BILL ANALYSIS Ó
SENATE COMMITTEE ON EDUCATION
Senator Carol Liu, Chair
2015 - 2016 Regular
Bill No: SB 277
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|Author: |Pan and Allen |
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|Version: |April 9, 2015 Hearing |
| |Date: April 22, 2015 |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant:|Lynn Lorber |
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Subject: Public health: vaccinations
NOTE : This bill has been referred to the Committees on Health,
Education and Judiciary. A "do pass" motion should
include referral to the Committee on Judiciary.
NOTE : This bill was previously heard by this Committee on April
15, 2015. The authors will present proposed amendments to
this bill during the April 22 hearing. The proposed
amendments are as follows:
1. Broaden the exemption for home-schools by
deleting reference to students being members of the
same household or family.
2. Add an exemption for students who are
enrolled in an independent study program that meets
existing criteria for independent study programs.
SUMMARY
This bill removes the ability for parents to file a personal
belief exemption from the requirement that children receive
vaccines for specific communicable diseases prior to being
admitted to any private or public elementary or secondary
school, child care center, day nursery, nursery school, family
day care home, or development center.
BACKGROUND
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Current law:
Compulsory education
1. Provides that each child between the ages of 6 and 18
years is subject to compulsory full-time education, and
requires attendance at the public full-time day school or
continuation school or classes for the full schoolday.
2. Requires parents and guardians to send the student to
school for the full schoolday. (Education Code § 48200)
Required immunizations
3. Prohibits the unconditional admission of a student to
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 the child's
first admission to that institution, the child has been
fully immunized. The following are the diseases for which
immunizations shall be documented:
A. Diphtheria.
B. Haemophilus influenzae type b.
C. Measles.
D. Mumps.
E. Pertussis (whooping cough).
F. Poliomyelitis.
G. Rubella.
H. Tetanus.
I. Hepatitis B.
J. Varicella (chickenpox).
AA. Any other disease deemed appropriate by the
California Department of Public Health, taking into
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consideration the recommendations of the Advisory
Committee on Immunization Practices of the United
States Department of Health and Human Services, the
American Academy of Pediatrics, and the American
Academy of Family Physicians.
(Health and Safety Code § 120335)
1. Prohibits schools from unconditionally admitting or
advancing any student to grade 7 unless the student has
been fully immunized against pertussis, including all
pertussis boosters appropriate for the student's age.
Current law provides that full immunization against
hepatitis B shall not be a condition by which a school
admit or advance a student to the 7th grade. (HSC §
120335)
2. Authorizes school districts to permit specified licensed
health practitioners to administer an immunizing agent to a
student whose parent or guardian has consented in writing
to the administration of the immunizing agent. (EC §
49403)
Personal belief exemption
3. Provides that immunization is not required for admission
to a school or other institution if the parent or guardian
files with the school a letter or affidavit that documents
which immunizations have been given and which immunizations
have not been given on the basis that they are contrary to
his or her beliefs.
4. Requires, beginning January 1, 2014, a form prescribed
by the California Department of Public Health (CDPH) to
accompany the letter or affidavit.
5. Requires the CDPH form to include both of the following:
A. A signed attestation from the health care
practitioner that indicates that the health care
practitioner provided the parent or guardian with
information
regarding the benefits and risks of the immunization
and the health risks of the communicable diseases to
the child and the community.
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B. A written statement signed by the parent or
guardian that indicates that the signer has received
the information provided by the health care
practitioner.
C. Authorizes schools or other institutions, when
there is good cause to believe that the child has been
exposed to one of the communicable diseases, to
temporarily exclude the child from attendance until
the local health officer is satisfied that the child
is no longer at risk of developing the disease. (HSC
§ 120365)
Medical exemption
1. Provides that a child is exempt from immunization
requirements if the parent or guardian files with the
school or other institution 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
probably duration of the medical condition or circumstances
that contraindicate immunization. (HSC § 120370)
Conditional admission
2. Authorizes a school or other institution to admit a
child who has not been fully immunized against one or more
of the communicable diseases on condition that the child
presents evidence that he or she has been fully immunized
against all of these diseases within time periods
designated by regulation of the California Department of
Public Health (CDPH).
(HSC § 120340)
3. Requires a school or other institution to exclude from
further attendance any child who fails to obtain the
required immunizations within no more than 10 schooldays
following receipt of the notice that the child does not
meet immunization requirements, unless the child is exempt
for medical reasons or personal beliefs, until the child
provides written evidence that he or she has received
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another dose of each required vaccine due at that time.
