Tightening Requirements for Vaccine Exemptions

Legislators said the law was designed to prevent doctors from doling out medical exemptions to children who do not require them and, in some cases, charging for them.

Legislators said the law was designed to prevent doctors from doling out medical exemptions to children who do not require them and, in some cases, charging for them. Shutterstock

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Under a new law in California, state public health officials will have final authority over the validity of children's medical exemptions for vaccinations.

A new law in California gives public health officials the ability to override medical exemptions for children’s vaccinations, a measure designed to target doctors who sell the waivers to parents who do not have valid reasons for seeking them.

“This legislation provides new tools to better protect public health, and does so in a way that ensures parents, doctors, public health officials and school administrators all know the rules of the road moving forward,” Gov. Gavin Newsom, who signed the bill last week, said in a statement.

The bill amends existing California law, which requires children to either be vaccinated or obtain a medical exemption before attending school. As written, the new law creates a review process that grants public health officials final authority over those exemptions, including the power to veto them. 

State officials are currently not involved in the medical exemption process—parents simply obtain a form from their medical provider and submit it to their child’s school. The schools then aggregate their vaccine records and submit those to the state each fall, which can see if they are in compliance with the recommended 95% herd-immunity vaccination rate. State officials do not receive individual exemption forms or information about the doctors who have provided them.

Under the new process, state health officials will review all medical exemptions from schools where the overall vaccination rate falls below the required threshold of 95%, as well as from schools that do not share their vaccination rates with the state. State officials will also review all exemptions from doctors who submit five or more in a single year. If a doctor is found to be “contributing to a public health risk,” he or she can be reported to the state medical board. If that happens, every waiver written by that doctor will be immediately canceled.

Beginning in 2021, doctors will be required to examine patients and then submit their recommendations directly to the state Department of Public Health via a standardized form. Officials there will cross-check those recommendations against federal guidelines.

The bill was necessary, proponents said, after the number of medical exemptions climbed across the state following the passage of legislation that eliminated parents’ ability to obtain exemptions for personal beliefs. Its passage comes after several high-profile measles outbreaks across the country, including five in California so far this year. Passage was prompted by suspicions among lawmakers that doctors had begun charging parents for bogus medical waivers, according to state Sen. Richard Pan, who authored both the new law and the bill that did away with the personal-belief exemptions.

“It is my hope that parents whose vulnerable children could die from vaccine-preventable diseases will be reassured that we are protecting those communities that have been left vulnerable because a few unscrupulous doctors are undermining community immunity by selling inappropriate medical exemptions,” Pan, a pediatrician, said in a statement.

The law grants a grace period to children with existing medical exemptions, allowing their current waivers to remain intact until they pass from one grade span to another (the bill defines grade spans as birth to preschool, kindergarten through sixth grade, and seventh through 12th grades). After July 1, 2021, students with temporary exemptions will require a new one each year, and no exemptions will carry over when a child enters a new grade.

During debate, some residents raised concerns the law could make it more difficult for parents to obtain exemptions for children who need them. Dozens of demonstrators descended on the state capitol while legislators considered the bill, protesting in increasingly fervent ways that culminated at the conclusion of the legislative session Friday when a woman tossed a menstrual cup with what appeared to be blood on the Senate floor while yelling, “That’s for the dead babies!”

After she exited the Senate Gallery, the woman was arrested and charged with assault, vandalism, disorderly conduct, willfully preventing the legislature from meeting, disturbing the legislature, and “willfully and knowingly engaging in any conduct within the state capitol which disrupts the orderly conduct of official business,” according to the California Highway Patrol.

The law takes effect in January.

Kate Elizabeth Queram is a Staff Correspondent for Route Fifty and is based in Washington, D.C.

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