BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                      



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          |SENATE RULES COMMITTEE            |                  AB 2109|
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                                 THIRD READING


          Bill No:  AB 2109
          Author:   Pan (D), et al.
          Amended:  6/20/12 in Senate
          Vote:     21

           
           SENATE HEALTH COMMITTEE  :  7-1, 6/27/12
          AYES:  Hernandez, Harman, Alquist, Blakeslee, DeSaulnier, 
            Rubio, Wolk
          NOES:  Anderson
          NO VOTE RECORDED:  De León

           SENATE APPROPRIATIONS COMMITTEE  :  5-2, 8/6/12
          AYES:  Kehoe, Alquist, Lieu, Price, Steinberg
          NOES:  Walters, Dutton
           
          ASSEMBLY FLOOR  :  47-26, 5/10/12 - See last page for vote


           SUBJECT  :    Communicable disease:  immunization exemption

           SOURCE  :     American Academy of Pediatrics 
                      California Medical Association 
                      Health Officers Association of California 


           DIGEST  :    This bill requires, after July 1, 2014, a 
          separate form prescribed by the Department of Public Health 
          (DPH) to accompany a letter or affidavit to exempt a child 
          from immunization requirements under existing law on the 
          basis that immunization is contrary to beliefs of the 
          child's parent or guardian.

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           ANALYSIS  :    

          Existing law:

          1. Prohibits the governing authority of a school or other 
             institution from unconditionally admitting any person as 
             a pupil of any private or public elementary or secondary 
             school, child care center, day nursery, nursery school, 
             family day care home, or development center, unless, 
             prior to his/her first admission to that institution, 
             he/she has been fully immunized against diphtheria, 
             haemophilus influenzae type b (Hib), measles, mumps, 
             pertussis, poliomyelitis, rubella, tetanus, hepatitis b 
             (except after 7th grade), and chickenpox, as specified. 

          2. Permits DPH to add to this list any other disease deemed 
             appropriate, taking into consideration the 
             recommendations of the Centers for Disease Control and 
             Prevention (CDC) Advisory Committee on Immunization 
             Practices (ACIP) and the American Academy of Pediatrics 
             (AAP) Committee on Infectious Diseases.  

          3. Waives the above requirements if the parent or guardian 
             or adult who has assumed responsibility for the child's 
             care and custody, or the person seeking admission, if an 
             emancipated minor, files a letter or affidavit with the 
             governing authority stating that the immunization is 
             contrary to his/her beliefs.  

          4. Permits a child for whom the requirement has been 
             waived, whenever there is good cause to believe that he 
             or she has been exposed to one of the specified 
             communicable diseases, to be temporarily excluded from 
             the school or institution until the local health officer 
             is satisfied that the child is no longer at risk of 
             developing the disease. 

          This bill:

          1. Requires, after July 1, 2014, a separate form prescribed 
             by DPH to accompany a letter or affidavit to exempt a 
             child from immunization requirements under existing law 
             on the basis that immunization is contrary to the 
             beliefs of the child's parent or guardian.

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          2. Requires the form to include:

             A.    A signed attestation from a health care 
                practitioner that indicates that he/she provided the 
                parent or guardian of the person who is subject to 
                the immunization requirements in existing law, the 
                adult who has assumed responsibility for the care and 
                custody of the person, or to the person if he or she 
                is a emancipated minor, with information regarding 
                the benefits and risks of the immunization and the 
                health risks of specified communicable diseases to 
                the person and to the community. 

             B.    A written statement signed by the parent or 
                guardian of the person who is subject to the 
                immunization requirements in existing law, the adult 
                who has assumed responsibility for the care and 
                custody of the person, or the person if he or she is 
                an emancipated minor, that indicates that the signer 
                has received the information provided by the health 
                care practitioner. 

          3. Requires the form to be signed not more than six months 
             prior to the date when the person first becomes subject 
             to the immunization requirement for which exemption is 
             being sought.

          4. Permits a photocopy of the signed form or a letter 
             signed by a health care practitioner that includes all 
             information and attestations included on the form to be 
             accepted in lieu of the original form.

