BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:                    SB 277    
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          |AUTHOR:        |Pan and Allen                                  |
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          |VERSION:       |February 19, 2015                              |
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          |HEARING DATE:  |April 8, 2015  |               |               |
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          |CONSULTANT:    |Melanie Moreno                                 |
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           SUBJECT  :  Public health:  vaccinations

           SUMMARY  :  Eliminates the personal belief exemption from the requirement  
          that children receive specified vaccines for certain infectious  
          diseases prior to being admitted to any public or private  
          elementary or secondary school or day care center.
          
          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 or her  
            first admission to that institution, he or 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 the Department of Public Health (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 immunization requirements if the parent or  
            guardian files with the governing authority a written  
            statement by a licensed physician to the effect that the  
            physical condition of the child is such, or medical  
            circumstances relating to the child are such, that  
            immunization is not considered safe, indicating the specific  
            nature and probable duration of the medical condition or  







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            circumstances that contraindicate immunization.

          4.Waives the above immunization 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 with the governing  
            authority stating that the immunization is contrary to his or  
            her beliefs.  

          5.Requires a separate form prescribed by DPH to accompany a  
            letter or affidavit to exempt a child from immunization  
            requirements on the basis that an immunization is contrary to  
            beliefs of the child's parent or guardian.  Requires the form  
            to include:

                  a.        A signed attestation from the health care  
                    practitioner that indicates that the parent or  
                    guardian of the person who is subject to the  
                    immunization requirements, the adult who has assumed  
                    responsibility for the care and custody of the person,  
                    or the person if an emancipated minor, was provided  
                    with information regarding the benefits and risks of  
                    the immunization and the health risks of the  
                    communicable diseases listed above to the person and  
                    to the community. Requires the attestation to be  
                    signed not more than six months before the date when  
                    the person first becomes subject to the immunization  
                    requirement for which exemption is being sought.

                  b.        A written statement signed by the parent or  
                    guardian of the person who is subject to the  
                    immunization requirements, the adult who has assumed  
                    responsibility for the care and custody of the person,  
                    or the person if an emancipated minor, that indicates  
                    that the signer has received the information provided  
                    by the health care practitioner pursuant a) above.  
                    Requires the statement to be signed not more than six  
                    months before the date when the person first becomes  
                    subject to the immunization requirements as a  
                    condition of admittance.

          6.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  








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            the local health officer is satisfied that the child is no  
            longer at risk of developing the disease.
          
          This bill:
          1.Deletes the exemption for personal beliefs in #4 above and  
            related existing law requiring a specified form to accompany a  
            letter to exempt a child from immunization requirements on the  
            basis that an immunization is contrary to beliefs of the  
            child's parent or guardian.  
                             
          2.Requires school districts, at the beginning of the first  
            semester or quarter of the regular school term, to notify  
            parents or guardians of students of the immunization rates for  
            the school in which a pupil is enrolled, as specified.

           FISCAL  
          EFFECT  :  This bill has not yet been analyzed by a fiscal  
          committee.
           
          COMMENTS  :
          1.Author's statement.  According to the author, in early 2015,  
            California became the epicenter of a measles outbreak which  
            was the result of unvaccinated individuals infecting  
            vulnerable individuals including children who are unable to  
            receive vaccinations due to health conditions or age  
            requirements. According to the CDC, there were been more cases  
            of measles in January 2015 in the U.S. than in any one month  
            in the past 20 years. Measles has spread through California  
            and the U.S., in large part, because of communities with large  
            numbers of unvaccinated people. Between 2000 and 2012, the  
            number of Personal Belief Exemptions (PBE) from vaccinations  
            required for school entry that were filed rose by 337 percent.  
            In 2000, the PBE rate for Kindergartners entering California  
            schools was under one percent. However, as of 2012, that  
            number rose to 2.6 percent. From 2012 to 2014, the number of  
            children entering Kindergarten without receiving some or all  
            of their required vaccinations due to their parent's personal  
            beliefs increased to 3.15 percent (a 25 percent increase over  
            the previous two years).  In certain pockets of California,  
            exemption rates are as high as 21 percent which places our  
            communities at risk for preventable diseases. Given the highly  
            contagious nature of diseases such as measles, vaccination  
            rates of up to 95 percent are necessary to preserve herd  
            immunity and prevent future outbreaks.









