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.