BILL ANALYSIS Ó
SB 277
Page 1
SENATE THIRD READING
SB
277 (Pan and Allen)
As Amended June 18, 2015
Majority vote
SENATE VOTE: 25-11
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+-----------------------+---------------------|
|Health |12-6 |Bonta, Bonilla, Chiu, |Maienschein, Chávez, |
| | |Gomez, Gonzalez, Roger |Lackey, Patterson, |
| | |Hernández, Nazarian, |Steinorth, Waldron |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Thurmond, Wood | |
| | | | |
| | | | |
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SUMMARY: Eliminates non-medical exemptions 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. Specifically, this bill:
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1)Deletes the exemption based on personal beliefs from the
existing immunization requirement for children in child care
and public and private schools. Deletes related law requiring
a form to accompany a personal belief exemption (PBE).
2)Allows pupils who, prior to January 1, 2016, have a letter or
affidavit on file at a private or public elementary or
secondary school, child day care center, day nursery, nursery
school, family day care home, or development center stating
beliefs opposed to immunization, to continue enrollment until
the pupil enrolls in the next grade span, as defined. Defines
grade span as birth to preschool, kindergarten to grade 6, and
grades 7 to 12.
3)Exempts students enrolled in home-based private schools or in
an independent study program that is not classroom-based from
the existing immunization requirement.
4)Specifies that a pupil who qualifies for an individualized
education program, pursuant to specified laws, must have
access to any special education and related services required
by his or her individualized education program.
5)Clarifies that a student is exempt from vaccination
requirements if a written statement by a licensed physician is
obtained 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, including, but not limited to,
family medical history, which the physician does not recommend
immunization.
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6)Permits the California Department of Public Health (DPH) to
add diseases to the immunization requirements only if
exemptions are allowed for both medical reasons and personal
beliefs.
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 meningitis), measles, mumps, pertussis (whooping cough),
poliomyelitis, rubella (German measles), tetanus, hepatitis B,
and varicella (chickenpox).
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 Committee on Infectious Diseases.
3)Waives immunization requirements in 1) above, 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
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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,
guardian, or 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
indicating that the parent, guardian, or emancipated minor,
was provided with information regarding the benefits and
risks of the immunization and the health risks of the
specified diseases 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, guardian, or
emancipated minor, that indicates that the signer has
received the information provided by the health care
practitioner pursuant to a) above.
6)Permits a local health officer to temporarily exclude from the
school or institution 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
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diseases, until the local health officer is satisfied that the
child is no longer at risk of developing the disease.
FISCAL EFFECT: None
COMMENTS: According to the author, in early 2015, California
became the epicenter of a measles outbreak, which spread in
large part because of communities with large numbers of
unvaccinated people. According to the CDC, there have been more
cases of measles in January 2015 than in any one month in the
past 20 years. Between 2000 and 2012, the number of PBEs 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, by 2013, that number
rose to 3.15%. In certain geographic pockets of California,
exemption rates are 21% or more, placing our communities at risk
for the rapid spread of entirely preventable diseases, according
to the author. Given the highly contagious nature of diseases
such as measles, vaccination rates of up to 95% are necessary to
protect the public health of the community and prevent future
outbreaks.
The diseases that vaccines prevent can be dangerous, or even
deadly. According to the CDC, vaccines reduce the risk of
infection by working with the body's natural defenses to help it
safely develop immunity to disease. When bacteria or viruses
invade the body, they attack and multiply, creating an
infection. The immune system then has to fight the illness.
Once it fights off the infection, the body is left with a supply
of cells that help recognize and fight that disease in the
future. Vaccines contain the same antigens or parts of antigens
that cause diseases, but the antigens in vaccines are either
killed or greatly weakened. This exposure to the antigens
teaches the immune system to develop the same response as it
does to the real infection so the body can recognize and fight
the disease in the future.
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Public health experts agree that vaccines represent one of the
greatest achievements of science and medicine in the battle
against disease. Vaccines are responsible for the control of
many infectious diseases that were once common around the world,
including polio, measles, diphtheria, pertussis, rubella, mumps,
tetanus, and Hib meningitis. Vaccine helped to eradicate
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.