Regulations require any child so excluded to be reported to
the attendance supervisor or to the building administrator.
(California Code of Regulations (CCR), Title 17, § 6055)
Temporary exclusion
4. Authorizes a child for whom the immunization requirement
has been waived, whenever there is good cause to believe
that he or she has been exposed to one of the communicable
diseases, to be temporarily excluded from the school or
other institution until the local health officer is satisfied
that the child is no longer at risk of developing the
disease. (HSC § 120365)
5. Requires county offices of education and school
districts to exclude any student who has not been immunized
as required by the Health and Safety Code, and requires the
school to notify the parent or guardian that they have two
weeks to
supply evidence either that the student has been fully
immunized, or that the student is exempted from the immunization
requirement. (EC § 48216)
6. Provides that an already admitted child who is
subsequently discovered not to have received all the
immunizations which were required before admission or who
is subsequently discovered not to have complied with the
requirements for conditional admission is to continue in
attendance only if he or she receives all vaccine doses for
which he or she is currently due and provides documentation
of having received such doses no later than 10 school days
after he or she or the parent or guardian is notified.
Regulations require a school or other institution to notify
the child or the parent or guardian of the time period (no
longer than 10 school days) within which the doses must be
received. (CCR § 6040)
ANALYSIS
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This bill removes the ability for parents to file a personal
belief exemption from the requirement that children receive
vaccines for specific communicable diseases prior to being
admitted to any private or public elementary or secondary
school, child care center, day nursery, nursery school, family
day care home, or development center. Specifically, this bill:
1. Deletes the exemption from immunization requirements for
personal beliefs and requirement that a parent or guardian:
A. File a letter or affidavit stating
which immunizations the child has not been given.
B. Also provide a form prescribed by the
California Department of Public Health including both
of the following:
(1) A signed attestation from the health
care practitioner indicating that the health care
practitioner provided information regarding the
benefits and risks of the immunization and the
health risks of the communicable diseases to the
child and the community.
(2) A written statement signed by the
parent or guardian that the signer has received
the information provided by the health care
practitioner.
2. Exempts from immunization requirements a home-based private
school if all of the students are residents of the
household or are members of a single family.
3. Expands existing annual notification requirements for
school districts to include notification to parents or
guardians of the immunization rates for each of the
required immunizations for the school in which a student is
enrolled.
STAFF COMMENTS
1. Need for the bill. According to the authors, "In early
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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 Centers for Disease Control
and Prevention, there were more cases of measles in January
2015 in the United States than in any one month in the past
20 years. Measles has spread through California and the
United States, 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%. In 2000, the PBE rate for Kindergartners entering
California schools was under 1%. However, as of 2012, that
number rose to 2.6%. 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%. In certain pockets of
California, exemption rates are as high as 21% 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% are necessary to preserve
herd immunity and prevent future outbreaks."
2. Recent amendments. This bill was amended on April 9 to
include amendments discussed and informally adopted by the
Senate Health Committee during the April 8 hearing. The
amendments:
A. Exempt homeschools if all of the students are
residents of the household or are members of a single
family.
B. Reinsert and relocate current law regarding the
authority for schools to temporarily exclude a child
with a personal belief exemption when there is good
cause to believe that child has been exposed to one of
the communicable diseases.
3. Vaccine safety and related issues. This bill was heard by
the Senate Health Committee on April 8. Please refer to
the Senate Health Committee analysis for information
regarding vaccine safety, the entities that recommend
vaccines, the measles outbreak, and laws in other states.
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4. Vaccination rates and community immunity. According to the
United States Department of Health and Human Services,
"when a critical portion of a community is immunized
against a contagious disease, most members of the community
are protected against that disease because there is little
opportunity for an outbreak. Even those who are not
eligible for certain vaccines, such as infants, pregnant
women, or immunocompromised individuals, get some
protection because the spread of contagious disease is
contained. This is known as 'community immunity.'"
According to California Department of Public Health (CDPH's)
2014-15 Kindergarten Immunization Assessment Results, the
statewide immunization coverage remained above 92% for each
vaccine for all schools since last year. However, CDPH's
school level data files show that many individual schools
have much lower rates of fully immunized students.
http://www.cdph.ca.gov/programs/immunize/Pages/ImmunizationL
evels.aspx
The authors and proponents express concern about localized
vaccination rates, rather than statewide rates. Some
opponents of this bill suggest it would be more appropriate
to provide additional resources and/or compliance
incentives in geographic areas where community immunity
levels have not been achieved.