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          2.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.

          3.ACIP.  According to ACIP, it consists of 15 experts who are  
            voting members and are responsible for making vaccine  
            recommendations. The Secretary of the U.S. Department of  
            Health and Human Services selects these members after an  
            application, interview, and nomination process. Fourteen of  
            the members have expertise in vaccinology, immunology,  
            pediatrics, internal medicine, nursing, family medicine,  
            virology, public health, infectious diseases, and/or  
            preventive medicine; one member is a consumer representative  
            who provides perspectives on the social and community aspects  
            of vaccination. 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.  

            ACIP, along with AAP, the American Academy of Family  
            Physicians, and the American College of Obstetricians and  
            Gynecologists, approved the 2015 Recommended Immunization  
            Schedules for Persons Aged 0 Through 18 Years. Children under  








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            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.

          4.School vaccination requirements.  States enact laws or  
            regulations that require children to receive certain vaccines  
            before they enter childcare facilities and school, but with  
            some exceptions, including medical, religious, and  
            philosophical objections. School vaccination requirements are  
            thought to serve an important public health function, but can  
            also face resistance. An article published in the 2001-2002  
            Kentucky Law Journal reviewed historical and modern legal,  
            political, philosophical, and social struggles surrounding  
            vaccination requirements. The authors stated that though  
            school vaccination has been an important component of public  
            health practice for decades, it has had a controversial  
            history in the United States and abroad. Historical and modern  
            examples of the real, perceived, and potential harms of  
            vaccination, governmental abuses underlying its widespread  
            practice and strongly held religious beliefs have led to  
            fervent objections among parents and other persons who object  
            to vaccines on legal, ethical, social, and epidemiological  
            grounds. The article states that public health authorities  
            argue that school vaccination requirements have led to a  
            drastic decrease in the incidence of once common childhood  
            diseases. Those who object to vaccines tend to view the  
            consequences of mass vaccination on an individualistic basis,  
            focusing on alleged or actual harms to children from  
            vaccinations. As part of their research, the authors compared  
            childhood immunization rates and rates of vaccine-preventable  
            childhood diseases before and after the introduction of school  
            vaccination requirements. The data suggest that school  
            vaccination requirements have succeeded in increasing  
            vaccination rates and reducing the incidence of childhood  
            disease
          5.Exemptions to vaccine requirements. There are two types of  
            non-medical exemptions to the requirement that children be  
            vaccinated before entering school: religious exemption and  
            philosophical exemption.  Religious exemption means that there  
            is a provision in the statute that allows parents to exempt  
            their children from vaccination if it contradicts their  
            sincere religious beliefs.  Philosophical exemption means that  
            the statutory language does not restrict the exemption to  
            purely religious or spiritual beliefs.  For example, Maine  








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            allows restrictions based on "moral, philosophical or other  
            personal beliefs," and California allows objections based on  
            simply the parent(s) beliefs.  According to the National  
            Conference of State Legislatures, as of June 2014, 48 states  
            allow religious exemptions (all but Mississippi and West  
            Virginia), and 20 states (Arizona, California, Colorado,  
            Idaho, Louisiana, Maine, Michigan, Minnesota, Missouri  
            (limited to childcare enrollees), New Mexico, North Dakota,  
            Ohio, Oklahoma, Pennsylvania, Texas, Utah, Vermont,  
            Washington, West Virginia and Wisconsin) permit philosophic  
            exemptions.  As of February, several state legislatures had  
            introduced bills that would address non-medical exemptions.   
            In addition to California, legislators in Oregon, Vermont, and  
            Washington proposed to remove philosophical/personal belief  
            exemption this year.  Those bills were tabled in Oregon and  
            Washington.

          6.California vaccination rates. According to an August 2014 DPH  
            fact sheet, vaccination coverage in California is at or near  
            all-time high levels. DPH states that the implementation of  
            current vaccine requirements has been effective in maintaining  
            greater than or equal to 92 percent immunization coverage  
            among children in licensed child care facilities and  
            kindergartens.  The DPH Immunization Branch maintains data on  
            its website related to vaccination rates and is searchable  
            statewide and by school (kindergarten and 7th grade rates) and  
            child care facility.  For school year 2014-15, DPH reported  
            that 90.4 percent of the 535,332 students enrolled in  
            reporting kindergartens received all required immunizations,  
            which is a 0.2 percent increase from last year. In addition,  
            the percentage of conditional entrants increased by 0.4  
            percent from last year. The percentage of students with  
            permanent medical exemptions (PMEs) stayed the same at 0.19  
            percent, and there was a 0.61 percent decrease in students  
            with PBEs compared with last year. Immunization coverage  
            remained above 92 percent for each vaccine for all schools  
            since last year.