          5. Defines, for the purposes of this bill, a "health care 
             practitioner" as a physician and surgeon, a nurse 
             practitioner, a physician assistant, an osteopathic 
             physician and surgeon, or a naturopathic doctor, as 
             specified.

          6. Exempts issuance and revision of the form from 
             rulemaking requirements under the Administrative 
             Procedure Act.

           Background  

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           Immunizations  .  According to the CDC, vaccines contain the 
          same antigens or parts of antigens that cause diseases, but 
          the antigens in vaccines are either killed or greatly 
          weakened.  Vaccine antigens are not strong enough to cause 
          disease but, they are strong enough to make the immune 
          system produce antibodies against them.  Memory cells 
          prevent re-infection when they encounter that disease again 
          in the future.  Vaccines are responsible for the control of 
          many infectious diseases that were once common around the 
          world, including polio, measles, diphtheria, pertussis 
          (whooping cough), rubella (German measles), mumps, tetanus, 
          and Hib.  Vaccine eradicated smallpox, one of the most 
          devastating diseases in history. Over the years, vaccines 
          have prevented countless cases of infectious diseases and 
          saved literally millions of lives.  Vaccine-preventable 
          diseases have a costly impact, resulting in doctor's 
          visits, hospitalizations, and premature deaths.  Sick 
          children can also cause parents to lose time from work.  
          CDC recommends routine vaccination to prevent 17 
          vaccine-preventable diseases that occur in infants, 
          children, adolescents, or adults.  According to DPH, 
          implementation of statewide immunization requirements has 
          been effective in maintaining a 92% immunization coverage 
          rate among children in licensed child care facilities and 
          kindergartens.

           ACIP  .  ACIP consists of 16 experts in fields associated 
          with immunization who have been selected by the Secretary 
          of the U.S. Department of Health and Human Services to 
          provide advice and guidance to the Secretary, the Assistant 
          Secretary for Health, and the CDC on the most effective 
          means to prevent vaccine-preventable diseases.  ACIP 
          develops written recommendations for the routine 
          administration of vaccines to pediatric and adult 
          populations, along with schedules regarding the appropriate 
          periodicity, dosage, and contraindications applicable to 
          the vaccines and is the only entity within the federal 
          government which makes such recommendations.  The overall 
          goals of ACIP are to provide advice to assist in reducing 
          the incidence of vaccine-preventable diseases and to 
          increase the safe usage of vaccines and related biological 
          products.  


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          ACIP, along with AAP and the American Academy of Family 
          Physicians, approved the 2012 Recommended Immunization 
          Schedules for Persons Aged 0 Through 18 Years.  Children 
          under six are recommended to receive vaccines for hepatitis 
          b; rotavirus; diphtheria, tetanus, and pertussis (DTaP); 
          Hib; pneumococcal; polio; influenza; measles, mumps, 
          rubella (MMR); varicella; hepatitis a; and meningococcal.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes   
          Local:  Yes

          According to the Senate Appropriations Committee:

           DPH will incur one-time costs of about $80,000 (federal 
            funds) to develop and distribute the required forms and 
            related materials to schools and health practitioners.

           Costs to the Department of Education and the Department 
            of Social Services for staff training are expected to be 
            minor and absorbable (General Fund).

           Minor potential reimbursable mandate costs to schools to 
            collect the new form with currently required 
            documentation of personal belief exemptions (General 
            Fund).  Under existing law, parents who elect not to have 
            their child vaccinated before enrolling in school must 
            provide information to the school regarding their 
            personal belief exemption.  Under the bill, parents would 
            also be required to provide the required form signed by a 
            health professional.  Any marginal costs to collect and 
            store the additional form are likely to be minor.

