BILL ANALYSIS                                                                                                                                                                                                    �




                   Senate Appropriations Committee Fiscal Summary
                           Senator Christine Kehoe, Chair


          AB 2109 (Pan) - Communicable diseases: immunization exemption.
          
          Amended: June 20, 2012          Policy Vote: Health 7-1
          Urgency: No                     Mandate: Yes
          Hearing Date: August 6, 2012                           
          Consultant: Brendan McCarthy    
          
          This bill does not meet the criteria for referral to the 
          Suspense File.
          
          
          Bill Summary: AB 2109 requires a separate form indicating that a 
          health care provider has provided information on the benefits 
          and risks of vaccination to accompany a personal belief 
          exemption letter or affidavit when a parent or guardian elects 
          not to have a child vaccinated before school admission.

          Fiscal Impact: 
              The Department of Public Health will incur one-time costs 
              of about $80,000 (federal funds) to develop and distribute 
              the required forms and related materials to schools and 
              health practitioners.

              Costs to the Department of Education and the Department of 
              Social Services for staff training are expected to be minor 
              and absorbable (General Fund).

              Minor potential reimbursable mandate costs to schools to 
              collect the new form with currently required documentation 
              of personal belief exemptions (General Fund). Under current 
              law, parents who elect not to have their child vaccinated 
              before enrolling in school must provide information to the 
              school regarding their personal belief exemption. Under the 
              bill, parents would also be required to provide the required 
              form signed by a health professional. Any marginal costs to 
              collect and store the additional form are likely to be 
              minor.

          Background: Under current law, children admitted to schools or 
          child care facilities, must be vaccinated against certain, 
          specified diseases. Current law provides an exemption from the 
          vaccination requirement, if the parent or guardian attests that 








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          he or she has a religious or philosophical objection to 
          vaccination (collectively referred to as personal belief 
          exemptions). In either case, the parent or guardian must provide 
          either a vaccination record or an attestation to the personal 
          belief exemption before the child is admitted to school.

          Proposed Law: AB 2109 would require, beginning on January 1, 
          2014, any parent or guardian claiming a personal belief 
          exemption to vaccination requirements to provide an additional 
          form signed by a health practitioner alongside the parent's 
          attestation to the school.

          The Department of Public Health would be required to develop the 
          form. The form must indicate that the health practitioner has 
          discussed the benefits and risks of vaccination with the parent 
          or guardian.

          In order to be accepted by the school, both the practitioner and 
          the parent or guardian must have signed the form not more than 
          six months prior to enrollment.

          The bill specifies that physicians and surgeons, nurse 
          practitioners, physician assistants, osteopathic physicians and 
          surgeons, and naturopathic doctors are eligible practitioners 
          who can sign the form. 

          Staff Comments: According to the Department of Public Health, 
          the percentage of kindergarteners who have not received required 
          immunizations increased from 0.5 percent in 1978 to 2.5 percent 
          in 2010, due to parents using personal belief exemptions.

          It is important to note that not all children can be immunized 
          against common childhood illnesses. Children under six months of 
          age and children with compromised immune systems cannot always 
          be vaccinated. In order to protect those children, a high level 
          of community immunization levels are needed to provide the "herd 
          immunity" that will protect those children from exposure. To the 
          extent that increasing numbers of children are unvaccinated, 
          herd immunity is lessened and children who cannot be vaccinated 
          are put at risk.

          The Centers for Disease Control and Prevention indicates that 
          there are rare instances of adverse reactions to immunization 
          (for example 1 in 1,000,000 people who receive the 








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          measles-mumps-rubella vaccination will experience encephalitis 
          or a severe allergic reaction). On the other hand, the mortality 
          risk for someone contracting the measles is 1 in 500. Further, a 
          single published study indicating that there is a connection 
          between the measles-mumps-rubella vaccine and the incidence of 
          autism has been discredited.