          7.California measles outbreak. The authors point to an outbreak  
            of measles that began in December 2014 in Disneyland (Orange  
            County) as one of the reasons for the introduction of this  
            bill. There have been 134 confirmed measles cases reported in  
            California residents as part of this outbreak. The latest  
            confirmed measles case had rash onset on March 2nd, and DPH  
            will consider the outbreak over when 42 days have elapsed from  








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            the end of the infectious period of the last known measles  
            cases that was a not a new importation. As of the most recent  
            DPH Surveillance Update, that date will be April 17, 2015. Of  
            the confirmed cases: 40 cases visited Disneyland between  
            December 17 and 20 where they are presumed to have been  
            exposed to measles; 30 are household or close contacts to a  
            confirmed case; 11 were exposed in a community setting (e.g.,  
            emergency room) where a confirmed case was known to be  
            present; 50 have an unknown exposure source but are presumed  
            to be linked to the outbreak based on a combination of  
            descriptive epidemiology or strain type; and, three cases are  
            known to have a different genotype from the outbreak strain.  
            The ages of those infected with the measles during this  
            outbreak varied, with 56 percent being 20 years or older, 18  
            percent were between the ages of five and 19, 15 percent were  
            ages one to four, and 11 percent were under the age of one.  
            Among measles cases for whom DPH have vaccination  
            documentation, 57 were unvaccinated and 25 had one or more  
            doses of MMR vaccine.


          8.Triple referral. This bill has been triple referred to the  
            Committees on Health, Education, and Judiciary.  Should it  
            pass out of this Committee, it will be heard in Senate  
            Education Committee next.

          9.Related legislation. SB 792 (Mendoza) would prohibit a person  
            from being employed at a day care center or day care home  
            unless he or she has been immunized against influenza,  
            pertussis, and measles.  SB 792 is set to be heard in this  
            Committee on April 15, 2015.

          10.Prior legislation. SB 2109 (Pan), Chapter 821, Statutes of  
            2012, requires, on and after January 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 an immunization is contrary to beliefs of the  
            child's parent or guardian.  Requires the form to include:

               a.     A signed attestation from the health care  
                 practitioner that indicates that the parent or guardian  
                 of the person who is subject to the immunization  
                 requirements, the adult who has assumed responsibility  
                 for the care and custody of the person, or the person if  
                 an emancipated minor, was provided with information  








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                 regarding the benefits and risks of the immunization and  
                 the health risks of the communicable diseases listed  
                 above 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, the adult who has assumed responsibility  
                 for the care and custody of the person, or the person if  
                 an emancipated minor, that indicates that the signer has  
                 received the information provided by the health care  
                 practitioner pursuant a) above.

            The Governor included a message with his signature on this  
            bill, which stated, in part:

               "I will direct (DPH) to allow for a separate religious  
               exemption on the form.  In this way, people whose religious  
               beliefs preclude vaccinations will not be required to seek  
               a health care practitioner's signature."

            AB 2064 (V. Manuel Pérez), would have required a health care  
            service plan or health insurer that provides coverage for  
            childhood and adolescent immunizations to reimburse a  
            physician or physician group in an amount not less than the  
            actual cost of acquiring the vaccine plus the cost of  
            administration of the vaccine, as specified. AB 2064 was held  
            on the Assembly Appropriations Committee suspense file.

            SB 614 (Kehoe), Chapter 123, Statutes of 2011, allowed a pupil  
            in grades seven through 12, to conditionally attend school for  
            up to 30 calendar days beyond the pupil's first day of  
            attendance for the 2011-12 school year, if that pupil has not  
            been fully immunized with all pertussis boosters appropriate  
            for the pupil's age if specified conditions are met.

