California Bill to Strengthen Oversight Vaccine Exemptions

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism.   This bogus idea can hurt people by allowing disease to spread.

Despite vocal protests from antivaxxers, The California State Senate Health Committee approved important legislation.  From AP:

A release from California State Senator Richard Pan:

California state health officials grapple with containing the outbreak of measles, Senate Bill 276, authored by Dr. Richard Pan, a pediatrician and state senator representing the Sacramento region and Assemblywoman Lorena Gonzalez, representing the San Diego area, was passed by the Senate Health Committee. SB 276 will strengthen oversight of the medial exemption process, which some doctors in the state are abusing by selling medical exemptions to parents.

“Medical exemptions for required vaccines have more than tripled since the passage of SB 277, putting kids and communities at risk,” said Dr. Richard Pan. “Unscrupulous physicians are profiting from selling medical exemptions to parents seeking to evade laws to protect children at school.  Measles outbreaks in communities with low vaccination rates are now spreading in our country and the world, and our public health doctors and nurses need to be able to protect our schools and neighborhoods.”

“Three years ago, we stepped up our state’s vaccination laws to protect students and the entire public from being exposed to the danger of disease. Now, we’re seeing ant-vaccination parents and a few doctors get around that law by loosely seeking and issuing medical exemptions when families are willing to pay. The real cost is a threat to herd immunity and public health. Enough is enough,” said Assemblywoman Lorena Gonzalez, D-San Diego, principal co-author of Senate Bill 276.

To combat the proliferation of fake medical exemptions, Senate Bill 276 will reshape California’s process to require state-level public health approval of all exemptions. Senate Bill 276 is co-sponsored by the California Medical Association, the American Academy of Pediatrics, California and Vaccinate California.

“As physicians, we know the importance of community immunity, and the role we play in protecting our patients and the public at large. SB 276 will ensure that public health comes first, that no physician is able to act outside the accepted standard of care, and that medical exemptions will be reserved for those rare cases where they are actually needed,” said CMA President David H. Aizuss, MD.

Under SB 276, physicians will submit information to California Department of Public Health (CDPH), including the physician’s name and license number and the reason for the exemption, which CDPH will check to ensure they are consistent with the Center for Disease Control’s contraindications to vaccination. The physician must also certify that they have examined the patient in person.

Additionally, under SB 276, CDPH will create and maintain a database of medical exemptions. CDPH and County Health Officers will have the authority to revoke medical exemptions granted by licensed physicians if they are found to be fraudulent or inconsistent with contraindications to vaccination per CDC guidelines. This authority will give state and county health officers the tools necessary to contain and prevent further outbreaks.

“Vaccinating our patients is one of the most important tools pediatricians have to prevent illness and death,” said Kris Calvin of the American Academy of Pediatrics, California. “It is the rare physician who does not take this responsibility to heart, but they put all of us, our children and our communities, at risk. By ensuring medical exemptions to vaccines are reviewed and valid, this bill will protect the health of California's children and of our larger communities. It is a reasonable and urgently needed measure."

“Vaccinate California is committed to keeping all children safe from vaccine-preventable illness at school,” said Leah Russin, a mother from Palo Alto and co-founder of Vaccinate California. “Senate Bill 276 will help protect our children and rebuild community immunity in California by closing a loophole in current law. A child who has had a heart transplant or a child recovering from cancer has enough to worry about – we applaud this important measure to keep them safe from measles at school.”

As a result of the implementation of Senate Bill 277, which abolished the personal belief exemption in California, overall vaccination rates increased sharply to more than 95 percent statewide.  That is greater than the 94 percent vaccination rate necessary to achieve community immunity to prevent the spread of a measles outbreak.

The increase followed the dramatic increase from 92.9 percent in the 2015-16 school year to 95.6 percent in the 2016-17 school year after implementation of SB 277 in 2016 and a vaccination rate of only 90.7 percent in 2010-11 when Dr. Pan entered the legislature and authored AB 2109. AB 2109 required parents to be counseled before they opted out of legally mandated vaccines.

