Changes to California’s vaccination law make it more difficult for parents to use medical exemptions to avoid immunizing their children before enrolling them in school.
The new law is meant to close loopholes in the 2015 vaccination law that eliminated so-called “personal belief” exemptions allowing parents to opt out of immunizing their children based solely on their personal beliefs.
Hearings on the proposed changes brought large crowds of opponents to the state Capitol. In exchange for his signature on Senate Bill 276, Gov. Gavin Newsom asked for a slate of revisions in the form of a second bill – Senate Bill 714 – that loosened some of the restrictions and tighten others. Newsom signed both bills Sept. 9.
Sen. Richard Pan, D-Sacramento, who authored the 2015 vaccination law, proposed changes to the law after a series of measles outbreaks in California and across the country. In his original proposal, doctors would have been required to submit all medical exemption requests to the California Department of Public Health, which would have had to approve them.
His bill would have required doctors to certify they examined the child and included in the request their name, their medical license number and the reason for the exemption. The public health department would have been 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.
After discussions with the governor’s office, the newly amended version of the bill retains many of the same requirements, but would only require review of medical exemptions by the Dept. of Public Health if a child’s school has an immunization rate of less than 95 percent, or if the doctor who signed the request has written five or more medical exemptions during the year.
To recap: Parents do not have to immunize their children. But under the law, children must be immunized against 10 serious communicable diseases – diphtheria, Haemophilus influenzae Type B (bacterial meningitis), measles, mumps, pertussis (whooping cough), polio, rubella, tetanus, hepatitis B and chicken pox – if they want to attend public or private schools and child care centers. Studies have linked clusters of unimmunized children to outbreaks of measles, pertussis and varicella or chicken pox.
Students are affected by the immunization law only at certain grade-levels or other checkpoints: upon entering child care, transitional kindergarten/kindergarten or 7th grade, or when transferring into schools or child care from out of state or out of the country. Otherwise, the immunization status of students is not an issue.
How is the current law different from the previous law?
The 2015 vaccination law eliminated the personal belief exemption for required vaccinations. This exemption allowed parents to opt out of vaccinating their children by completing a form, signed by a health care practitioner, attesting that vaccinations were counter to their personal beliefs. The law also overrode an allowance for religious exemptions to vaccinations that was not explicitly in state law, but still allowed medical exemptions.
The new law adds state oversight to medical exemptions by requiring that the Dept. of Public Health review exemptions at schools with an immunization rate of less than 95 percent or if a doctor has written more than five medical exemptions in a year.
Any student with a medical exemption issued before Jan. 1, 2020 would not be subject to the new restrictions until he or she reaches the next vaccination checkpoint. At such points, students would be required to be vaccinated – or get a new medical exemption that complies with the law.
Temporary exemptions would be limited to one year, instead of allowing a doctor to determine the term.
Patients who had exemptions before Jan. 1, 2020 could have them revoked if their doctor has been subject to disciplinary action from either the Medical Board of California or the Osteopathic Medical Board of California.
Can some children get exemptions from vaccinations?
Medical:Medical exemptions will still be allowed, but will have added restrictions. Beginning Jan. 1, 2021 licensed physicians or surgeons will be required to write up medical exemption requests on a standardized electronic form that will be filed with the California Immunization Registry. The State Department of Public Health will monitor immunization levels at schools, as well as whether individual doctors have submitted unusually high numbers of exemptions.
The new bill states that children who may have been exposed to one of the 10 diseases and who don’t have proof they have been immunized for that illness may be temporarily excluded from school. They would remain out of school until the local health officer determines they are no longer at risk of developing the disease or transmitting it.
Homeschooling or independent study without classroom instruction: Students who attend a home-based private school or an independent study program without classroom-based instruction are not subject to immunization requirements for entry. Home schools and independent study programs are obligated to maintain records of students’ immunization status. Students in independent study programs that include classroom-based instruction must be vaccinated according to state laws.