            AB 354 (Arambula), Chapter 434, Statutes of 2010, allows DPH  
            to update vaccination requirements for children entering  
            schools and child care facilities and adds the American  
            Academy of Family Physicians to the list of entities whose  
            recommendations DPH must consider when updating the list of  
            required vaccinations. Requires children entering grades 7  
            through 12 receive a TDaP booster prior to admittance to  
            school.

            AB 1201 (V. Manuel Pérez), of 2009, would have required a  








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            health care service plan or health insurer that provides  
            coverage for childhood and adolescent immunizations to  
            reimburse a physician or physician group the entire cost of  
            acquiring and administering the vaccine, and prohibits a  
            health plan or insurer from requiring cost-sharing for  
            immunizations. AB 1201 was held on the Assembly Appropriations  
            Committee suspense file.

            SB 1179 (Aanestad), of 2008, would have deleted DPH's  
            authority to add diseases to the list of those requiring  
            immunizations prior to entry to any private or public  
            elementary or secondary school, child care center, day  
            nursery, nursery school, family day care home, or development  
            center. SB 1179 died in Senate Health Committee.

            AB 2580 (Arambula), of 2008, would have required pupils  
            entering the seventh grade to be fully immunized against  
            pertussis by receiving any necessary adolescent booster  
            immunization. AB 2580 was held on the Senate Appropriations  
            Committee suspense file.

            SB 676 (Ridley-Thomas), of 2007, would have required pupils  
            entering the seventh grade to be fully immunized against  
            pertussis. SB 676 was held on suspense in Assembly  
            Appropriations Committee. 

            SB 533 (Yee), of 2007, would have added pneumococcus to the  
            list of diseases that pupils are required to be immunized  
            against before entry into any private or public elementary or  
            secondary school, child care center, day nursery, nursery  
            school, family day care home, or development center, except  
            for children who are 24 months of age or older.  SB 533 was  
            vetoed by the Governor, who stated that a mandate for this  
            vaccination was not necessary.
            
          11.Support.  Vaccinate California, the sponsor of this bill,  
            writes that there is an overwhelming scientific consensus that  
            vaccines work, and vaccines prevent terrible diseases that  
            kill and maim. Vaccinate California states that when too many  
            people forego vaccines, everyone is put at risk since no  
            vaccine is 100 percent effective, and there are always people  
            too young or too frail to be vaccinated.  Vaccinate California  
            asserts that experts can explain the science in detail, but  
            the bottom line is that even though vaccine-refusers are small  
            in number, their impact on the state is huge, and it is scary.  
                   







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             The Health Officers Association of California (HOAC) states  
            that despite the effectiveness of vaccines, California's  
            public health departments have seen a rise in  
            vaccine-preventable diseases such as pertussis and measles  
            largely because many residents are choosing to selectively  
            immunize or opt out of vaccinating their children.  HOAC  
            writes that these decisions risk the health of the community  
            and can be particularly detrimental, even fatal, to newborns,  
            infants, toddlers, and those living with immunocompromising  
            health conditions.  The Los Angeles County Board of  
            Supervisors states that increased immunizations of school  
            children can avoid preventable illnesses that could result in  
            additional visits to hospital emergency rooms. The California  
            Medical Association states that vaccines have undergone  
            significant rigorous scientific review and continue to have  
            ongoing safety tracking and that this indisputably shows that  
            vaccines are effective and have very low risks.  The  
            California School Nurses Organization states that changing the  
            school entry requirement to a medical exemption only will  
            serve the public and schools well as "community immunity"  
            varies by vaccine but it provides protection for those  
            students and staff who, for medical reasons are unable to be  
            vaccinated or are immunocompromised.  California Coverage &  
            Health Initiatives, Children NOW, The Children's Partnership,  
            and Children's Defense Fund write that benefits of  
            immunizations outweigh costs, and the social and direct  
            economic costs of ensuring each child receives the ACIP  
            recommended schedule of vaccines far outweighs the costs of  
            not providing routine immunizations. This coalition states  
            that it is estimated that for every $1 spent on immunizations,  
            as many as $29 can be saved in direct and indirect costs.  The  
            California State PTA recognizes that there are children in our  
            schools who cannot receive vaccines and immunizations due to  
            medical reasons and are therefore susceptible to diseases  
            should an outbreak occur, and it is our duty as a community  
            protect vulnerable children and families by vaccinating those  
            children who can be vaccinated. The California Immunization  
            Coalition writes that although AB 2109 helped tighten up the  
            personal belief exemption process, it is not enough and  
            California needs to take stronger measures to protect children  
            in our schools and in our communities.  Insurance Commissioner  
            Dave Jones writes that that the higher number of unvaccinated  
            students is jeopardizing public health not only in schools but  
            in the broader community, and that we need to take steps to  
            keep schools safe and students healthy by preventing serious  








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            and potentially life-threatening diseases.