Despite the success of SB 277 in increasing the overall immunization rate of kindergarten students, California has also experienced a dramatic increase in the number of medical exemptions. Since the passage of SB 277, the rate of medical exemptions has more than tripled (from 0.2% in 2015-16 to 0.7% in 2017-18). Low vaccination rates in certain pockets of the state put children and communities at risk.

A very small percentage of the population, less than 1 percent, suffers from qualifying medical condition, such as a severe allergic reaction to a vaccine component that would lead to the granting of medical exemption.

CDPH reports the number of confirmed measles cases here, which as of April 17 was at 23 confirmed cases. But that number is already out of date as more than 30 cases have been reported around the state. The vaccine schedule prevents other types of diseases as well, including pertussis, (also known as whooping cough), which is marked by severe coughing attacks that can last for months. Infants too young for vaccination are at greatest risk for life-threatening cases of pertussis, and a baby in Orange County died from the disease last week.

When measles spreads in a community with immunization rates below 94 percent, the protection provided by ‘community immunity’ is lost. This means many people are at risk of becoming infected including people who cannot be immunized, including infants, chemotherapy patients and those with HIV or other conditions.

The hesitation to vaccinate on the part of a growing number of parents stems from misinformation such as the now retracted 1998 study that falsified data to purport a link between autism and the measles vaccine.  The study was authored by Andrew Wakefield who was later found to be lying. Also, numerous subsequent studies worldwide involving hundreds of thousands of children have proved that vaccines are safe and do not cause autism. 

The Wakefield Generation and a Record Level of Measles

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism.   This bogus idea can hurt people by allowing disease to spread.

Jacqueline Howard and Debra Goldschmidt at CNN:

Measles cases in the United States have surpassed the highest number on record since the disease was declared eliminated nationwide in 2000.

Overall, there have been 681 measles cases across 22 states this year, according to CNN's analysis of data from state and local health departments.

The states reporting measles cases are Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Tennessee, Texas and Washington.

As of Monday, the US Centers for Disease Control and Prevention reported 626 individual cases of measles confirmed in those 22 states. This includes illnesses reported by state health departments to the CDC through April 19 and therefore does not include cases reported since then.

Soumya Karlamangla at the Los Angeles Times:

Los Angeles health officials warned this week that students and staff at UCLA and Cal State L.A. may be at risk of catching measles, an announcement that has raised questions about universities’ susceptibility to disease outbreaks.

Not only can cramped dorm rooms and crowded classrooms be breeding grounds for contagion, but young adults in California are less likely to be vaccinated than other age groups, experts say. One of the people infected in L.A.’s measles outbreak is a UCLA student, university officials confirmed Tuesday.

People who are now in their early 20s are part of what’s known as the “Wakefield generation,” because they were infants in 1998 when British scientist Andrew Wakefield published a now discredited paper claiming that vaccines cause autism. Scared of the side effects of vaccination, many parents chose to opt out.

Measles and Antivaxxers

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism.   This bogus idea can hurt people by allowing disease to spread.

CDC reports:

From January 1 to April 19, 2019, 626** individual cases of measles have been confirmed in 22 states. This is an increase of 71 cases from the previous week. This is the second-greatest number of cases reported in the U.S. since measles was eliminated in 2000, second only to the 667 cases reported during all of 2014. In the coming weeks, 2019 confirmed case numbers will likely surpass 2014 levels.

The states that have reported cases to CDC are Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Texas, Tennessee, and Washington.

Alfred Lubiano at The Philadelphia Inquirer:

The rebel forces in America’s latest culture war — the so-called anti-vaxxers — are often described as middle- and upper-class women who breast-feed their children, shop at Whole Foods, endlessly scour the web for vaccine-related conversation, and believe that their thinking supersedes that of doctors. Typically their families earn more than $75,000 a year.

That’s based on findings from various studies, including the National Immunization Surveys conducted by the federal Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases.

... 

Reports indicate many of the infected weren't vaccinated. The CDC says that the percentage of children who are unvaccinated has quadrupled since 2001. About 25 per cent of parents are delaying vaccinations or allowing only certain vaccines to be used "cafeteria style," said Jennifer Reich, sociologist at the University of Colorado and author of the book "Calling the Shots: Why Parents Reject Vaccines."

