California looks to crack down on vaccine exemptions amid national measles outbreak

SAN FRANCISCO — Against the backdrop of an unprecedented national measles outbreak, California lawmakers are weighing new legislation aimed at cracking down on vaccination exemptions.

On Thursday, Senate Bill 276 goes before the state’s Assembly Health Committee before likely moving on to a full Assembly vote and, ultimately, the desk of Gov. Gavin Newsom. Earlier this week, he expressed concerns that led to amendments to the bill, narrowing its focus. 

The vote comes at a time of heightened concern about both exposure to once eradicated diseases, as well as the potential side-effects of vaccinations on young children.

While a chorus of “anti-vax” voices has been growing across the country, California residents appear largely in the pro-vaccination camp. The state already is one of the nation’s toughest when it comes to avoiding vaccinations.

Jessica Biel, right, shown here at the 89th Oscars along with Justin Timberlake, recently voiced her opinion that a proposed California law making it more difficult to obtain exemptions from vaccines is misguided. (Photo: Dan MacMedan/USA TODAY)

A recent Public Policy Institute of California poll shows 75% of respondents said parents should vaccinate their children, and 80% are concerned that a U.S. outbreak of nearly 1,000 measles cases, the largest in more than 25 years, will continue to spread. At least 52 of those cases were reported in California. 

As amended, the bill is now less specific about what qualifies for an exemption, and considers family medical history as part of the evaluation process. Exemptions typically are granted if a patient has an autoimmune disease or cancer, which may be adversely affected by a vaccine.

California governor Gavin Newsom and his wife Jennifer Siebel Newsom are parents of four young children. Newsom is trying to position himself as a pro-family and child governor, and is likely to sign an amended version of a bill tightening vaccine exemptions if it hits his desk later this summer. (Photo: Salvador Melendez, AP)

Originally, the bill allowed the state’s health department to review and even reject any medical exemption, but as rewritten allows for such reviews only at schools where immunization rates fall below 95%.

Those supporting SB 276 are concerned about the rapid jump in vaccine exemptions across the state since SB 277 went into effect in 2015 — that law ended exemptions based on religious beliefs.

A recent California Healthline survey indicates exemptions for kindergartners in the state have jumped to 4,812 in 2018-2019 from 931 in 2015-2016. (Exemptions for religious beliefs were at 16,817 in 2013-2014, and are at zero now.)

Laws similar to SB 277 are on the books in Maine, Washington and New York. Most recently, the Board of Health in Nashville, Tennessee has expressed an interest in eliminating the exemption based on religion. 

On Tuesday, Newsom said the amendments to SB 276 “will make it workable and addressed some of my bureaucratic anxieties.”

But while supporters of the bill are buoyed by the governor’s intention of signing the bill — especially after he expressed concern about government overreach earlier this month — opponents warn that it puts a bureaucrat between parents and doctors.

Robert Kennedy Jr., left, stands with participants last February at a rally in Olympia, Washington, held in opposition to a proposed bill that would remove parents' ability to claim a philosophical exemption to opt their school-age children out of the combined measles, mumps and rubella vaccine. (Photo: Ted S. Warren, AP)

“The media hype tends to immediately make these issues about vaccination versus anti-vaccination groups, but that’s not where I’m at,” says Assemblymember Devon Mathis (R-Visalia), who is critical of the bill. “I care about keeping the government out of this decision-making process.”

A number of high-profile newsmakers have added their voices to the fight against SB 276, including actress Jessica Biel, who has said she is not anti-vaccines but supports the rights of families to choose, and Robert F. Kennedy Jr., who has called vaccines “a holocaust,” drawing fire from his own family members.

Vaccine exemptions spike

The bill’s author, physician and State Sen. Richard Pan (D-Sacramento), says the state needs an even more robust safeguard against potential epidemics.

“This is about the right of children and their families to be safe at school, and the freedom of those who truly need exemptions from vaccines to get them,” Pan says. “Over 100 schools in California have had excessively high exemption rates, and that’s unsafe.”

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SB 276 takes 277 one step further, targeting “rogue doctors” who are freewheeling with exemptions.

“There are a small number of unscrupulous doctors out there, and we need to make sure they don’t continue,” says Pan, noting that the bill would also trigger investigations of doctors who write five or more exemptions.

The staff of Legacy Pediatrics in Rochester, New York, wanted to stress the importance of vaccination after a measles outbreak in its county. (Photo: Courtesy of Legacy Pediatrics)

Christina Hildebrand, president of A Voice for Choice Advocacy, which opposes SB 276, agrees that unscrupulous doctors should be rooted out. But she says the fear of investigation may cause doctors to be hesitant about writing exemptions even when they’re legitimate.

“You’re penalizing 140,000 other doctors in this state, and the parents and children they serve,” says Hildebrand. “We can’t rush this bill, and there are many questions left unanswered.”

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Among them, she says, are defining what constitutes a fraudulent medical exemption, and allowing for temporary exemptions, such as when a child has a cold, which could count against a doctor’s exemption count record.

“I’m told, ‘Trust your doctor,’ but now I’m being told, ‘Don’t trust your doctor, trust the state,’” she says. “We’re at risk of losing the doctor-patient relationship.”

Measles outbreak fuels debate

That view overstates the targeted focus of SB 276, says Kris Calvin, CEO of the American Academy of Pediatrics, California, which co-sponsored the bill along with the California Medical Association, a professional organization that represents nearly a third of state’s physicians.

Mothers Ariana Rawls, left, of Stratford, and Shannon Gamache, right, of Ashford, talk to reporters about legislative efforts to change the state's vaccination laws, Wednesday, March 13, 2019, at the Capitol in Hartford, Conn. They were among parents and guardians to voice their opposition to ending the ability to claim a religious exemption from the state's school vaccination requirements. Proponents argue the change is needed to protect the health of the general population. (AP Photo/Susan Haigh) (Photo: Susan Haigh/AP)

“The key purpose of this bill is to address the quadrupling of exemptions in California since SB 277 went into effect, because there’s no reason for that,” she says. “It was clear to practicing physicians that having more kids unvaccinated would just hurt those who really do need exemptions.”

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Calvin says a small number of California doctors were seeing parents and “instead of having hard discussions about vaccines, were charging them a lot of money to get out of them,” she says. “This bill tackles that issue.”

But Hildebrand is skeptical that SB 276 will be limited to catching bad actors in the medical profession.

One of her children has a medical exemption for vaccines and she worries about the state possibly denying that exemption should it be investigated if the school falls below that 95% vaccination level.

Officials near anti-vaccination "hot spot" Portland, Oregon, are declaring a public health emergency over a measles outbreak. (Photo: CHAIDEER MAHYUDDIN, AFP/Getty Images)

“So, what options am I left with?” she says. “Do I move out of the state? Well, I’m divorced, so I can’t. Do I homeschool my child, even when she is doing incredibly well in school? There are just too many questions still left unanswered, and the impact of this becoming law could be huge.”

For bill sponsor Pan, SB 276 is a case where the rights of the many may well at times outweigh the needs of the few.

“The opponents of this bill are talking about having a privilege, getting an exemption from vaccines, that could put people in harm’s way,” he says. “People being afraid to go outside because of a measles outbreak, that’s not freedom.”

Follow USA TODAY national correspondent @marcodellacava

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