In California, AB2109, which reduced nonmedical exemptions for the first time in over a decade from 3.15% to 2.5% in 1 year, did not restore community immunity. The 2015 measles outbreak, beginning at Disneyland, spread across California and the country, reminding the public they were no longer safe from measles. Parents demanded action, and I authored SB277, abolishing nonmedical exemptions, which became law despite vociferous, well-funded opposition by antivaccine groups. In SB277’s first year of implementation, California’s kindergarten class achieved a vaccination rate of 96% through educational and public health efforts to increase public awareness and improve compliance with state vaccination laws.5 Further evaluation is needed to fully determine the success of SB277; however, numerous pediatricians have informed me that they now need to spend less time persuading families to vaccinate their children, but there are also reports of some physicians monetizing their license by selling medical exemptions.6
Thus, vaccination policy should not only address barriers to nonmedical exemptions but also address medical exemptions and the role of antivaccine groups in endangering public safety. Standards of care for granting medical exemptions must be clearly defined by the medical profession, and public health authorities should review medical exemptions to ensure these standards are met. Organizations that set professional standards (including certification boards, medical specialty societies, and licensing bodies) should sanction physicians who seek profit from unprofessional conduct that undermines public health and endangers children and communities. Antivaccine physicians tout these credentials to gain credibility with parents. In addition, policymakers need to establish consequences for people profiting from spreading misinformation that enables the spread of disease. Half of all Twitter posts about vaccines contain antivaccine beliefs.7 Just this year in Minnesota, antivaccine groups targeted a community, causing a significant drop in vaccination rates.8The resulting measles outbreak exposed >8000 people, sickened 79 (of which 73 were <10 22.="" a="" and="" hospitalized="" href="http://pediatrics.aappublications.org/content/141/1/e20173449#ref-9" old="" years="">910>
Most importantly, pediatricians need to build the political will to pass effective vaccine policy. Antivaccine groups are organized and well funded, and they resort to intimidation and threats to suppress proscience advocacy on social media10 and in legislatures. To create the political will to pass SB277, we organized proscience parents to lead a broad coalition of not only physicians and public health advocates but also education, business, labor, and local government groups. Educating the public that vaccines are safe and effective is not enough. To protect our children and communities, child health advocates must organize proscience parents who care about public safety in their community to campaign for laws to restore community immunity. Vaccines work. Every child needs community immunity. For our children’s safety, we must fight back.