          12.Support if amended. The Marin County Board of Supervisors  
            writes that in order to address concerns of parents who home  
            school their children in their own home, they request that  
            this bill be amended to clarify that it does not apply in a  
            home school setting.
          
          13.Concerns. The ACLU of California writes that while they  
            appreciate that vaccination against childhood diseases is a  
            prudent step that should be promoted for the general welfare,  
            they do not believe there has been a sufficient showing of  
            need at present to warrant conditioning access to education on  
            mandatory vaccination for each of the diseases covered by this  
            bill.  ACLU of California writes that unlike other states,  
            public education is a fundamental right under the California  
            Constitution, and equal access to education must therefore not  
            be limited or denied unless the State demonstrates that its  
            actions are "necessary to achieve a compelling state  
            interest."  ACLU of California writes that this bill does not  
            declare what this interest might be, nor does it explain why  
            denying students access to education is necessary to advance  
            that interest. If there is, in fact, a compelling governmental  
            interest in mandating that all students in every school be  
            vaccinated against each of the enumerated diseases except for  
            medical reasons, the bill should be amended to explain  
            specifically what that interest is, where it exists, and under  
            what conditions and circumstances it arises.  

            ACLU of California further states that the reforms enacted by  
            AB 2109 had been in effect for only about 12 months before  
            this bill was announced, and that those reforms should be  
            allowed an opportunity to work before they are stricken and  
            replaced by an approach that restricts the fundamental right  
            to education.  If AB 2109 is thought not to be working, its  
            effects should be analyzed and any deficiencies should be  
            corrected. If for example herd-immunity levels have not been  
            achieved for certain diseases in geographic areas where school  
            districts may not be not fully complying with the law, those  
            districts should be provided with additional resources and/or  
            compliance incentives. ACLU of California writes that in some  
            cases it appears the deficiencies may reflect a need for  
            better data-keeping and reporting, rather than the actual rate  
            of vaccinations.  It has been reported for example that in  
            just one week the Los Angeles Unified School District  








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            increased its vaccination rates significantly after the recent  
            measles outbreak by temporarily hiring additional staff to  
            replace nursing and clerical staff that had been laid off.   
            Other media reports indicate that some districts may not be  
            complying with existing law because there is no penalty and no  
            mechanism for enforcement.  ACLU of California states that in  
            any event, herd immunity is a concept that applies to the  
            entire population in a geographic area, not simply to public  
            school students.

          14.Opposition.  The Association of American Physicians and  
            Surgeons Inc. state that the need for informed consent is a  
            firmly established principal of medical ethics and human  
            rights and that the state has no right to force medical  
            interventions on people without their consent.  
            ParentalRights.Org contends that this measure violates the  
            fundamental right of parents to direct the care and upbringing  
            of their child and that it disenfranchises children whose  
            parents oppose vaccinations from receiving free public  
            education as provided by their parents' taxes. The California  
            Chiropractic Association mentions that the Mayo Clinic warns  
            against undermining the principle of informed consent in favor  
            of universal vaccination and further states we ought not let a  
            handful of measles cases at Disneyland turn into a full-scale  
            assault on civil and human rights in America. The National  
            Vaccine Information Center argues that it's particularly  
            disturbing that physicians in the American Medical Association  
            Code of Ethics affirm philosophical and religious exemptions  
            for themselves yet want to remove this right for California  
            parents.  The Pacific Justice Institute argues that statewide  
            vaccination rates exceed the threshold for herd immunity and,  
            to the extent that a few communities have fallen below  
            vaccination levels needed for herd immunity, the Legislature  
            could consider approaches that allow greater local  
            decision-making and accountability rather than imposing  
            across-the-board statewide mandates. Families for Early Autism  
            Treatment contend that this bill is contrary to the rights  
            protected by the State and Federal Constitutions as it denies  
            rights to privacy, education, free assembly, religious  
            expression, consensual use of one's physical body and liberty.  
            Educate. Advocate. writes that every medical intervention has  
            both benefits and risks and that parents, not the State of  
            California, have the right to decide which medical  
            interventions their children receive. The Canary Party  
            maintains that the United States Justice System deems each and  








