.

“You’re a tyrant,” said a man who described himself as the father of a “a healthy, fully unvaccinated child.”

“Sen. Pan, I believe you are committing crimes against humanity,” said a Bay Area mom.

Pan stood at a lectern, listening respectfully, as he was accused of violating the Nuremberg Code, the U.S. Constitution and of imperiling his mortal soul.

“I am a pediatrician. My job is to help children and protect children,” Pan told me Thursday morning, after his bill passed in committee on a party-line vote of 7 to 2. “I have tremendous sympathy for the parents there whose children may be suffering from something. If you have a loved one who is sick, you want to know what caused it.”

Sometimes, there simply are no satisfying answers.

Vaccination rates in California, thankfully, have gone up, in some cases dramatically, which shows the effectiveness of legislation like Pan’s. However, there are still pockets of resistance. As my colleague Soumya Karlamangla reported last July, in a big chunk of the state’s elementary schools, 90% or less of kindergartners had all their required shots. At 20 schools, more than a quarter of the children had medical exemptions, a statistical impossibility given that about 3% of the population may have a legitimate medical reason to forgo vaccines.

To prevent outbreaks of highly contagious illnesses like measles, epidemiologists say, 95% of children in a school should be immunized.

But where there is a will to avoid vaccines, parents have found a way.

One legislative staffer sent me screenshots of parents advising each other on where to find physicians willing to write the exemptions and how much they charge. (“The doctor I went to gives medical exemptions for eczema,” said one mom. “Paid upfront $285.”)

Last month, Voice of San Diego reported that a single physician has written one-third of all medical exemptions given in the San Diego Unified School District since 2015.

There are very good reasons for some children to avoid vaccines — a child with severe, life-threatening allergies, for example, or a child whose immune system is depressed by HIV/AIDS or chemotherapy.

The idea for Pan’s bill came from West Virginia, which has one of the most stringent vaccination policies in the country and has not had a confirmed measles case since 2009.

Imagine that: California, which is ranked the No. 1 state for public health, is using West Virginia, which is ranked 49th, as a role model.

On Thursday morning, California public health officials announced that 38 cases of measles have been diagnosed this year, 15 of them in the last week, including at UCLA and Cal State L.A. That afternoon, UCLA officials announced that more than 100 students and staff members would be quarantined for at least a day.

Young adults who were not vaccinated as children may be at particular risk because they were too old to be affected by California’s 2015 law. Their parents were probably influenced by the discredited work of Andrew Wakefield, the British physician whose license to practice medicine was revoked after he alleged a link between vaccines and autism in the late 1990s.

Vaccines do not cause autism. This is a fact.

I expect to be deluged with responses from readers who believe otherwise. Yes, I know there is a vaccination court that pays money to people who can convince it that they have been injured by vaccines. Yes, I know you cannot sue pharmaceutical companies for harms you think are caused by vaccines. (That’s why the vaccine court was created; so lawsuits would not drive vaccine makers out of business, because vaccines are so important to our health. The court has not awarded a cent to anyone claiming that a vaccine caused autism.)

Yes, I know that a very small number of children have had adverse reactions to vaccines, some catastrophic.

And yes, there still exists a kind of hysteria about vaccines among certain portions of the population, and this is why we are seeing a resurgence in diseases like measles, once believed to have been eradicated.

Vaccines — cited by many scientists as a more important human advancement than antibiotics — are a victim of their own success.

More than one parent in Sacramento on Wednesday claimed to be the parent of “healthy, unvaccinated children.”

But that’s the thing.

You are healthy until you are not. If a child is not vaccinated and comes in contact with someone who has measles, or chickenpox or another preventable disease, that kid may get sick.

And perhaps the kid will transmit the disease to someone else’s child who cannot be vaccinated because he or she has cancer, takes immunosuppressant drugs or is severely allergic to vaccines. Even if you are willing to gamble on your own kid’s health, repugnant enough, you shouldn’t be able to gamble on the health of someone else’s child.