In the United States (U.S.), the high vaccination rate for
routinely recommended immunizations for infant and childhood
diseases has brought about dramatic declines in the incidence of
polio, measles, mumps, rubella, Haemophilus influenza type b,
hepatitis, and chickenpox. In the past decade, recommendations
for annual influenza vaccination have been expanded to encompass
all children six months to 18 years of age, and new vaccines
have been added to the immunization schedule to help protect
infants from rotavirus disease and adolescents from meningitis.
As a result of the advances in developing vaccines and including
them as standard of care, most diseases that are preventable by
vaccination are at record low levels in the U.S.
For years many of these diseases were thought to be ordinary
childhood experiences and many older adults had these diseases
as children. Nevertheless, they are serious deadly diseases for
some. For example, measles in children has a mortality rate as
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high as about one in 500 among healthy children, higher if there
are complicating health factors.
In the past couple of decades, controversy has arisen about
vaccines and autism, the best number of injections to be
administered during a single visit or over the course of the
first years of life, and vaccine ingredients which has prompted
parents, the media, policy makers, and others to raise concerns
about the safety of recommended immunizations as well as the
vaccination schedule. Despite their positive impact on health
and well-being, vaccines have had a long history of arousing
anxiety. The rapid growth of the Internet and social media has
made it easier to find and disseminate immunization-related
concerns and misperceptions. According to a 2011 study
published in the journal Health Affairs, results indicate that
although the overwhelming majority of parents surveyed intended
to vaccinate their children fully, a majority of parents still
had questions or concerns about vaccines.
School immunization 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.
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, while public health officials and
policy makers consider the benefits of vaccination to society
at-large. As part of their research, the authors compared
childhood immunization rates and rates of vaccine-preventable
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childhood diseases before and after the introduction of school
vaccination requirements.
Current state law mandates immunization of school-aged children
against 10 specific diseases. Each of the 10 diseases was added
to California code through legislative action, after careful
consideration of the public health risks of these diseases, cost
to the state and health system, communicability, and rates of
transmission. The Legislature has a long history of thoughtful
consideration for which diseases pose the most serious health
risks to the public. The following is a brief summary of
activity related to mandated immunizations for children
enrolling in school:
1889: School districts first allowed to exclude a student who
is not vaccinated against smallpox, and schools were
required to maintain a list of unvaccinated children [SB
92 (Briceland), Chapter 24].
1961: Polio immunization added as a requirement, as well as the
first appearance of a philosophical exemption [AB 1940
(DeLotto), Chapter 837].
1977: Diphtheria, pertussis, tetanus, and measles were added to
immunization requirements for children entering school [SB
942 (Rains), Chapter 1176].
1979: Mumps and rubella were added to the list [AB 805
(Mangers), Chapter 435].
1992: Haemophilus influenzae type b was added [AB 2798 (Floyd),
Chapter 1300, and AB 2294 (Alpert), Chapter 1320].
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1995 and 1997: Hepatitis B was added [AB 1194 (Takasugi),
Chapter 291, Statutes of 1995 and AB 381 (Takasugi),
Chapter 882, Statutes of 1997].
1999: The Legislature voted to add hepatitis A to the list, but
it was vetoed by Governor Davis [AB 1594 (Florez)].
1999: Varicella was added to the list [SB 741 (Alpert), Chapter
747].
2007: The Legislature voted to add pneumococcus to the list,
but it was vetoed by Governor Schwarzenegger [SB 533
(Yee)].
2010: Tetanus, diphtheria and pertussis (TDaP) booster was
required for 7th graders [AB 354 (Arambula), Chapter 434].
All of the diseases for which California requires school
vaccinations are very serious conditions that pose very real
health risks to children. Most of the diseases can be spread by
contact with other infected children. Tetanus does not spread
from student to student but because it is such a serious
potentially fatal disease, and it is easily preventable by
vaccine, the vaccination of children is required prior to
enrollment in school.
Community immunity. Herd immunity occurs when a significant
proportion of the population (or the herd) has been vaccinated,
and this provides protection for unprotected individuals. The
larger the number of people who are vaccinated in a population,
the lower the likelihood that a susceptible (unvaccinated)
person will physically come into contact with the infection. It
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is more difficult for diseases to spread between individuals if
large numbers of people are already immune, and the chain of
infection is broken. The reduction of herd immunity places
unvaccinated persons at risk, including those who cannot receive
vaccinations for medical reasons. Those who cannot receive
vaccines include those with compromised immune systems, older
adults, small children and babies, all depending on the vaccine.
