State Sen. Richard Pan, D-Sacramento, earlier this month recounted to a group of medical students a common belief about preventable diseases that he once heard while studying to become a pediatrician.
“You’re not likely to ever to see them because of the vaccines here in the United States,” said Pan, recalling the words of his microbiology professor, who had worked with Jonas Salk to develop the polio vaccine.
“Unfortunately, today I cannot tell you that,” Pan said he told the students.
The day prior to Pan’s talk, news outlets reported that UC Davis Health had warned roughly 200 people about a potential exposure to the highly contagious measles virus last month in the emergency room at UC-Davis Medical Center. Travelers with measles also have passed through Los Angeles and Long Beach airports in recent weeks.
On Monday, the Centers for Disease Control and Prevention announced a continued spike in the number of cases of measles reported across the country, putting 2019 on pace for a record-breaking number of cases since measles was declared eliminated in the year 2000.
In pockets across the country, recent outbreaks have put the spotlight on a growing movement among some parents who decline to vaccinate their children. Clusters of unvaccinated people — many of them children — and travel by Americans to countries battling measles has led to outbreaks this year in California, New York, New Jersey, Washington and Michigan.
In response to these outbreaks, Pan recently proposed legislation to close a loophole regarding exemptions granted for medical reasons in a 2015 state law that he authored. The law, SB 277, banned so-called “personal belief” exemptions, which allowed parents not to have their children immunized based simply on whether it ran counter to their personal beliefs.
The law led to a significant decline in the number of children who arrive at school unvaccinated. Immunization rates are now at an all-time high.
However, the full impact of the bill has been undercut by the rise in medical exemptions, which have tripled since Pan’s original bill was approved three years ago.
The new bill, SB 276 — which Pan is co-sponsoring with Assemblywoman Lorena Gonzalez Fletcher, D-San Diego — aims to curb fraudulent medical exemptions for vaccines against diseases, such as measles, mumps, rubella, polio, whooping cough and chickenpox. The Senate Health Committee plans to hold a hearing on the bill on April 24.
Pan recently spoke with EdSource about the new legislation:
What are the key differences between the proposed legislation and current law?
Current law — based on the 2015 legislation — requires all children to be vaccinated unless they are homeschooled or have a medical exemption, which has helped boost the overall vaccination rate. But medical exemption rates for students entering kindergarten increased more than three-fold, from 0.2 percent to 0.7 percent.
There are physicians that are essentially advertising medical exemptions: “Come to me and I will evaluate your child for a medical exemption. In fact, here are the reasons I might give a medical exemption,” essentially directing the parent on what to say in order to get the medical exemption. It appeared that they were essentially selling medical exemptions and some people even grant them without examining patients.
The proposed law would require doctors to submit medical exemption requests to the California Department of Public Health, which would have to approve them. The doctors would have to certify they examined the patient and they would have to include in the request their own name, their medical license number and the reason for the exemption. The public health department would be required to keep a database of the exemptions and it would have the authority to revoke exemptions if they’re later found to be fraudulent.
Why are you pushing for this now?
Outbreaks are more likely now because the exemptions are concentrated in certain schools.
If it were evenly spread across the whole state, we wouldn’t be so worried. We also know that particular schools have medical exemption rates that are 20 percent, 30 percent, 50 percent…They no longer have community immunity. If one of those students travels to Europe on vacation, catches measles and goes back to school, then we’ll have an outbreak in one of those schools, and that’s the concern. And then those students will go around the community because you’re infectious for four days before you have symptoms and they’ll go around and spread it to other people.
SB 277 tried to restore community immunity to California. But it’s not the vaccination rate of the state that matters. It’s the vaccination rate of each individual school.
You dealt with a recall effort and even death threats after you proposed similar legislation, SB 277, in 2015. What does the opposition look like now?
It’s always vehement and it’s unfortunate because without science or facts on your side, [anti-vaccine groups] resort to bullying and intimidation. Why don’t you provide the evidence instead of death threats?
People get harassed on social media for posting scientific articles about vaccines.
Doctors who post any sort of pro-vaccine thing on social media are attacked, not just on the social media, but also they have their ratings on things like Yelp…downgraded [in an effort] to ruin their practice’s reputation. [Vaccine opponents] engage in this kind of bullying and intimidation, hoping to silence people from speaking out. But I dedicate my life to the good health and safety of children as a pediatrician.
What type of support is there for the legislation?
The bill is co-sponsored by Vaccinate California, the California Medical Association and the California chapter of the American Academy of Pediatrics.
All but one of the 10 schools with the highest percentages of medical exemptions in the 2017-18 school year are located in Northern California. What is the relationship, if any, between outbreaks — such as the one in the Bay Area last year and the isolated case in Davis this month — and folks who aren’t vaccinated?
There are two effects with vaccinations. First, the person getting vaccinated is anywhere from 90 to 98 percent protected — depending on when you got the vaccine. Then, of course, it’s an infectious disease, a contagious disease, which means that if you get sick it’s not only that you get sick, everybody you get contact with has now been exposed.
Community or herd immunity is when you have enough people around you who have been vaccinated so even if you’re unvaccinated, it’s unlikely the disease will get to you.
The outbreak in Santa Clara County started with a student who got the disease while traveling in England and passed it to others when he returned home. The parents of two boys exposed had initially told public health officials that their sons were vaccinated. It was only after measles started spreading that authorities realized they had not been immunized.
It also seems charter schools are over-represented when looking at the top 10 schools with exemptions. Five of the top 10 are charters while about half are Waldorf method schools. Why do you think that is?
The problem we’re facing right now is that social media and its algorithms are creating, essentially, echo chambers and social norms around not vaccinating. And so what you see in the Waldorf schools is that they’ve developed a culture against vaccination, so they say, ‘Well, vaccines aren’t natural.’ The interesting thing is that if the child gets a disease and gets hospitalized, that’s less natural than any vaccine.
A representative of the Waldorf schools — which integrate the arts into all academic disciplines — said it doesn’t take a position on vaccines but wants parents to do what’s best to ensure the health of their children and others. “There are as many belief systems in our schools as there are in any part of the wider community. I can’t say or speculate why our vaccination rates are lower than other communities,” said Stephanie Rynas, executive director of operations and member resources for the Association of Waldorf Schools of North America. “Our schools follow state and local public health department laws …We take no position on any health-related issue other than those we need to as a school.”
The Senate health committee plans to hold a hearing on SB 276 on April 24.