1. What does the new law do?
In California, children are required to be vaccinated, or have a medical exemption, to attend school. The new law creates a review process that gives public health officials the final say on those waivers, with the authority to reject them. Reasons for medical exemptions must still follow strict guidelines, and doctors will now be barred from charging any fees for exams or forms related to them.
Sen. Richard Pan, D-Sacramento, the law’s author, said he was concerned when the number of medical waivers rose across the state after a previous law that he wrote eliminated personal-belief exemptions in 2016 but kept medical exemptions intact. Pan said his goal this year was to keep physicians from issuing waivers for payment or for reasons that are not allowed.
The law, signed by the governor last week, requires doctors to examine patients and submit their recommendations to the state Department of Public Health. State officials will then cross-check recommendations against guidelines from the Centers for Disease Control’s Advisory Committee on Immunization Practices or the American Academy of Pediatrics.
Currently, the state is not involved in how students are granted medical exemptions. Parents get them from doctors and submit them to schools, and schools with kindergartens are required to submit aggregate data to the state each autumn. The state does not receive exemption forms or information about doctors writing exemptions, according to the Department of Public Health.
Starting next year, parents will continue to get waiver letters from doctors, as they do now, and submit them to schools. In 2021, the state is set to have a standardized form and a new submission process: Doctors will send exemptions directly to the state for review and dissemination to schools.
Once the law takes effect in January, state health officials will begin reviewing all medical exemptions at schools in which fewer than 95% of students are vaccinated. They will also review doctors who submit five or more exemptions in one year as well as schools that have not shared vaccination rates with the state.
If the state determines a physician is “contributing to a public health risk,” it will report the physician to California’s medical board. The state will cancel waivers written by doctors who are under investigation by the medical board.
“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” by local doctors selling inappropriate exemptions, Pan said in a written statement.
Kids with medical exemptions issued before next Jan. 1 may keep their exemptions until they move into the next grade span. The spans are defined as birth to preschool, kindergarten to sixth grade and seventh to 12th grades. After July 1, 2021, students with temporary exemptions will need to receive a new one each year, and no exemptions will carry over when a child enters a new grade span.
2. How did we get here?
Vaccinations have been a hot issue in California for several years, even though nearly 95% of kindergartners were fully vaccinated in the last school year. At the same time, the portion of kindergartners with medical exemptions has been rising since personal-belief exemptions were eliminated. Last year, nearly 1% of kindergartners — 4,812 of them — had exemptions. In some places rates are higher: The legislation notes that 16 counties had kindergarten vaccination rates lower than 90% in the last school year.
Pan’s latest proposal drew opposition groups to the capital for weeks of protest, at times all but shutting down meetings and regularly scheduled operations in the Capitol building. Advocates for Physicians’ Rights, Physicians for Informed Consent and parents from across the state testified against the bill in committee hearings, saying their children had been injured by vaccines and that they didn’t want to be required to obtain more immunizations. Some also said their children had autoimmune disorders or similar conditions and many feared the bill would dissuade doctors from providing new exemptions.
Anti-vaccination activists reacted similarly in 2015, when Pan first proposed elimination of personal-belief exemptions. At that time, he agreed that a medical exemption is absolutely up to a physician and argued that parents would be able to find a practitioner to sign a form.
And, to the surprise some of the bill’s supporters, Gov. Gavin Newsom also had reservations.
Initially, he expressed concern about state involvement in the doctor-patient relationship. But after negotiations with the author and some amendments, Newsom said he would support the proposal. But as the bill advanced through the Legislature, Newsom signaled he wanted more changes. Pan agreed again and put them in a companion bill. Newsom signed both bills into law.
The changes Newsom asked for allow kids who have medical exemptions before the law goes into effect on Jan. 1 to keep them until they enter a new grade span. Doctors also gained some breathing room in the amended version: Initially, Pan’s proposal said they would sign exemptions under penalty of perjury, but that clause was removed.
3. The vast majority of kids are vaccinated, so what’s the big deal?
A state Department of Public Health’s review shows that California’s vaccination rates are high: 94.8% of kindergartners in the last school year were vaccinated, a slight decrease from the year before. Meanwhile, the slight increase in medical exemptions represents families who had previously sought personal-belief exemptions and switched to medical waivers, say parents who oppose the new law.
Supporters of the new law, including the California Medical Association and the American Academy of Pediatrics in California, say it will strengthen community immunity and that vaccines are safe and effective for keeping communities healthy. They also content that it will crack down on physicians “practicing outside the accepted standard of care,” said David Aizuss, president of the medical association, in a written statement.
Doctors who oppose the law say they are concerned about losing their right to say what’s best for their patients, and about the lack of liability for those injured by vaccines, explained Debra Schaefer, spokeswoman for Advocates for Physicians’ Rights, in an email.
“The CDC itself warns that there are risks involved with vaccinations, and where there is risk, there should at least be a discussion between a doctor and a patient, like with any other pharmaceutical,” she said. “This bill is nothing more than government overreach. ... Doctors were scared to write (medical exemptions) before this bill; this is just creating an additional killing effect.”
Other opponents say the law tries to solve a problem that doesn’t exist. Instead, it may force thousands of children to leave school or quickly get caught up on vaccines even if they have legitimate medical exemptions, said Toby Rogers, an independent researcher and prominent critic of the law.
“If you are missing a single shot in this bloated schedule, you are considered noncompliant and kicked out of school,” said Rogers, referring to the CDC schedule of vaccinations for children. In California, kids are required to receive 15-16 vaccine shots to enter kindergarten. Some of the shots carry combined doses.
Rogers suggested the state focus instead on the larger percentage of children affected by such diseases and conditions as diabetes, asthma, autoimmune disorders and autism.
4. Are vaccines dangerous, as some critics say?
Critics of the new law argue that it does not properly acknowledge the risk that vaccines pose. The law states that “for all but a small number of individuals, immunizations are safe and effective,” but does not elaborate.