There the protective effect of herd immunity wanes as large
numbers of children do not receive some or all of the required
vaccinations, resulting in the reemergence of vaccine
preventable diseases in the U.S. Statewide statistics indicate
that in 2014-15 school year, 90.4% of kindergartens received all
required immunizations. The widespread reporting of statewide
numbers, however, potentially mask a better understanding of
more relevant data, such as town, city, or county vaccination
rates. Because students are not interacting with every
individual in the entire state, the local vaccination rate is
more relevant to the discussion of community immunity.
The vaccination rate in various communities varies widely across
the state. Those areas become more susceptible to an outbreak
than the state's overall vaccination levels may suggest. These
communities make it difficult to control the spread of disease
and make us vulnerable to having the virus re-establish itself.
Studies find that when belief exemptions to vaccination
guidelines are permitted, vaccination rates decrease. An
analysis by the New York Times found that more than a quarter of
schools in California have measles-immunization rates below the
92% to 94% recommended by the CDC. Research shows that people
with lower vaccine acceptance tend to group together in
communities. A study recently published in the journal
Pediatrics found that schools with high PBE rates are clustered
in suburbs in the peripheral areas of California cities. The
same analysis found that schools with low proportion of white
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students, or a high proportion of students receiving free or
reduced lunch, were more likely to have high vaccination rates
(less PBEs).
California measles outbreak. The authors point to an outbreak
of measles linked to Disneyland in in December 2014 as one of
the reasons for the introduction of this bill. This outbreak
led to 131 confirmed measles cases reported in California as
part of this outbreak. The outbreak, now declared over by DPH,
led to 19% of those infected requiring hospitalization. The
outbreak likely started from a traveler who became infected
overseas with measles, then visited the amusement park while
infectious; however, no source was identified. Analysis by CDC
scientists showed that the measles virus type in this outbreak
(B3) was identical to the virus type that caused the large
measles outbreak in the Philippines in 2014.
According to the CDC, measles is one of the first diseases to
reappear when vaccination coverage rates fall. In 2014, there
were over 600 cases reported to the CDC, the highest in many
years. Between 2000 and 2007, the average number of cases was
63 per year, less than half the number of the Disney outbreak,
which is one of five outbreaks so far this year reported by the
CDC.
Of the confirmed cases, DPH reported:
1)Forty-two cases visited Disneyland during December 17-20, 2014
where they are presumed to have been exposed to measles;
2)Thirty-one are household or close contacts to a confirmed
case;
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3)Fourteen were exposed in a community setting (e.g., emergency
room) where a confirmed case was known to be present;
4)Forty-four have unknown exposure source but are presumed to be
linked to the outbreak based on a combination of descriptive
epidemiology or strain type;
5)Five cases are known to have a different genotype from the
outbreak strain; and,
6)Among measles cases for whom DPH has vaccination
documentation, 57 were unvaccinated and 25 had one or more
doses of measles, mumps, and rubella (MMR) vaccine. A number
of those unvaccinated had a personal belief exemption and also
include many infants too young to be vaccinated.
National Childhood Vaccine Injury Act. During the mid-1970s,
there was an increased focus on personal health and more people
became concerned about vaccine safety. Several lawsuits were
filed against vaccine manufacturers and healthcare providers by
people who believed they had been injured by the TDaP vaccine.
Damages were awarded despite the lack of scientific evidence to
support vaccine injury claims. In 1976, a preemptive attempt to
conduct a nationwide influenza vaccination campaign for the
swine flu stoked peoples' fears. The predicted epidemic did not
occur and there were some who argued this particular influenza
vaccine resulted in serious side effects.
As a result, potential liability costs and vaccine prices
soared, and several vaccine manufacturers halted production. A
vaccine shortage resulted and public health officials became
concerned about the return of epidemic disease.
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To reduce liability and respond to public health concerns,
Congress passed the National Childhood Vaccine Injury Act
(NCVIA) in 1986. The NCVIA established the National Vaccine
Program Office (NVPO) to coordinate immunization related
activities among various federal agencies and requires health
care providers who give vaccines to provide an information
statement to the patient or guardian that contains a brief
description of the disease as well as the risks and benefits of
the vaccine. Additionally, the NCVIA requires health care
providers to report certain adverse health events following
vaccination to the Vaccine Adverse Event Reporting System
(VAERS). The VAERS system remains an important source of
information for the CDC and others to monitor the vaccine
program, but the system allows self-reporting by any citizen or
healthcare provider what they believe to be an adverse
vaccine-related event, but the event numbers publicly available
have not necessarily been medically verified or scientifically
studied. The National Vaccine Injury Compensation Program
(NVICP) was created to compensate those injured by vaccines on a
"no fault" basis. The NVICP has been loudly criticized by some
for inefficient operations, and for providing legal immunity to
the pharmaceutical industry.