5. Compulsory education, public health and personal rights.
Current law requires each child between the ages of 6 and
18 years to attend school for the full schoolday, and
requires parents to compel children to attend school.
Truancy laws provide various levels of intervention and
punishment for both students and parents.
The United States Supreme Court has ruled that states may use
their "police power" to require vaccinations, including
vaccinations for children entering schools.
http://fas.org/sgp/crs/misc/RS21414.pdf
The American Civil Liberties Union writes with concerns to this
bill: "Unlike other states, public education is a
fundamental right under the California Constitution.
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(Serrano v. Priest, 5 Cal.3d 584 (1971); Serrano v. Priest,
18 Cal.3d 728 (1976).) 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."
The issues of police power, compelling state interest, and other
legal matters may be more appropriately considered by the
Senate Judiciary Committee. Considering the jurisdiction
of the Senate Education Committee, this Committee may wish
to consider issues specific to the role of schools in
providing a safe and appropriate educational opportunity
for each student.
6. What options will parents have? It appears that, if this
bill were to become law, parents or guardians who do not
vaccinate their children as required by the Health and
Safety Code would be limited to homeschooling or risk
violating truancy laws.
This bill affects private schools. The State compels each
student to attend school and provides opportunities for
attendance at public schools. Should this bill be limited
to public schools to enable attendance at private schools
that may choose to enroll students who are not fully
vaccinated?
7. Reasonable timeline? This bill will become effective on
January 1, 2016, if it becomes law. Will schools
immediately require students to be fully vaccinated, or
will existing personal belief exemptions be valid for the
remainder of this
school year? Will students who have no vaccinations have
enough time to catch-up to full vaccination? The author
may wish to consider a phased-in approach.
8. Fiscal impact. To the extent that parents remove their
children from public schools, this bill could impose
significant costs on school districts, as a portion of
school funding is based on average daily attendance.
However, to the extent that students are not absent due to
illnesses, this bill could create cost savings to school
districts.
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9. Personal belief exemption. Children with a personal belief
exemption are not necessarily without any vaccines, but
likely are not fully vaccinated.
According to California Department of Public Health (CDPH's)
2014-15 Kindergarten Immunization Assessment Results, the
statewide percentage of personal belief exemptions had
consistently increased annually among all reporting schools
until 2014-15, when there was a 19% decrease compared with
last year. While public school personal belief exemption
rates decreased by 21% (from 2.92% to 2.31%), private
school personal belief exemption rates decreased only 9%
(from 5.88% to 5.33%).
http://www.cdph.ca.gov/programs/immunize/Documents/2014-15%2
0CA%20Kindergarten%20Immunization%20Assessment.pdf
California's personal belief exemption covers all beliefs,
including religious; there is not a separate exemption
specific to religion. Therefore, this bill eliminates the
ability of parents or guardians to seek exemption from
immunization requirements based on religious beliefs.
Governor Brown included a signing message related to AB 2109
(Pan, Ch. 821, 2012), which reads in part:
I am signing AB 2109 and am directing the
Department of Public Health to oversee this
policy so parents are not overly burdened in its
implementation. Additionally, I will direct the
department 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.
It is unclear whether California Department of Public
Health (CDPH) is working to develop a separate
religious exemption.
10. Medical exemption. Current law exempts from
immunization requirements children whose parent or
guardian have filed with the school or other
institution a written statement by a licensed
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physician to the effect that the physical condition or
medical circumstances are such that immunization is
not considered safe. Some opponents maintain that a
medical exemption is very difficult to obtain,
especially if the medical concern is not overtly
severe. The decision whether to grant a medical
exemption from immunizations is at the discretion of each
physician. It is unclear if guidelines for physicians are
available.
11. Vaccination requirements. The Centers for Disease Control
and Prevention recommend a schedule of immunizations for
children from birth through age 18.
http://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-sch
edule.pdf
The California Department of Public Health (CDPH) determines
which immunizations children must have, and at what age,
before being unconditionally admitted to a private or
public school or licensed child care program.
For child care: http://www.shotsforschool.org/child-care/
For K-12 schools: http://www.shotsforschool.org/k-12/
12. Hepatitis B. Some opponents of this bill question the need
for the Hepatitis B vaccination, and point to the right of
attendance for students who are infected with HIV.