...
"Frankly, these Caucasian, suburban, educated parents believe they can Google the word vaccine and get as much information as anybody," said Paul Offit, a professor of pediatrics and director of the Vaccine Education Center at Children's Hospital of Philadelphia.These people are educated just well enough to make terrible decisions for their children."

...
Vaccine resistance has become a “form of privilege,” Reich said. Educated mothers develop a sense of entitlement that helps them decide which vaccines are unnecessary, Reich said, adding, “They focus on organic foods, health-promoting practices at home — ways they see of mitigating disease risk.”

Dental Care

The Politics of Autism discusses health care, and explains that autism services can be complicated, creating difficulties for autistic people and their families. 

David Tuller of Kaiser Health News at The Washington Post:

People with autism, cerebral palsy and other developmental disorders face enormous barriers to adequate and timely dental care — on top of their other challenges. Many dentists either avoid treating these patients or lack the skills needed to do so. Some patients with developmental disabilities are unable to endure even regular dental exams or cleanings without general anesthesia.

But most dentists don’t offer it and getting insurance to cover it for routine dental work is often a struggle.

Because it is difficult for them to get treatment, people with developmental disorders suffer “a high burden of dental disease,” according to a 2012 study of more than 4,700 patients published in the Journal of the American Dental Association. Thirty-two percent of the patients studied suffered from untreated cavities and 80 percent from serious gum infections.

“Many individuals with developmental disabilities cannot personally maintain their own dental hygiene,” according to a September study by the California Legislative Analyst’s Office (LAO). “Often, they need extra appointments or special accommodations that dentists are unable or unwilling to provide.”

In many cases, patients need these extra appointments to help them get accustomed to the environment of a dental office, including the equipment, procedures and personnel. This can help minimize their anxiety and reduce the need for deep sedation or general anesthesia.

But sometimes there is no alternative to anesthesia.

The Church of Bleach

In The Politics of Autism, I discuss autism quackery.  One particularly dangerous "cure" involves bleach.

Chiara Giordano at The Independent:

A self-described “church” is promoting a dangerous miracle cure which claims to eradicate 95 per cent of illnesses including HIV and autism by making people drink bleach.

The quasi-religious organisation called Genesis II Church of Health and Healing was due to host an event in Leavenworth, Washington, on Saturday to push the “effective alternative healing”.

The group asked for payments of between $450 and $800 per person (£346 to £615) for couples attending the event in exchange for a year’s membership to the organisation and packages of bleach, known as “sacraments”.

From FDA:

Products or treatments claiming to cure autism are deceptive and misleading, because there is no cure for autism. The same is true of many products claiming to “treat” autism or autism-related symptoms. Some may carry significant health risks.

The Food and Drug Administration (FDA) plays an important role in warning companies against making improper claims about their products’ intended use as a treatment or cure for autism or autism-related symptoms.
...
FDA Cracks Down on False Claims
The Food and Drug Administration has warned and/or taken action against a number of companies that have made improper claims about their products’ intended use as a treatment or cure for autism or autism-related symptoms. Some of these so-called therapies carry significant health risks. For example,

• “Chelation Therapies.” These products claim to cleanse the body of toxic chemicals and heavy metals by binding to them and “removing” them from circulation. They come in a number of forms, including sprays, suppositories, capsules, liquid drops and clay baths. FDA-approved chelating agents are approved for specific uses that do not include the treatment or cure of autism, such as the treatment of lead poisoning and iron overload, and are available by prescription only. FDA-approved prescription chelation therapy products should only be used under professional supervision. Chelating important minerals needed by the body can lead to serious and life-threatening outcomes.
• Hyperbaric Oxygen Therapy. This involves breathing oxygen in a pressurized chamber and has been cleared by FDA only for certain medical uses, such as treating decompression sickness suffered by divers.
• Detoxifying Clay Baths. Added to bath water, these products claim to draw out chemical toxins, pollutants and heavy metals from the body. They are improperly advertised as offering “dramatic improvement” for autism symptoms.
• Various products, including raw camel milk, MMS (chlorine dioxide) and essential oils. These products have been marketed as a treatment for autism or autism-related symptoms, but have not been proven safe and effective for these advertised uses.

FDA some quick tips to help you identify false or misleading claims.

