Despite Improvements, California’s Campaign for Childhood Immunizations Faces Pushback

LOS ANGELES (Los Angeles Times) -

Two years after California adopted one of the toughest child vaccination laws in the nation, the state’s immunization rates are near record-high levels.

Approved after a measles outbreak that originated at Disneyland, the law makes California one of only three states that bar parents from citing their personal beliefs to avoid having their children vaccinated.

Yet, even with the strict new law, there remain schools and neighborhoods with dangerously low vaccination rates, experts say, largely because a growing number of parents are obtaining doctors’ notes exempting their kids from the required shots.

At least 95 percent of the population needs to be vaccinated to prevent an outbreak of a highly contagious disease such as measles, experts say.

But at 105 schools in the state, 10 percent or more of kindergartners had a medical exemption in the school year that ended last month, according to a Los Angeles Times analysis of state data. That was nearly double the number of such schools in the first year the law was in effect.

State Sen. Richard Pan (D-Sacramento), who sponsored the immunization law, said he is contemplating legislation that would tighten the state’s vaccination laws even further. Some physicians have advertised online that they will consider medical exemptions for children with asthma or skin conditions such as psoriasis.

“People are getting fraudulent exemptions,” Pan said in an interview. “If we continue to see abuses, then I think there should be some thought as to how to address it. … People need to realize this is about the safety of their kids.”

But parents resistant to vaccines seem to be digging their heels in. Many were angered last month when Dr. Bob Sears, an Orange County pediatrician, was punished by the state medical board for improperly exempting a young boy from all childhood vaccinations. The penalty — 35 months’ probation — inspired many to rally around Sears, who appeared to be gearing up for a battle with the state.

“Is this fight over? No it is not,” Sears wrote on social media. “I will fight against mandatory vaccination laws until they are no more.”

The debate over how to enforce the immunization law is shaping up to be the next chapter in the vaccine fight in California, a state that has become somewhat of a test case for regulating anti-vaccine attitudes.

California lawmakers took action after a measles outbreak that began in Disneyland in 2014 was linked to children whose parents had refused vaccines.

Despite parents’ fears, vaccines are largely safe, experts say. The most common side effects are soreness at the injection site or developing a fever or rash, according to the U.S. Centers for Disease Control and Prevention.

“Everything else people are worried about doesn’t happen, like autism or developmental delays,” said Dr. Paul Offit, an infectious diseases expert at Children’s Hospital of Philadelphia.

With the personal belief exemption banned in California, the only way to skip the required shots is by home schooling kids or having a doctor state that a child can’t tolerate vaccines because of a health reason.

The law, known as SB 277, has largely been effective. The vaccination rate among kindergartners is up to 95 percent, from 93 percent before it took effect in 2016.

But doctors say that preventing outbreaks requires high vaccination rates not just statewide, but also in each neighborhood or school. Otherwise, diseases can spread in pockets with low immunity.

But at 785 of the roughly 6,500 elementary schools in the state, 90 percent or fewer kindergartners had all of their required shots. Some of those students were planning to get their shots later in the school year and they hadn’t come due yet. But many had notes from their doctors saying they shouldn’t be vaccinated for the rest of their childhood.

Doctors say that at most, three percent of people could have a medical reason for not tolerating vaccines, such as a gelatin allergy or because they’re undergoing chemotherapy. But at 20 schools, more than a quarter of students had a medical exemption, according to state data.

“One can only conclude that children are getting bogus medical exemptions and the doctors are willing to give them,” said Offit. “It’s unconscionable — suddenly, 25 percent of children can’t get vaccines? Really? It doesn’t make any sense.”

Many public health advocates said they worried that medical exemptions were becoming easier to obtain without a valid reason.

Indeed, the number of kindergartners in California with a vaccine exemption from a doctor has quadrupled since the law took effect.

“We’re disappointed to see it, but not shocked,” said Leah Russin, a member of Vaccinate California, a group that sponsored the 2015 vaccine law. “We know there are some communities where people really do resist vaccines in large numbers, and parents get together and share information about doctors who are sympathetic.”

Currently, no regulatory body in California is charged with vetting the validity of the medical exemptions. Schools merely collect the forms from parents and turn them in to the state.

Pan said he thinks that California could benefit from a system like the one in West Virginia, one of the two other states that have banned personal belief exemptions. There, the state requires that each exemption be vetted by the public health department. Their medical exemption rate is half of California’s.

“Obviously that would require some change in the law,” he said.

But that feels like a slap in the face for many parents.

Rebecca Estepp, who was part of a group that opposed SB 277, pointed out that the law allows doctors to use their professional judgment to decide whether a child qualifies for an exemption. There is no list of criteria that a patient must meet to get an exemption.

She said she felt that medical exemptions were facing undue scrutiny, as were doctors, such as Sears, who write them. Though some schools have higher medical exemption rates, only 0.7 percent of kindergartners have a medical exemption statewide.

“I guess I would understand if we had a very high rate of medical exemptions in the state of California, but we’re talking less than 1 percent, she said. “I don’t see where this sort of witch hunt is warranted.”

Last month, the California medical board ordered 35 months’ probation for Sears for wrongly writing an exemption for a 2-year-old boy. Sears later wrote on social media that the medical board was investigating four more cases against him for improper vaccine exemptions.

“It seems there is an attempt to keep me on probation for the rest of my medical career,” Sears wrote.

In addition to the complaint that launched the Sears investigation, more than 50 others have been filed against physicians who are accused of improperly writing exemptions in the past three years, according to the medical board. Roughly half have been investigated and closed without any disciplinary action, while the others are still pending.

Russin said she was relieved the board came out against Sears and hoped it would pursue other doctors selling exemptions.

“As far as I’m concerned, that’s their job,” Russin said. “If the medical board doesn’t do enough, doesn’t start investigating these, we may need to revisit the law.”

Schools with low vaccination rates are located across the state, but many are clustered in Sonoma, Humboldt, Mendocino, Santa Cruz and San Diego counties, the Times analysis found.

Many school administrators declined to comment on their vaccination rates or could not be reached because their offices were closed for summer break.