The NCVIA established a committee from the Institute of Medicine
(IOM) to review the literature on vaccine reactions. This group
concluded that there are limitations in our knowledge of the
risks associated with vaccines. The group looked at 76 health
problems to see if they were caused by vaccines. Of those, 50
(66%) had no or inadequate research to form a conclusion. The
IOM identified several specific problems, such as a limited
understanding of biological processes that underlie adverse
events, incomplete and inconsistent information from individual
reports, poorly constructed research studies (not enough people
enrolled for the period of time), inadequate systems to track
vaccine side effects, and few experimental studies were
published in the medical literature. The CDC states that in the
time since the publication of the IOM reports in the 1990s,
significant progress has been made to monitor side effects and
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conduct research relevant to vaccine safety. In 2011 the IOM
published Adverse Effects of Vaccines: Evidence and Causality,
representing an extensive study of peer-reviewed vaccine related
research to date. The IOM Committee reviewed eight vaccines
given to children or adults (MMR, varicella, influenza,
hepatitis A, hepatitis B, human papillomavirus, meningococcal,
and DTP) and again found that vaccines are generally very safe
and that serious adverse events are quite rare.
Vaccines and Autism. The idea that autism is caused by
vaccination is influencing public policy, even though rigorous
studies do not support this hypothesis. The hypothesis is based
on the observation that the number of autism cases increased in
the 1980s, coinciding with a push for greater childhood
vaccinations, which increased above recommended levels
children's exposure to mercury in the vaccine preservative
thimerosal. However, autism diagnosis continued to rise even
after thimerosal was removed from U.S. childhood vaccines in
2001. A review by the IOM of over 200 studies concluded that
that there was no causal link between thimerosal-containing
vaccines and autism. Other studies have found that autism is no
more common among vaccinated than unvaccinated children.
Exemptions to vaccine requirements. There are currently three
types of exemptions to the requirement that children be
vaccinated before entering school: medical; religious; and,
philosophical.
1)A medical exemption letter can be written by a licensed
physician that believes that vaccination is not safe for the
medical conditions of the patient, such as those whose immune
systems are compromised, who are allergic to vaccines, are ill
at the time of vaccination, or have other medical
contraindications to vaccines for that individual patient.
Every state allows medical exemptions from school vaccination
requirements. This determination is entirely up to the
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professional clinical judgment of the physician. There are no
required medical criteria for diagnosing circumstances that
contraindicate vaccination. A physician must base that
decision on their professional judgment and the standard of
practice for their field. According to the Medical Board of
California, the "standard of care" (or "standard of practice")
for general practitioners is defined as that level of skill,
knowledge and care in diagnosis and treatment ordinarily
possessed and exercised by other reasonably careful and
prudent physicians in the same or similar circumstances at the
time in question. Specialists are held to the standard of
skill, knowledge and care ordinarily possessed and exercised
by other reasonably careful and prudent specialist in the same
or similar circumstances.
2)Religious exemptions allow parents to exempt their children
from vaccination if it contradicts their sincere religious
beliefs. Many states allow religious exemptions from school
vaccination requirements, although states interpret the
enforcement of them differently. In some states, a parent may
simply attest that vaccinations are against their religious
beliefs, while in other states the parent must show membership
in a church, and that the church's official policy is opposed
to vaccination. According to the National Conference of State
Legislatures (NCSL), as of June 2014, 48 states allow
religious exemptions (all but Mississippi and West Virginia).
3)Philosophical exemption, which is defined differently in
different states, generally 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 NCSL, 20 states (Arizona, California,
Colorado, Idaho, Louisiana, Maine, Michigan, Minnesota,
Missouri (limited to childcare enrollees), New Mexico, North
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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. The bills were tabled in Oregon and Washington.
On May 25, 2015, the Governor of Vermont signed legislation
removing philosophical exemptions, but not religious ones, in
that state.