• Be suspicious of products that claim to treat a wide range of diseases.
• Personal testimonials are no substitute for scientific evidence.
• Few diseases or conditions can be treated quickly, so be suspicious of any therapy claimed as a “quick fix.”
• So-called “miracle cures,” which claim scientific breakthroughs or contain secret ingredients, are likely a hoax.

If you have a question about treatment, talk to a health care provider who specializes in caring for people with ASD.

The National Institute for Child Health and Human Development has more information about therapies and interventions for ASD, as does the Centers for Disease Control and Prevention.

Increasing Vaccine Coverage

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism.   This bogus idea can hurt people by allowing disease to spread.

At JAMA, Lawrence O. Gostin, Scott C. Ratzan, and Barry R. Bloom have an article titled Safe Vaccinations for a Healthy Nation: Increasing US Vaccine Coverage Through Law, Science, and Communication."

As summarized by the National Academy of Medicine, large clinical trials, and numerous observational studies, have definitively refuted any connection between vaccines and autism.3 Further, multiple vaccines spaced together, another expressed health concern, pose no greater risk. Two doses of vaccine provide 97% protection for measles. “Herd immunity” requires 95% immunization coverage to provide community protection against measles.

...

Policy makers have clear tools to increase vaccine coverage, thus reducing harm to children and their families. Because vaccines play such a critical role in the health of children, a long-term national health communication campaign to build vaccine literacy, potentially called Safe Vaccines for a Healthy America, could be useful in increasing and restoring faith in the safety and importance of vaccines. The dissemination of evidence-based information should be a key part of the program and should be uncontroversial. ... Pediatricians and obstetricians could also counsel parents, reassuring them about vaccine safety. When parents request vaccine exemptions, states could require a physician’s certificate affirming they have discussed vaccines’ benefits and risks, and indicate that they are aware that false responses have legal consequences.

Public information campaigns compete with a complex web of false information. Public health authorities, therefore, should partner with the private sector to improve the informational environment. Encouragement, and oversight, of major social network organizations is needed to stem the flow of misleading information. Private and publicly traded companies should screen out false antivaccine messages and cease providing a platform for harmful exchange of falsehoods that promote childhood disease, just as they do for sexually explicit, violent, or threatening messages. Social media companies could go further, exercising corporate responsibility by disseminating science-based health information to advance societal well-being and vaccine confidence.

The federal government should encourage states to end or tighten religious or philosophical exemptions, following the lead of California, which enacted evidence-based policies. If states fail to act, federal authorities have the power to incentivize compliance. They could, for example, condition a portion of Medicaid or Affordable Care Act funding on states tightening their vaccine laws. Conditional funding should not be overly coercive, and Congress should take steps to avoid harming already disadvantaged populations. While the federal government has limited power to compel vaccination, the Supreme Court has affirmed its use of conditional funding. In 1987, the Court upheld a law conditioning national highway funding based on states enacting a minimum drinking age of 21 years. Immunization is a national problem as childhood diseases transcend state borders; vaccine hesitancy, therefore, requires a national solution.

Trump Would Cut Help for People with Disabilities

In The Politics of Autism, I discuss the issue's role in campaign politics.   In the 2016 campaign, a number of posts discussed Trump's bad record on disability issues more generally.   As his actions as president indicate, he has little use for Americans with disabilities.

Tom Ridge, former GOP governor of Pennsylvania and the first DHS secretary, chairs the National Organization on Disability.  He writes at The New York Times about Trump's proposed cuts to programs for people with autism and other disabilities.

Independent living centers, assistive-technology programs, supports for individuals living with brain injuries and family caregiver support services are among those programs and services on the chopping block. So too is the Office of Disability Employment Policy. This office, within the Labor Department, is the only nonregulatory federal agency that promotes policies and coordinates with employers and all levels of government to increase workplace success for people with disabilities.

...
I agree with Senators Bob Casey and Sherrod Brown, who recently wrote to the director of the Office of Management and Budget and said that any budget proposal by any administration should reflect the goals of the A.D.A.: equal opportunity, independent living, full participation and economic self-sufficiency. The exclusion of any group of people from our economy is not only a problem for those who’ve been excluded. It’s a scourge on our democracy that touches us all.