On 20 June 2019, after a long day of testimony on California SB276 from both sides of the mandatory vaccine issue, the assembly health committee voted 9 in favor, 2 against, and 2 abstaining to move forward with the bill which can prevent fake medical exemptions.
This post will describe the amended bill and then shortly address the day’s events.
On 22 May 2019, the California Senate voted in favor of SB276. The bill then passed to the assembly and was assigned to be heard in the Assembly health committee. However, in early June Governor Gavin Newsom expressed concerns about the bill. There followed negotiations between the Governor’s office and the bill’s initiator, Senator Richard Pan, MD, which ended with a substantially amended bill.
I will say now that while SB276 makes concessions, I think overall it is a better, and stronger system, which preserves legitimate medical exemptions and correctly focuses on the doctors writing fake exemptions as the source of the problem, and creates tools to deal with them. And at any rate, the Governor expressed willingness to sign the amended bill – and a signed bill is better than a vetoed one.
In terms of concessions, the main concession of the bill was to remove the ex-ante general review process. In the original version, every medical exemption would have to be reviewed before it is approved. In the new version, a physician would have to submit a copy of the exemption to the department, and the department would create a system to review medical exemptions from schools with less than 95% immunization rates or doctors who submitted more than 5 exemptions.
Examining the SB276 compromises
So a medical exemption for a child in a school with high rates, whose physician only grants a very rare exemption, will not be reviewed.
I think this is a reasonable compromise for SB276. It creates criteria to identify problem spots – problem schools and problem doctors – but saves concerns and efforts for those in non-trouble spots. Yes, it may mean that some children will not face oversight, but there are other measures to oversee problem doctors, and limiting oversight to problem spots would probably already happen in practice, because of scarce resources.
For existing exemptions, the process is a bit more complex. They need to be submitted to the Department of Health by January 1, 2021, but to trigger a review by the department, a local health officer has to determine that the exemption “is fraudulent or inconsistent with applicable federal Centers for Disease Control and Prevention (CDC), Federal Advisory Committee on Immunization Practices (ACIP),” and request review.
In both cases, if an exemption was found invalid the amended bill creates an appeal process. It also clarifies that the officer will be “clinically trained.”
It also broadens the grounds for exemptions: where previously only CDC contraindications and precautions could be valid, no other grounds could be allowed if they are “consistent with the relevant standard of care.”
These changes likely allow for more medical exemptions than under the original act, and more medical exemptions to stand, but they still create oversight. I am comfortable with allowing more discretion than CDC guidelines – extraordinary or complex cases may come up that do not completely fit the guidelines but still merit exemptions, and the process assures that doctors can address these cases while leaving in place a review.
Oversight of physicians writing medical exemptions
Where SB276 adds very strong provisions is in relation to the physicians writing medical exemptions. One reason I am not very worried about the relaxation of some of the elements of the original bill is that these provisions, I think, give powerful tools to deal with physicians abusing their discretion.
First, as with the original bill, the physician needs to actually see the child – no more online or phone exemption.
Second, physicians who are not the child’s treating physician need to notify the child’s treating physician of the exemption. This allows the treating physician to respond to any misinformation in the exemption if needed. Further, they can – if they choose – file a complaint with the medical board against an abusive physician, based on their knowledge.
Third, the form requires the physician to clearly address the contraindication to each vaccine the child is exempt from – no more blanket exemptions from all vaccines for all time with no detailed explanation.
Fourth, the physicians need to certify, under pain of perjury, that the information in the form is accurate. It is unclear whether the state will aggressively act against physicians who are found to have been less than fully truthful on the act, but the possibility of a criminal sanction provides a big stick in the background.
Fifth, the amended bill provides that the parents agree to release the records related to the exemption as part of the medical record form, solving the problems the medical board faced in retrieving records from parents to investigate a claim of fake exemptions.
Sixth, physicians cannot charge for filing an exemption form (though they can charge for an examination), or for renewing a temporary medical exemption (a direct response to the practice of some doctors that only wrote temporary exemptions and made money by charging for renewal).
Finally, and most importantly, the amended bill gives the department of health powers to stop accepting exemptions from a physician in two circumstances:
- if the department determines that a doctor poses a risk to public health,
- or if there is a pending accusation before the medical board related to “immunization standard”.
In other words, the department can completely shut off the ability of an abusive doctor to write exemptions. Together, these provisions make it much harder for doctors to abuse their discretion and write fake exemptions. I think the stronger oversight more than makes up for any weakening of the process.
