BILL ANALYSIS Ó ------------------------------------------------------------ |SENATE RULES COMMITTEE | AB 2109| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ------------------------------------------------------------ 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. CONTINUED AB 2109 Page 2 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. CONTINUED AB 2109 Page 3 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 CONTINUED AB 2109 Page 4 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. CONTINUED AB 2109 Page 5 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 CONTINUED AB 2109 Page 6 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 CONTINUED AB 2109 Page 7 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 CONTINUED AB 2109 Page 8 SUPPORT/OPPOSITION: SEE ABOVE **** END **** CONTINUED