Photo: Max Pixel
New state legislation aims to curb fraudulent medical exemptions for vaccines against diseases, such as measles, mumps, rubella, polio, whooping cough and chickenpox. 

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. 

Phtoto courtesy of Richard Pan

State Sen. Richard Pan has introduced legislation that aims to curb fraudulent medical exemptions for vaccines against diseases, such as measles, mumps, rubella, polio, whooping cough and chickenpox.

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?

Polls in California and nationally indicate support for vaccination and an understanding that vaccines are necessary to protect kids.

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.

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  1. Elizabeth 4 months ago4 months ago

    I am not anti-vaccine. All of our children have had their vaccines. However, one of our children had a hideous reaction to the measles mumps rubella varicella and DPT that he was given all at one time at 22 months. This included high fevers, for a month, vomiting, several trips to ER, encephalopathy, a total loss of all speech, and regression in cognitive abilities to focus and recognition of being spoken to. He was later … Read More

    I am not anti-vaccine. All of our children have had their vaccines. However, one of our children had a hideous reaction to the measles mumps rubella varicella and DPT that he was given all at one time at 22 months. This included high fevers, for a month, vomiting, several trips to ER, encephalopathy, a total loss of all speech, and regression in cognitive abilities to focus and recognition of being spoken to. He was later diagnosed Autism spectrum. He was , prior to the vaccines, totally normal and on target for age from the day he was born until the day he got those vaccines.

    A report was made to VEARS and nothing was done other than taking the report except a letter stating acknowledgment that it had been filed. His doctor did not recommend him getting further MMR vaccines or any other vaccines due to the obvious reaction. I have heard so many people say it was not the vaccine that it makes me sick.

    We and his doctor know for a fact that it was, just as thousands of other children have reacted in similar ways and were perfectly fine prior to getting the vaccines. After investigating for myself, I found that the encephalopathy (often inducing neurological disorders and speech loss) is a listed (side effect possible ) right in the vaccine adverse effects section of the vaccine inserted information! So I would like to know why some obviously very uneducated person proposes to disallow a child from school or deny a child education based on the fact that the child would be placed at extreme risk for further injury and has been by advised by an educated pediatrician not to receive further vaccines? Would this ignorant person that wishes to inflict this on other people’s children inflict further damage to his own child if he were the one that signed for the vaccine and watched in horror and sorrow as his own child became severely ill for a month and suffered to have zero communications, digestive issues for years and had to have special education, speech therapists, ongoing digestive issues for all of his childhood and great difficulty being in a room full of people, covered his ears and ran screaming just from hearing applause, or many people singing together at once, gagged on the smell of most foods , couldn’t comprehend the meaning of many words and all phrases that are figurative taking every word literally, social problems due to communication difficulties, and still has the biggest kindest heart I’ve ever seen?

    I’m not one to rush out and have more damage and harm shoved into his arm again and I do not believe that he should be disallowed an education just because an ignorant nitwit wants it that way. That is my opinion and I have now, 10 years later learned that there are literally thousands of children that reacted in the same manner to varying degrees of harm after having these vaccines that clearly state in their own information that this is a possible reaction.

    Others I personally know have children that were perfectly fine until certain vaccines were given at which point their child began seizing and suffered a lifetime of seizures afterward. Still others were brain damaged and will never walk or talk again. A few have died. It is ludicrous to think that one uneducated and obviously ignorant of facts person should be allowed to create a law that would inflict this further intense harm in the children that have already been injured or have them forfeit their education for life. Thank you.

  2. Tiana 7 months ago7 months ago

    My issue is that titers showing immunity aren’t accepted for school in the language of the bill. If this is really about the population having immunity, then my children’s titers proving their immune systems only needed one shot to respond as desired should be good. The second shot of varicella was added for the small percentage of kids that don’t get immunity after one shot. According to Dr. James Watt, chief of the Division of … Read More

    My issue is that titers showing immunity aren’t accepted for school in the language of the bill. If this is really about the population having immunity, then my children’s titers proving their immune systems only needed one shot to respond as desired should be good. The second shot of varicella was added for the small percentage of kids that don’t get immunity after one shot.

    According to Dr. James Watt, chief of the Division of Communicable Disease Control at the California Department of Public Health, “When you give a second dose, you go from the upper 80s in terms of the percent who are immune to the upper 90s.” (San Diego Tribune, May 21, 2019) My kids are in the upper 80% of kids who gained immunity from the first shot. They don’t need a second one. Medical schools accept titers, some insist on them. Why isn’t it good enough for elementary school??

  3. Laurie 8 months ago8 months ago

    You claim that people who are opposed to vaccines do not have the research. It is precisely because they have the research and history of the vaccine industry that they speaking from conviction that healthy children do not need vaccines, unhealthy children should not have them because it is a medical risk and that this for-profit industry cannot further deny people the right to investigate the facts and make their own informed choice based on individual circumstances.

  4. Rachelle 2 years ago2 years ago

    This has to do more with methylation status than anything, if they would check that before vaccinating then the kids would be ok. Too many of us have SNPs that are causing us and moreso our kids to not methylate properly…”DNA is the lock, environment is the key”

  5. Julia Zhu 2 years ago2 years ago

    OK this is confusing: "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." But he wants to vaccinate everyone, there won't be more than a couple hundred unvaccinated basically cancer patients on chemotherapy. Is that what he is talking about being "unvaccinated"? Article does not clarify. So he wants a 99% plus … Read More

    OK this is confusing:
    “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.”
    But he wants to vaccinate everyone, there won’t be more than a couple hundred unvaccinated basically cancer patients on chemotherapy. Is that what he is talking about being “unvaccinated”? Article does not clarify.
    So he wants a 99% plus vaccine rate.
    Well in China even with 99% vaccine rate we have measles outbreaks.
    Who will he blame then?

  6. Concerned Parent 2 years ago2 years ago

    One sided reporting. Pan lies on every point. Most importantly is that with his bills, a vax injured child is forced to take more vaccines. But he isnt sharing that.

    Replies

    • TN 2 years ago2 years ago

      How is a vax injured child forced to take more vaccines? The bill just holds doctors accountable for why they gave a child medical exemption from vaccinations. If a child reacted badly to a vaccination, that would be a valid reason to be medically exempt. Before 2015, you could say "vaccines aren't natural" and not have your child vaccinated. Too many people took advantage of that and put the community in danger, so they restricted … Read More

      How is a vax injured child forced to take more vaccines?

      The bill just holds doctors accountable for why they gave a child medical exemption from vaccinations. If a child reacted badly to a vaccination, that would be a valid reason to be medically exempt. Before 2015, you could say “vaccines aren’t natural” and not have your child vaccinated. Too many people took advantage of that and put the community in danger, so they restricted it to needing a medical exemption. People found doctors who profited off of offering exemptions and again put the community at risk. So here we are, literally having to record a doctor’s name and medical license over something so stupid because people fight so hard against vaccines. For no reason (or, please, reference some scientific study showing that the dangers of vaccinations outweigh epidemics). Y’all are selfish.