Special education. Pursuant to the federal Individuals with
Disabilities Education Act (IDEA), children with disabilities
are guaranteed the right to a free, appropriate public
education, including necessary services for a child to benefit
from his or her education. Between 1976 and 1984, to meet this
federal mandate, California schools provided mental health
services to special education students who needed the services
pursuant to an Individualized Education Program (IEP). An IEP
is a legally binding document that determines what special
education services a child will receive and why. IEPs include a
child's classification, placement, specialized services,
academic and behavioral goals, a behavior plan if needed,
percentage of time in regular education, and progress reports
from teachers and therapists. A child may require any related
services in order to benefit from special education, including
(but not limited to): speech-language pathology and audiology
services, early identification and assessment of disabilities in
children, medical services, physical and occupational therapy,
orientation and mobility services; and psychological services.
According to the California Department of Education (CDE), over
700,000, or approximately 11% of, California students received
Special Education services in the 2013-14 academic year.
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Independent study. April 22, 2015, amendments to this bill
exclude pupils who are enrolled in an independent study program
from the immunization requirements of this bill. Independent
study is an optional educational alternative, available to
students from kindergarten through high school that is meant to
respond to the student's specific educational needs, interests,
aptitudes, and abilities. Independent study is an alternative
to classroom instruction consistent with a school district's
regular course of study and is expected to be equal or superior
in quality to classroom instruction. Each school district can
develop Independent Study options in its own way. Parents and
students may also develop alternative forms of independent study
and propose them to the school board. The options are based on
the kinds of students being served. The following are some of
the ways in which independent study is organized:
1)School-within-a-school;
2)District or county alternative in a community location;
3)School-based independent study offered part-time and
full-time;
4)Countywide home-based independent study offered by the county
superintendent of schools;
5)District dropout prevention centers at selected community
sites;
6)Curricular enrichment options offered to high school students
with special abilities and interests, scheduling problems, or
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individual needs that cannot be met in the regular program;
7)Alternative school-based independent study, on-or off-site;
and,
8)Some combination of the above.
Independent study can be operated on a traditional school
calendar, with a summer school option for eligible students, or
on a year-round calendar within a year-round school. Students
must have the option of a classroom setting for a full program
at the time independent study is made available. This option
must be continuously available should the student decide to
transfer from independent study. The classroom setting option
can be offered by the county office of education if the district
and county have a formal agreement that has the effect of
providing the student with a program that is equivalent to what
is offered in the school of residence.
According to CDE, in 2013-14 there were approximately 122,000
independent study students reported by charter schools and
34,000 reported by school districts. Independent study
enrollment was not collected for the 2009-10 and 2010-11 school
years. In October 2008, data collected from schools reported
that 128,000 students in kindergarten through grade 12 were
enrolled in independent study.
Legal considerations. Courts have determined that the family
itself is not beyond regulation in the public interest and
neither rights of religion nor rights of parenthood are beyond
limitation. As discussed at length in the Senate Judiciary
Committee analysis, extensive case law establishes that the
police powers of the state may restrict the parent's control in
many ways, such as requiring school attendance and regulating or
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prohibiting the child's labor. This authority is not nullified
because the parent grounds his claim to control the child's
course of conduct on religion or conscience. Thus, a parent
cannot claim freedom from compulsory vaccination for their child
more than for himself on religious grounds. The right to
practice religion freely does not include liberty to expose the
community or the child to communicable disease or the latter to
ill health or death. For a further discussion of the legal
rights and ramifications of this bill, please see the Senate
Judiciary Committee analysis as published on April 28, 2015.
Support. The Superintendent of Public Instruction (SPI), Tom
Torlakson, supports this bill, stating that school and child
care immunization requirements have proven effective in
increasing immunization rates, limiting the spread of disease,
and providing an overall public health benefit. He further
states that California has seen a dramatic increase in the PBE
rate for students entering kindergarten over the past 15 years,
placing other children, and the overall public health of our
citizens, at risk of illness or death from preventable diseases.
The SPI concludes that education is a fundamental right in
California, and this bill provides education choices for
families opting not to vaccinate their children.
The California Medical Association, a co-sponsor of this bill,
states that efforts to contain the 2014 measles outbreak
resulted in unnecessary mandatory quarantines and the
redirection of public health resources to investigations into
exposure. The California Immunization Coalition, writing in
support of this bill, notes that in the 2013-14 school year more
than 16,800 kindergarteners in California started school with
either no vaccinations or only some of their required
vaccinations because their parent had chosen to exempt them from
vaccinations, representing a 25% increase over the previous two
school years.
