BILL ANALYSIS                                                                                                                                                                                                    Ó

                                                                  AB 2109
                                                                  Page  1

          AB 2109 (Pan)
          As Amended April 23, 2012
          Majority vote 

           HEALTH              13-5        APPROPRIATIONS      12-5        
          |Ayes:|Monning, Ammiano, Atkins, |Ayes:|Fuentes, Blumenfield,     |
          |     |Bonilla, Eng, Gordon,     |     |Bradford, Charles         |
          |     |Hayashi,                  |     |Calderon, Campos, Davis,  |
          |     |Roger Hernández, Bonnie   |     |Gatto, Hall, Hill, Lara,  |
          |     |Lowenthal, Mitchell, Pan, |     |Mitchell, Solorio         |
          |     |V. Manuel Pérez, Williams |     |                          |
          |     |                          |     |                          |
          |Nays:|Logue, Mansoor, Nestande, |Nays:|Harkey, Donnelly,         |
          |     |Silva, Smyth              |     |Nielsen, Norby, Wagner    |
          |     |                          |     |                          |
           SUMMARY  :  Makes changes to existing requirements which allow 
          school-aged children, as specified, to be exempt from 
          immunization requirements as long as a parent or a guardian 
          files a letter or affidavit to the governing authority 
          indicating that immunization is contrary to the parent or 
          guardian's beliefs.  Specifically,  this bill  :  

             1)   Requires, on and after July 1, 2012, a separate form 
               prescribed by the California Department of Public Health 
               (DPH), to accompany the letter or affidavit to exempt a 
               child, as specified, from required immunization 
               requirements because immunization is contrary to the 
               child's parent's or guardian's beliefs.

             2)   Requires the form in 1) above to include both of the 

             a)   A written statement signed by a health care practitioner 
               that indicates that the health care practitioner provided 
               the parent or guardian of the person, or the person if an 
               emancipated minor, who is subject to the immunization 
               requirements, with information regarding the benefits and 
               risks of the immunization and the health risks of the 
               communicable diseases, as specified, to the person and to 


                                                                  AB 2109
                                                                  Page  2

               the community; and,

             b)   A written statement signed by the parent or guardian of 
               the person, or the person if an emancipated minor, who is 
               subject to the immunization requirements that indicates the 
               information specified in 2) a) above was received.  

             3)   Requires the written statements signed by the health 
               care practitioner and the parent or guardian, as specified 
               in 2) a) and b) above to be signed not more than six months 
               from the date when the person subject to the immunization 
               requirements is first admitted to the school.  States that 
               if the person was admitted to the school prior to entering 
               the seventh grade and is about to enter the seventh grade, 
               then an additional letter or affidavit shall be filed with 
               the written statement signed by the parent or health care 
               practitioner not more than six months from the first day of 

             4)   Authorizes a copy of the signed written statement to be 
               accepted in lieu of the original form.  Requires a signed 
               letter from the health care practitioner that references 
               the person's name to be accepted in lieu of a statement on 
               the original form.
             5)   Defines a health care practitioner for purposes of this 
               bill as any of the following:

             a)   A physician and surgeon licensed by the Medical Board of 

             b)   A nurse practitioner who is authorized to furnish drugs, 
               as authorized by 

             c)   A physician assistant who is authorized to administer or 
               provide medication, as authorized by law; 

             d)   An osteopathic physician, as specified; or,

             e)   A naturopathic doctor who is authorized to furnish or 
               order drugs under a physician and surgeon's supervision, as 

           FISCAL EFFECT  :  According to the Assembly Appropriations 


                                                                  AB 2109
                                                                  Page  3


          1)Based on DPH experience with another recent change to 
            immunization requirements, one-time costs for notification 
            including printing, mailing, and development of informational 
            materials in the range of $80,000 federal funds.  Issuing 
            regulations and developing the form would result in one-time 
            staff time costs of $50,000, distributed among a number of 
            existing federally funded staff.  

          2)Minor, absorbable one-time costs to Department of Social 
            Services (DSS) Child Care Licensing Division staff and K-12 
            school administrative staff for training on the new 

          3)Potential increase of $20,000 General Fund under Proposition 
            98 funds annually in state-reimbursable mandate costs to K-12 
            school administrative staff to ensure compliance with the new 
            form.  DSS costs related to ongoing enforcement are expected 
            be minor and absorbable.

          4)Any impact on Medi-Cal or Healthy Families Program from a 
            small number of increased office visits, to the extent any 
            program enrollees seek exemptions and require additional 
            office visits to do so, is likely to be negligible.  

           COMMENTS  :  According to the author, "California is one of only 
          20 states that allows for a personal beliefs, or philosophical 
          exemption to school or childcare immunization requirements.  
          Under existing law, to exempt the child from the immunization 
          requirements, a parent or guardian must only provide a signed 
          written statement or sign their name to a two-sentence standard 
          exemption statement on the back of the School Immunization 
          Record.  While parents do have a choice to exempt their 
          children, they are not required to document their concerns about 
          vaccines or affirm that they have reviewed fact-based, accurate 
          information regarding the risks and benefits of vaccines and the 
          risks of vaccine-preventable diseases.  The continued increase 
          in personal belief exemptions and resultant decreases in 
          community immunization rates in California will result in 
          outbreaks of diseases such as measles, mumps, and pertussis.  
          Exposure to these preventable diseases not only places the 
          individual child at risk, but the entire community, including 
          infants too young to be fully immunized and individuals with 


                                                                 AB 2109
                                                                  Page  4

          compromised immune systems, who are vulnerable to complications 
          of vaccine-preventable diseases, including death.  This measure 
          would rectify this problem by creating a process where parents 
          would be able make an informed decision for their children."

          School-aged children are required to obtain immunizations for 
          certain types of diseases to be admitted in school.  There are 
          exceptions to this requirement.  First, if the physical or 
          medical condition of a child would make immunization unsafe, as 
          long as a statement by a licensed physician to this effect is 
          submitted to the governing authority.  Second, if a letter or 
          affidavit is filed with the governing authority indicating that 
          the immunization is contrary to the beliefs of a parent or 
          guardian; this exemption is generally referred to as the 
          personal belief exemption or philosophic exemption.  According 
          to the Centers for Disease Control and Prevention, aside from 
          the philosophic exemption, some states allow for religious 
          exemptions on the grounds that the religious beliefs of some 
          people are in opposition to vaccination.

          Analysis Prepared by  :    Rosielyn Pulmano / HEALTH / (916) 

                                                                FN: 0003463