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            every vaccine on the market as "unavoidably unsafe", which  
            means that even when used as directed, someone will be harmed,  
            or may even die from the vaccine. The Capitol Resource  
            Institute notes that following the passage of AB 2109 the  
            personal belief exemption rate fell from 3.1 percent in 2013  
            to 2.5 percent in 2014 after only a partial implementation of  
            the law, and that this bill is far reaching and unnecessary.  
            The Homeschool Association of California states this bill will  
            negatively impact the freedom to homeschool and would make it  
            impossible for many families to choose to homeschool legally.  
            They argue that almost all homeschooling families use a legal  
            option that involves attendance at some form of public or  
            private school, either operated by a third party or operated  
            by parents who file a private school affidavit, yet current  
            law requires children admitted to private schools be fully  
            vaccinated in accordance with existing law.

          15.Oppose unless amended.  California Naturopathic Doctors  
            Association (CNDA) states that it supports immunization for  
            the prevention of disease and the public health objective of  
            achieving high rates of immunity to infectious disease.  CNDA  
            states that as licensed primary care doctors who can diagnose  
            medical conditions such as anaphylaxis and immunodeficiency,  
            reasons outlined in the CDC's list of contraindications to  
            common pediatric vaccinations, naturopathic doctors must also  
            be able to sign medical waivers for vaccination, when such  
            medical conditions exist. CNDA opposes this bill unless it is  
            amended to include NDs as providers who can sign medical  
            waivers for vaccination.
          
          16.Amendments. The author requests that the committee approve  
            the following amendments:
                  a.        On page 5, delete lines 17-25, and move  
                    language contained in lines 26-31 to HSC 120370.

                  b.        On page 5,beginning on line 26:
                    (b) When there is good cause to believe that  the   a   
                    person  who has not filed proof of immunization  has  
                    been exposed to one of the communicable diseases  
                    listed in subdivision of Section 120325

                  c.        Add a new section:

                    120335 (b) "The governing authority shall not  
                    unconditionally admit any person as a pupil of any  








          SB 277 (Pan and Allen)                            Page 14 of ?
          
          
                    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 or her first admission to that institution, he or  
                    she has been fully immunized. This section shall not  
                    apply to home-based private schools whose students are  
                    all members of the household or all members of a  
                    single family."
          



           SUPPORT AND OPPOSITION  :
          Support:  Vaccinate California (sponsor)
                    American Academy of Pediatrics
                    American Lung Association
                    Biocom
                    California Association of Nurse Practitioners
                    California Chapter of the American College of  
               Emergency Physicians
                    California Children's Hospital Association
                    California Coverage and Health Initiatives
                    California Immunization Coalition
                    California Medical Association
                    California Optometric Association
                    California School Nurses Organization
                    California State Parent-Teacher Association 
                    Children Now 
                    Children's Defense Fund California 
                    Children's Specialty Care Coalition
                    County of Los Angeles
                    County of Santa Cruz
                    Health Officers Association of California
                    Insurance Commissioner Dave Jones
                    Kaiser Permanente
                    March of Dimes California Chapter
                    Providence Health and Services Southern California
                    San Francisco Unified School District
                    Secular Coalition for California
                    Silicon Valley Leadership Group
                    Solano Beach School District
                    The Children's Partnership
                    Hundreds of individuals
          
          Oppose:   Association of American Physicians and Surgeons








          SB 277 (Pan and Allen)                            Page 15 of ?
          
          
                    California Chiropractic Association
                    California Naturopathic Doctors Association (unless  
                    amended)
                    California Nurses for Ethical Standards
                    California ProLife Council
                    California Right to Life Committee, Inc.
                    Canary Party
                    Capitol Resource Institute
                    Educate. Advocate.
                    Families for Early Autism Treatment
                    Homeschool Association of California
                    National Vaccine Information Center
                    Pacific Justice Institute Center for Public Policy
                    ParentalRights.org
                    SafeMinds
                    Hundreds of individuals
          
                                      -- END --