The SB276 hearing and review
Opponents made much of SB276 requiring a doctor that writes more than five exemptions would be subject to review; and some doctors – for example, those routinely treating children with cancer, may indeed write more exemptions than others. But a review does not mean rejection – physicians treating vulnerable children who should be exempt can write many exemptions, and those will be reviewed and should be approved.
So what happened today? The usual format of such a hearing is an introduction of the bill by its sponsoring legislatures, testimony from both sides – time-limited expert witness testimony, and not time-limited “me toos” – people saying their name, affiliation, and whether they support or oppose the bill. Then there is a discussion by committee members, and then a vote.
The procedure followed that process, but there were some interesting things. There was a morning discussion, and the discussion of the bill started at around 10:40 and went until around 5.
Anticipating a large and aggressive anti-vaccine crowd, the assembly members prepared carefully, allocating an outside area to them and making clear that the number allowed in the building will be carefully limited (to 700 – not a small number), and members will be allowed in to express their support in batches.
The supporters were also provided space, separately, and aside from the few allowed in the room, watched the proceeding on a screen and only went into the room to express support.
Opponents brought with them signs – likely to get around the fact that they were not allowed to speak during the “me toos” – and had yellow stickers saying “lie” on their hands to lift.
Opponents held a rally at 8:30, and gave speeches. Among other things, anti-vaccine activists Robert F. Kennedy Jr. compared the bill to the way Jews were treated in the Holocaust, leading the Jewish Caucus of California to call the comparison out:
Testifying in support of SB276 was a mother of an immunocompromised child who explained the risk fake exemptions pose to vulnerable children, a representative of the California Medical Association, and a health officer. The “me-toos” included representatives of several important organizations, including teachers, nurses, doctors.
Much of the work of organizing the supporters, and on amending the bill, was done by the bill sponsors, including the American Academy of Pediatrics-CA , the California Medical Association, and the grassroots organization Vaccinate California lead by Ms. Leah Russin. Vaccinate California had a leading role at organizing the supporters on site.
The opponents brought several witnesses from out of state, including Attorney Kim Mack Rosenberg from New York and Robert F. Kennedy Junior. They also presented a parent of an alleged vaccine-injured child, and two doctors, including Dr. Bob Sears, who has been – and is – under investigation by the medical board, among other things for fake medical exemptions.
Robert F. Kennedy was, apparently, supposed to testify, but the other witnesses used up the allotted time. Anti-vaccine activists complained about that, but the time allotted was equal between the sides – if anything, the opponents got extra time, since one witness who was signed up as neutral was clearly opposed to the bill.
The opponents “me-toos” were lengthy, as many people presented their opposition. Many held signs or tried to give additional comments, and in some cases, the microphone had to be shut down.
After the testimony, the committee discussed the bill – with Dr. Pan fielding many questions. Dr. Pan’s behavior throughout was impressive – in the face of angry sounds from the opponents, and more than one nasty comment, he remained cool, collected and professional, answering questions – some repeated – patiently and at length.
The final vote was 9 for the bill, 2 opposed, and 2 abstaining.
Opponents, visibly very upset after the vote, remained in the building, singing songs and shouting slogans.
SB276 is now moving to the Assembly appropriations committee, and if successful there, to the assembly floor and to the desk of the Governor, who has already expressed support of the amended bill.
This article is by Dorit Rubinstein Reiss, Professor of Law at the University of California Hastings College of the Law (San Francisco, CA), is a frequent contributor to this and many other blogs, providing in-depth, and intellectually stimulating, articles about vaccines, medical issues, social policy, and the law.
Professor Reiss writes extensively in law journals about the social and legal policies of vaccination. Additionally, Reiss is also a member of the Parent Advisory Board of Voices for Vaccines, a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease.
Good news! Governor Gavin Newsom has announced his support of SB 276.
Dr. Pan and the sponsors of the bill have agreed on amendments that will ensure fake medical exemptions do not undermine community immunity. This means SB 276 has the Governor’s FULL SUPPORT as we head into Thursday’s hearing.
The amendments make clear that exemptions will be reviewed if they are:
- Written by a doctor who has signed more than five exemptions in any year
- Written for a child who attends a school where fewer than 95 percent — the immunization threshold for preventing outbreaks in a community — of its students are up to date on vaccines
This was all made possible because of your calls and emails urging Governor Newsom and the Assembly Health Committee to support the bill. Thank you for all you have been doing! Please keep calling and sending messages — the Assembly Health Committee will consider the bill THIS THURSDAY.