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The Medical Board of California states that vaccines have been
scientifically proven to be effective in preventing illnesses.
Ensuring that children receive the ACIP recommended vaccination
schedule is the standard of care, unless there is a medical
reason that the child should not receive the vaccine; this bill
would still allow for a medical exemption to address these
concerns. The Children's Specialty Care Coalition notes that
high vaccine coverage, particularly at the community level, is
extremely important for people who cannot be vaccinated,
including people who have medical contraindications to
vaccinations and those who are too young to be vaccinated.
Protecting the individual and the community from communicable
diseases such as measles, mumps, and pertussis, is important to
the public's health.
The Assembly Health Committee notes it has received hundreds of
letters in support of this bill. Many letters from individuals
in support write to raise similar points regarding reductions in
vaccination rates for school children, recent dangerous measles
and pertussis outbreaks, concerns for the health of children and
medically fragile individuals, and concerns for the safety of
communities at large.
Opposition. Opponents state that this bill is an extreme
measure that is not necessary at this time. The California
Chiropractic Association states that this bill proffers the
notion that health officials will be given the power to nullify
the doctor-patient relationship, and veto the judgment of any
physician who questions the status quo and believes that a
patient should not receive a particular vaccine. A Voice for
Choice states that the Legislature should look to alternative
approaches that will stop the transmission of disease and
continue to allow parents to work with their doctors for the
best vaccination schedule for their individual children, and
allow their children their constitutional right to a free and
public education.
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The Assembly Health Committee also notes that it received
hundreds of letters in opposition to this bill. A letter from
Our Kids Our Choice and many other similar letters argue that
this bill removes federally mandated rights of services to
students with disabilities under the federal IDEA. This group,
like many others, points to the National Vaccine Information
Center (NVIC) and the fact that the U.S. government "has paid
out more than $3 billion to the victims of vaccine injury" as
support for why medical choice is appropriate. "If there is
risk of injury or death there must be a choice." In contrast,
they argue that "vaccination rates of California schoolchildren
are high at 98.64%" and cite the success of recent legislation,
AB 2109 (Pan), Chapter 821, Statutes of 2012, which they say has
resulted in a 19% decrease in exemptions amongst kindergarteners
in just one year. They argue the public health concerns are
already adequately addressed with current California laws. Many
letters from individuals write to raise relatively similar
points regarding various constitutional rights, informed
consent, vaccine safety/injuries, absence of a health crisis,
lack of educational choice, difficulty in obtaining medical
exemptions, and the like.
ParentalRights.Org states that "?while we appreciate the intent
of the amendment to exempt homeschoolers from the vaccination
requirement, it is not sufficient to protect the rights of
parents and children in California. While there are many
parents with strong convictions that the risks of vaccines to
their child (as reflected in lengthy disclaimers which accompany
these products) outweigh the potential benefits, many of these
same parents are also deeply convinced that the best educational
opportunity they can provide their child is in the public
schools. These parents should not be forced to give up their
rights in one area to exercise their rights in another. No
child should have to forego the best available education for the
sake of his best health, nor give up his best health for the
sake of a better education."
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Concerns. American Civil Liberties Union of California
(ACLU-CA) states that "while we appreciate that vaccination
against childhood diseases is a prudent step that should be
promoted for the general welfare, we 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 for every school
district in the state." ACLU-CA further states that unlike
other states where a vaccination mandate may be more
permissible, public education is a fundamental right under the
California Constitution. 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 California Association of Private School
Organizations states that that association has taken no formal
position on the measure, and does not oppose the elimination of
the PBEs, they are concerned about the increased administrative
burden to which schools will be subjected should this bill
become law. The association urges amendments that would create
a phase-in period, lengthen the time horizon for compliance as
per the existing regulations, or enact such other provisions as
may produce a combination of increased compliance and a
decreased possibility of mandatory exclusion.
Related legislation. SB 792 (Mendoza) of the current
legislative session, prohibits 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 was
approved by the Senate on May 22, 2015, by a vote of 34-3 and is
currently pending committee referral in the Assembly.
Previous legislation. AB 2109, 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. Required the form
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to include:
1)A signed attestation from the health care practitioner that
indicates that the parent, guardian, or 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, guardian, or
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.
Analysis Prepared by:
Dharia McGrew and Paula Villescaz / HEALTH /
(916) 319-2097 FN: 0000953
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