BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 277|
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THIRD READING
Bill No: SB 277
Author: Pan (D) and Allen (D), et al.
Amended: 5/7/15
Vote: 21
SENATE HEALTH COMMITTEE: 6-2, 4/8/15
AYES: Nguyen, Hall, Mitchell, Monning, Pan, Wolk
NOES: Nielsen, Roth
NO VOTE RECORDED: Hernandez
SENATE EDUCATION COMMITTEE: 7-2, 4/22/15
AYES: Liu, Block, Hancock, Mendoza, Monning, Pan, Vidak
NOES: Runner, Leyva
SENATE JUDICIARY COMMITTEE: 5-1, 4/28/15
AYES: Jackson, Hertzberg, Leno, Monning, Wieckowski
NOES: Anderson
NO VOTE RECORDED: Moorlach
SUBJECT: Public health: vaccinations
SOURCE: Vaccinate California
DIGEST: This bill eliminates the personal belief exemption from
the requirement that children receive vaccines for certain
infectious diseases prior to being admitted to any public or
private elementary or secondary school or day care center.
ANALYSIS:
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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
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:
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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.
1)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)Deletes the exemption for personal beliefs (described in #4 of
existing law above) from the existing immunization requirement
for children in child care and public and private schools.
Deletes related law requiring a form (described in #5 of
existing law above) to accompany a personal belief exemption
(PBE).
2)Exempts home-based private schools or students enrolled in an
independent study program from the existing immunization
requirement.
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3)Permits DPH to add diseases to the immunization requirements
(described in #2 of existing law above) only if exemptions are
allowed for both medical reasons and personal beliefs.
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 PBEs 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.
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
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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
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
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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 U.S. 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
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
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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 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
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
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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.
Prior Legislation
AB 2109 (Pan, Chapter 821, Statutes of 2012) required, 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. Required the form to include:
1)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.
2)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 to 1) 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, 2012) would have required a health
care service plan or health insurer that provides coverage for
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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) allowed DPH to
update vaccination requirements for children entering schools
and child care facilities and added 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, 2009) 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 the entire cost of acquiring and
administering the vaccine, and would have prohibited 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, 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, 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, 2007) would have required pupils entering
the seventh grade to be fully immunized against pertussis. SB
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676 was held on the Assembly Appropriations Committee suspense
file.
SB 533 (Yee, 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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:NoLocal: No
SUPPORT: (Verified5/12/15)
Vaccinate California (source)
Insurance Commissioner Dave Jones
AIDS Healthcare Foundation
American Academy of Pediatrics
American Federation of State, County and Municipal Employees
American Lung Association
American Nurses Association
Association of Northern California Oncologists
Biocom
California Academy of Family Physicians
California Academy of Physician Assistants
California Association of Nurse Practitioners
California Association of Physician Groups
California Chapter of the American College of Emergency
Physicians
California Children's Hospital Association
California Coverage and Health Initiatives
California Disability Rights, Inc.
California HealthCare Institute
California Hepatitis Alliance
California Hospital Association
California Immunization Coalition
California Medical Association
California Optometric Association
California Pharmacists Association
California Primary Care Association
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California Public Health Association-North
California School Boards Association
California School Employees Association
California School Nurses Organization
California State Association of Counties
California State Parent-Teacher Association
Carlsbad High School Parent-Teacher-Student Association
Child Care Law Center
Children Now
Children's Defense Fund California
Children's Healthcare Is a Legal Duty, Inc.
Children's Hospital Oakland
Children's Specialty Care Coalition
City and County of San Francisco
City of Berkeley
City of Beverly Hills
City of Pasadena
County Health Executives Association of California
County of Alameda
County of Los Angeles
County of Marin
County of Santa Clara
County of Santa Cruz
County of Santa Cruz Democratic Party
County of Yolo
Democratic Women's Club of Santa Cruz County
First 5 California
Foundation for Pediatric Health
Health Officers Association of California
Junior Leagues of California
Kaiser Permanente
Los Angeles Community College District
Los Angeles County Supervisor Sheila Kuehl
Los Angeles Unified School District
March of Dimes California Chapter
MemorialCare Health System Physician Society
National Coalition of 100 Black Women Sacramento Chapter
Osteopathic Physicians and Surgeons of California
Project Inform
Providence Health and Services Southern California
San Dieguito Union High School District
San Francisco Unified School District
Santa Monica Malibu Union Unified School District
Secular Coalition for California
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Silicon Valley Leadership Group
Solano Beach School District
The Children's Partnership
UAW Local 5810, Postdoctoral Researchers at the University of
California
Hundreds of individuals
OPPOSITION: (Verified5/12/15)
AWAKE California
Association of American Physicians and Surgeons
California Chiropractic Association
California Naturopathic Doctors Association
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
Prepared by:Melanie Moreno / HEALTH /
5/13/15 16:37:45
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