Re: “Walters: Newsom comment links California vaccination, abortion debate” (Opinion section, Mercurynews.com, June 5):
In his column on Gov. Gavin Newsom’s misguided anti-vaccine comments, Dan Walters uncritically conveys an anti-vaccine fallacy: Support for increased vaccination rates is inconsistent with support for women’s reproductive rights. How, Walters wonders, can the governor support the tougher vaccine requirements of Senate Bill 276 and still support a woman’s right to choose? The answer is simple.
A woman has autonomy over her own body. The decision about whether to have an abortion is between her and her doctor because the decision affects only her. When parents pursue fraudulent medical exemptions, they are making a choice that affects others, including children unable to be vaccinated.
SB 276, cosponsored by California physicians, addresses only fraudulent medical exemptions and leaves legitimate medical exemptions intact. Anyone opposing SB 276 in the name of the ‘physician-patient relationship’ is really saying that a few cheaters should be able to jeopardize the health of all our children.
Leah Russin, Cofounder, Vaccinate California, Palo Alto
/ News /
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.
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.
/ News /
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.”
/ News /
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.”
/ News /
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.
/ News /
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.
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.
My 2 year-old son, Gideon, has been sick since the day he was born. First, it was weight gain, or lack there of. We discussed a feeding tube, but at the time it seemed so daunting. Little did we know that this feeding problem would portend health problems that would make tube feeding seem like child’s-play.
At around 4 months of age, Gideon began having seizures. The same week, he woke up one morning, he woke up having lost ALL his milestones. Within one week, my sweet baby had gone from a skinny but thriving 4 month old to a blind and deaf helpless creature whose body was over run by seizures.
We were quickly admitted to the hospital where Gideon was diagnosed with West Syndrome, a form of infant onset epilepsy known in the literature as the “Catastrophic Diagnosis” due to the high percentage of children who end up with life long disabilities. The first line of defense to West Syndrome, also known as Infantile Spasms is a high dose course of steroids.
Our doctor was very clear-the steroids would destroy his immune system. “You must be careful!” she said in her powerful Italian accent. “Don’t take him anywhere! No restaurants, no movies, no stores, no play dates AND no vaccines for the next 6 months!”. I was terrified of the diagnosis and the thought of him being out in a community with some of the lowest vaccination rates in the nation.
During the course of the steroids, my daughter’s teacher had to come to the street to pick her up and drop her off because I couldn’t bring my son into the classroom. She was stripped and scrubbed to the skin and changed before coming back into the house after school. We all washed our hands until our skin cracked. I relied on others to do my grocery shopping and other chores.
Gideon survived the course of steroids without further illness, but the steroids did not cure him of his epilepsy. Since his initial diagnosis, we have spent over 100 nights in the hospital, each night the heartbreaking ritual of a family unwillingly living apart. Advocating for my children as we navigate medical care and all the governmental and private agencies involved is a full time job that I must get done in addition to being their Stay at Home Mom.
And Gideon, though off the steroids, is still medically fragile. He recently contracted a mild flu. For Gideon, it was a formidable illness. Due to his cerebral palsy, he began gagging on his secretions causing him to vomit so frequently that he became dangerously dehydrated and lost 3 pounds in one week. He also presented with neurological symptoms similar to what he had the last time his epilepsy got out of control. We rushed him to the Emergency Room and he spent over a week in the hospital recovering.
In the world of the medically fragile, Gideon has it pretty good. He is not completely homebound, he is allowed to touch his sister, unlike the kids in the transplant ward. These precious children are suffering and struggling just to stay alive and their families are under relentless stress just to manage the requirements of day-to-day life. Here in CA, we now also live in fear of our children contracting one of the vaccine preventable illnesses that plagued generations past. This is simply unacceptable.
In order to keep these children alive, it is essential that we restore herd immunity to vaccine preventable illnesses. To vaccinate a child attending school is no more a matter of personal choice than to drive drunk on a public road and I am filled with the same rage towards those who choose not to vaccinate as I do towards those who put innocents at risk by driving drunk. But rage gets me nowhere and its time for action. This is why am working on SB277. I love this bill because it DOES NOT take a way a parents right to make their own choices about vaccination. It simply states that if a family chooses not to vaccinate they must find alternative methods of schooling their children.
Although I still personally question why anyone would choose not to vaccinate given the clear scientific benefits, I must admit that to force such an action would be unconstitutional. It is essential though, that we ask anyone who makes that choice to keep their children isolated from those who are vulnerable to these terrifying illnesses. We can only thrive as a society if we think not just about ourselves but about our community at large. I urge you to call your Senator and ask him or her to vote yes on SB277. It is medically, ethically, and legally a perfect solution to a public health crisis.