Special Education: According to the California Department of Public Health “students who have an individualized education program (IEP) may continue to receive all necessary services identified in their IEP regardless of their immunization status.”
Is there an appeal process if a medical exemption is denied?
Parents or guardians can appeal the denial of a medical exemption to the Secretary of California Health and Human Services. The secretary is required to appoint an independent expert review panel, consisting of three licensed primary care physicians or immunization experts, to evaluate and rule on appeals.
Are kindergartners allowed to enroll “conditionally” if they have not yet completed all of the required vaccinations?
Yes, if they meet certain requirements. Kindergartners must have a mumps and a rubella vaccination before enrolling — there is no conditional enrollment involving the mumps and rubella vaccinations. Kindergartners also must be as current as possible with other immunizations, given the need to space out certain vaccine doses.
Kindergartners may be conditionally admitted with at least one dose of the following vaccines: polio; diphtheria, tetanus and pertussis; measles; hepatitis B and varicella (chicken pox.)
School districts already have their own systems for tracking and following up with kindergartners who are not fully immunized. Whatever systems districts are currently using remain in place.
If students are entering the public school system as transitional kindergartners, these conditional immunization rules apply to them as well.
What about children who currently have personal belief exemptions on file?
Children who before Jan. 1, 2016 held personal belief exemptions to vaccinations are not subject to the new law until they reach their next vaccination checkpoint.
The law defines these checkpoints as “grade spans,” as follows:
- Birth to preschool;
- Kindergarten and grades 1 to 6, inclusive, including transitional kindergarten;
- Grades 7 to 12, inclusive.
For example, a 6th grade student with a personal belief exemption in December 2015 will still have to comply with vaccination requirements upon entering 7th grade, which is a vaccination checkpoint.
If a child has been exposed to one of the 10 diseases named in the immunization requirements and does not have proof of immunization, the child temporarily may be kept out of school.
Do unvaccinated children with personal belief exemptions who move from one California school or district to another have to meet the vaccination requirements of new students?
Not unless the student is entering a vaccination checkpoint grade span: a child care facility or preschool, a transitional kindergarten/kindergarten or 7th grade. Personal belief exemptions can be transferred between child care facilities and schools in California both within and across school districts, according to the state. Personal belief exemptions from another state or country are not valid.
What vaccinations are required of unvaccinated students before entering 7th grade?
All previously unvaccinated students entering 7th grade must provide documentation of the vaccines needed for school entry based on age. These include the polio series, the diphtheria/tetanus/pertussis series, the varicella (chicken pox) vaccine and two doses of MMR, according to the California Department of Public Health.
But while immunization against hepatitis B is required for entry to lower grades, the law states that it is not required for entry to 7th grade.
What are the options for parents who do not want to have their children vaccinated but want to enroll them in school?
Parents who do not want to vaccinate their children attending school have three options: obtain a medical exemption to vaccinations, enroll in homeschooling or independent study without classroom instruction, or have their children evaluated and enrolled in special education services.
What is homeschooling and independent study?
According to the California Homeschool Network, parents who wish to homeschool have four options:
- Establish their own private home school by filing a private school affidavit.Parents are free to collaborate with other homeschools. Homeschools are required to teach California mandated subject areas, but have latitude as to when and how such subjects are taught.
- Join another private home school and become a “satellite” home school.
- Enroll in a district or charter public school that offers independent study. The student receives assignments from a teacher but fulfills most of the work independently.
- Homeschool a child by hiring a credentialed tutor.
Are schools required to track immunizations?
Schools are required to document each student’s immunization history. The immunization record of each student enrolled conditionally must be reviewed regularly to ensure they receive their immunizations by the required time. Those who fail to get their immunizations by the designated date will be prohibited from attending school.
Each district school board is being asked to file an annual report on the immunization status of all new students to the California Department of Public Health or its local health department. The local health department will have access to the immunization record of every student in school.