According to the Centers for Disease Control and
Prevention, children can become infected by contact with
blood and body fluids through breaks in the skin such as
bites, cuts, or sores; by contact with objects that have
blood or body fluids on them such as toothbrushes, razors;
by having unprotected sex; and by sharing drug needles. Is
there a reasonable analogy between allowing the attendance
of a student infected with HIV and allowing the attendance
of a student who has not been fully vaccinated against
Hepatitis B? Do parents need to worry about students being
exposed to Hepatitis B while at school or child care?
13. Reporting. This bill requires school districts to include
in the annual notification to parents at the beginning of
the schoolyear the immunization rates for each of the
required immunizations for the school in which a student is
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enrolled.
Schools and licensed child care providers annually submit rates
of immunizations to the CDPH. Data submitted includes the
rates for each required vaccine, personal belief
exemptions, permanent medical exemptions, and conditional
entrants.
http://www.cdph.ca.gov/programs/immunize/Pages/ImmunizationR
atesatCaliforniaSchools.aspx
The authors may wish to consider instead requiring the
annual notification to parents to include a link to the
CDPH website and a date when the current data will be
available on CDPH's website.
14. Related and prior legislation.
RELATED LEGISLATION
SB 792 (Mendoza, 2015) prohibits a person from being employed at
a day care center or family day care home, if that person
has not been immunized against
influenza, pertussis, and measles. SB 792 is scheduled to
be heard by the Senate Health Committee on April 15.
PRIOR LEGISLATION
AB 2109 (Pan, Ch. 821, 2012) requires, beginning January 1,
2014, a separate form prescribed by the California
Department of Public Health (CDPH) to accompany a letter or
affidavit from a parent or guardian to exempt a child from
immunization requirements on the basis that the
immunization is contrary to beliefs of the child's parent
or guardian.
SB 614 (Kehoe, Ch. 123, 2011) authorizes a student in
grades 7- 12 to conditionally attend school for up to 30
calendar days beyond the student's first day of attendance
for the 2011-12 school year, if that student has not been
fully immunized with all pertussis boosters appropriate for
the student's age if specified conditions are met.
AB 354 (Arambula, Ch. 434, 2010) allows CDPH to update
vaccination requirements for children entering schools and
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child care facilities and adds the American Academy of
Family Physicians to the list of entities whose
recommendations CDPH must consider when updating the list
of required vaccinations. AB 354 requires students
entering grades 7-12 to receive a TDaP booster prior to
admittance to school.
SB 1179 (Aanestad, 2008) deleted CDPH'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
failed passage in the Senate Health Committee.
AB 2580 (Arambula, 2008) required students entering grade 7
to be fully immunized against pertussis. AB 2580 was held
on the Senate Appropriations Committee's suspense file.
SB 676 (Ridley-Thomas, of 2007) required students entering
grade 7 to be fully immunized against pertussis. SB 676 was
held on the Assembly Appropriations Committee's suspense
file.
SB 533 (Yee, 2007) added pneumococcus to the list of
required immunizations for children. SB 533 was vetoed by
the Governor, whose veto message read:
While I am a strong proponent of prevention and
support efforts to improve vaccine rates for
children, I am unable to sign this bill as
California's public health experts believe it is
not needed. The Department of Public Health can
already require that young children receive the
pneumococcal vaccine. California's vaccine
experts have not established a mandate
as they believe it is not needed. Approximately
86 percent of children are already being
vaccinated under a voluntary system.
SUPPORT (As of April 10; most are specific to the prior version
of the bill)
California Association for Nurse Practitioners
California Chapter of the American College of Emergency
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Physicians
California Coverage & Health Initiatives
California Medical Association
California Primary Care Association
California School Boards Association
California School Nurses Organization
CAPG
Children Now
Children's Defense Fund-California
County Health Executives Association of California
Health Officers Association of California
Kaiser Permanente
Los Angeles County Board of Supervisors
Reed Union School District
The Children's Partnership
Vaccinate California
Numerous individuals
OPPOSITION (As of April 10; most are specific to the prior
version of the bill)
Association of American Physicians and Surgeons
AWAKE California
California Chiropractic Association
California Coalition for Health Choice
California Nurses for Ethical Standards
Californians for Freedom of Choice
Educate Advocate
Homeschool Association of California
National Autism Association of California
Pacific Justice Institute
ParentalRights.Org
Plumas Charter School
Safe Minds
Standing Tall Chiropractic
The Canary Party
Unblind My Mind
Numerous individuals
-- END --
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