BILL ANALYSIS                                                                                                                                                                                                    �



                                                                  AB 2109
                                                                  Page  1

          CONCURRENCE IN SENATE AMENDMENTS
          AB 2109 (Pan)
          As Amended August 20, 2012
          Majority vote
           
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          |ASSEMBLY:  |47-26|(May 10, 2012)  |SENATE: |22-14|(August 22,    |
          |           |     |                |        |     |2012)          |
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           Original Committee Reference:    HEALTH  

           SUMMARY  :  Requires on and after January 1, 2014, a separate form 
          prescribed by the Department of Public Health (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.

           The Senate amendments  :

          1)Provide that the letter or affidavit document which 
            immunizations have been given, and which immunizations have 
            not been given on the basis that they are contrary to the 
            beliefs of the child's parent or guardian.

          2)Require 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 immunizations and the risks of communicable diseases, 
            as specified.

          3)Provides that the following shall be accepted in lieu of the 
            original form:  a) photocopy of the signed form; or, b) letter 
            signed by a health care practitioner that includes all 
            information and attestations included on the form.

          4)Exempts the form prescribed by DPH from the rulemaking 
            provisions of the Administrative Procedure Act, as specified. 

          5)Includes a credentialed school nurse, as specified, in the 
            list of health care practitioners who could sign the letters 
            or affidavits.

          6)Makes other technical, clarifying, and conforming changes.








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           AS PASSED BY THE ASSEMBLY  , this bill made changes to existing 
          requirements which allow school-aged children, as specified, to 
          be exempt from immunization requirements as long as a parent or 
          a guardian files a letter or affidavit to the governing 
          authority indicating that immunization is contrary to the parent 
          or guardian's beliefs.

           FISCAL EFFECT  :  According to the Senate Appropriations 
          Committee:

          1)DPH 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.

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

          3)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 this 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.

           COMMENTS  :  According to the author, "California is one of only 
          20 states that allows for a personal beliefs or philosophical 
          exemption to school or childcare immunization requirements.  
          Under existing law, to exempt the child from the immunization 
          requirements, a parent or guardian must only provide a signed 
          written statement or sign their name to a two-sentence standard 
          exemption statement on the back of the School Immunization 
          Record.  While parents do have a choice to exempt their 
          children, they are not required to document their concerns about 
          vaccines or affirm that they have reviewed fact-based, accurate 
          information regarding the risks and benefits of vaccines and the 
          risks of vaccine-preventable diseases.  The continued increase 
          in personal belief exemptions and resultant decreases in 
          community immunization rates in California will result in 
          outbreaks of diseases such as measles, mumps, and pertussis.  
          Exposure to these preventable diseases not only places the 








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          individual child at risk, but the entire community, including 
          infants too young to be fully immunized and individuals with 
          compromised immune systems, who are vulnerable to complications 
          of vaccine-preventable diseases, including death.  This measure 
          would rectify this problem by creating a process where parents 
          would be able make an informed decision for their children."

          School-aged children are required to obtain immunizations for 
          certain types of diseases to be admitted in school.  There are 
          exceptions to this requirement.  First, if the physical or 
          medical condition of a child would make immunization unsafe, as 
          long as a statement by a licensed physician to this effect is 
          submitted to the governing authority.  Second, if a letter or 
          affidavit is filed with the governing authority indicating that 
          the immunization is contrary to the beliefs of a parent or 
          guardian; this exemption is generally referred to as the 
          personal belief exemption or philosophic exemption.  According 
          to the Centers for Disease Control and Prevention, aside from 
          the philosophic exemption, some states allow for religious 
          exemptions on the grounds that the religious beliefs of some 
          people are in opposition to vaccination.
           

          Analysis Prepared by  :    Rosielyn Pulmano / HEALTH / (916) 
          319-2097 



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