           SUPPORT  :   (Verified  6/27/12) (per Senate Health Committee 
          analysis - unable to reverify at time of writing)

          American Academy of Pediatrics (co-source)
          California Medical Association (co-source)
          Health Officers Association of California (co-source)
          Association of Northern California Oncologists
          BayBio
          California Black Health Network
          California Hepatitis C Task Force
          California Immunization Coalition
          California Naturopathic Doctors Association

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          California Pharmacists Association
          California Primary Care Association
          California School Health Centers Association
          California State Association of Counties
          County Health Executives Association of California
          Los Angeles County Board of Supervisors
          Los Angeles Unified School District
          March of Dimes, California Chapter
          San Francisco Immunization Coalition
          Santa Clara County Board of Supervisors
          Tracy Unified School District

           OPPOSITION  :    (Verified  6/27/12) (per Senate Health 
          Committee analysis - unable to reverify at time of writing)

          California Federation of Republican Women
          California Right to Life Committee, Inc.
          Canary Party
          Child and Family Protection Association
          CORE Sacramento
          Health Advocacy in the Public Interest
          Maher Insurance and Financial Services
          National Vaccine Information Center
          Pacific Justice Institute
          ParentalRights.Org
          Private School Advocacy Center

           ARGUMENTS IN SUPPORT  :    The AAP, California Medical 
          Association, and the Health Officers Association of 
          California (HOAC), joint sponsors of this bill, state that 
          this bill increases protection for children and communities 
          from vaccine-preventable diseases, while still respecting 
          and preserving parent choice.  They state that the 
          continued increase in PBEs and resultant decreases in 
          community immunization rates could have a significant 
          impact on public safety and because PBEs are relatively 
          easy to obtain, parents or schools may use them simply 
          because they find vaccination inconvenient, or because they 
          have been misinformed about the health effects of vaccines.

          The California Maternal, Child and Adolescent Health 
          Directors, the California School Health Centers 
          Association, March of Dimes, and the California Black 
          Health Network state that this bill will make certain that 

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          all parents are aware of the individual and public health 
          risks of exempting a child from required immunizations.  
          They also state that this bill increases the protection of 
          children and communities from vaccine-preventable diseases 
          while still respecting and preserving parent choice.

           ARGUMENTS IN OPPOSITION :    The Pacific Justice Institute 
          states that existing law provides a reasonable process for 
          exemptions from mandated student vaccinations.  This bill 
          changes the current approach and inserts more bureaucracy 
          into intimate medical decisions.  Health Advocacy in the 
          Public Interest indicates that parents must have the 
          freedom to make their own decisions with respect to the 
          vaccination of their children.  Numerous letters from 
          individuals, parents, and practitioners state that this 
          bill is an intrusion into the personal freedom of parents 
          to make health care decisions for their children.  They 
          state that this bill causes an undue burden on parents, 
          discriminates against families utilizing complementary and 
          alternative medicine, and promotes more vaccine use and 
          profit from the pharmaceutical industry.
           
           
           ASSEMBLY FLOOR  :  47-26, 5/10/12
          AYES:  Alejo, Allen, Ammiano, Atkins, Beall, Block, 
            Blumenfield, Bonilla, Bradford, Brownley, Buchanan, 
            Butler, Charles Calderon, Campos, Carter, Cedillo, 
            Chesbro, Davis, Dickinson, Eng, Feuer, Fong, Fuentes, 
            Galgiani, Gordon, Hall, Hayashi, Roger Hernández, Hill, 
            Hueso, Huffman, Lara, Bonnie Lowenthal, Ma, Mendoza, 
            Mitchell, Monning, Pan, Perea, Portantino, Skinner, 
            Swanson, Torres, Wieckowski, Williams, Yamada, John A. 
            Pérez
          NOES:  Achadjian, Bill Berryhill, Cook, Donnelly, Beth 
            Gaines, Garrick, Gatto, Gorell, Grove, Hagman, Halderman, 
            Harkey, Huber, Jones, Knight, Logue, Mansoor, Miller, 
            Morrell, Nestande, Nielsen, Norby, Silva, Smyth, Valadao, 
            Wagner
          NO VOTE RECORDED:  Conway, Fletcher, Furutani, Jeffries, 
            Olsen, V. Manuel Pérez, Solorio


          CTW:m  8/8/12   Senate Floor Analyses 


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                         SUPPORT/OPPOSITION:  SEE ABOVE

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