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Health

Impatient: where a state bill mandating vaccinations stands now




Dr. Daniel Kahn holds the Tdap vaccine, which he administers to pregnant women in their third trimester.
Dr. Daniel Kahn holds the Tdap vaccine, which he administers to pregnant women in their third trimester.
Rebecca Plevin/KPCC

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A bill that would require all school-aged kids to be vaccinated passed the state Senate earlier this month. The Assembly is expected to take up SB 277 early this summer.

The legislation has proved to be extremely controversial. 

Southern California Public Radio’s Rebecca Plevin joins Take Two with an update on all you need to know.

She’s been tracking the bill and she joins us now for our weekly health segment that we call, “Impatient.”

California has long required kids to be vaccinated in order to attend school. What’s different about this bill?

Kids need to be vaccinated to attend school, but parents have had the choice of not vaccinating their kids if they were philosophically opposed to some or all of the shots. They could obtain what’s called a Personal Belief Exemption. There’s also a place on the form to say you object on religious grounds.

But following recent outbreaks of vaccine-preventable diseases like whooping cough and measles, the state legislature began taking steps to make it harder to get these exemptions. It passed a law that took effect last year that requires parents to speak with a doctor about vaccines and diseases before getting the Personal Belief Exemption.

What sort of effect, if any, did that law have on the number of families using the personal belief exemption?

The number of Personal Belief Exemptions in California had doubled since 2007. But in December, I reported that the percentage of parents not vaccinating their kids had dropped for the first time in a decade. In LA County, for example, the percentage of kids not vaccinated due to personal beliefs dropped 27 percent. In 2013, 2.2 percent of incoming kindergarteners had PBE’s. In 2014, it was 1.6 percent.

Part of that drop could be attributed to a law that took effect last year that requires parents to speak with a doctor about vaccines and diseases before getting the Personal Belief Exemption.

But that law alone couldn’t boost immunization rates enough to prevent this year’s measles outbreak. So now we have SB 277. It would completely eliminate the Personal Belief Exemption as well as the religious exemption. The only exemption that would remain would be a medical one.

Lawmakers started making it harder to get Personal Belief Exemptions a few years ago. Why did they introduce SB 277 now?

The short answer: Disneyland. A measles outbreak started there in December 2014. This bill was introduced in the midst of that.

The longer answer: the bill’s authors – senators Richard Pan and Ben Allen – really want to see childhood vaccination rates boosted.

Health experts say that during this year’s measles outbreak, the disease was able to spread due to low vaccination rates in some communities. They say you need a critical number of people to be vaccinated to prevent the spread of diseases. But in some communities, vaccination rates have dipped so low that we no longer have what’s called, “herd immunity.” That’s what scientists say keeps individual infections from turning into outbreaks.

SB 277 is intended to really shore up immunization rates.

The outbreak that started at Disneyland most recently looked like it was almost entirely over. Where do we stand with it now?

The state health department declared that outbreak officially over on April 17 after two incubation periods passed with no new cases reported. I checked in with the state health department and they say there have been no new cases of measles reported since then.

How does California compare with other states when it comes to vaccination requirements?

As of now, 31 states in the nation do not have a personal belief exemption. Legislators tried to pass similar bills earlier this year in two more states – Oregon and Washington – but those attempts failed.

Just two states – West Virginia and Mississippi – ban the religious exemption.

What religions address vaccinations and what do they have to say about it? 

KPCC reported earlier this year that none of the world’s major religions opposes immunizations.

Many modern religions don’t oppose vaccination, either. We’ve reported that the Mormon Church has long advocated for immunization. Even the Church of Christ, Scientist, which believes in achieving health through prayer, doesn’t oppose vaccination.

This fight over vaccinations and religious exemptions played out in Sacramento has gotten quite nasty at times. How so?

One of the bill’s authors, Senator Richard Pan, started getting beefed up security after his office received threatening messages via email, social media and over the phone.

Who's opposed this legislation?

There are people who have traditionally opposed vaccination. They tend to be politically liberal and better off economically, and are clustered in areas like Marin County, and parts of LA and Orange County.

Beyond that, there are people who ascribe to what some might call a more new-age lifestyle. Among them, interestingly, are chiropractors – whose state association has come out strongly against this bill.

Why chiropractors?

Stay tuned for a forthcoming story by KPCC's Elizabeth Aguilera exploring that very question.

But beyond chiropractors, there are also people who are highly mistrustful of government and the pharmaceutical industry who oppose vaccines. 

There’s also a strong libertarian streak in the arguments against the bill. I’ve spoken with parents who say they should have a say in which vaccines they give their children and when. They say the state government shouldn’t be able to force them to vaccinate.

Another concern is that, if parents don’t have that choice, they’ll have to pull their children out of school all together. The argument is that this could infringe on children’s right to an education, especially for people who might find it difficult to home school their kids. Even the ACLU of California has raised concerns about this. 

How have the bill's authors responded to these concerns?

Democratic Senators Pan and Allen had to address the issue within their own party if they wanted to keep the bill alive.

They added a couple of amendments. Now the bill says that unvaccinated kids could participate in a multiple-family home school, or parents could home school their kids using a public school independent study program. That seemed to satisfy lawmakers’ concerns, but not the rest of the opposition.

As the state assembly gets ready to take up SB 277, is there a sense of how it will fare?

It seems to have some momentum now that it’s passed the state senate. But the fight is far from over. And there’s no sign that the battle will be any less intense moving forward. Just last week we heard of a dustup between the California Medical Association – which supports the bill – and the state chiropractic association – which is against the bill. The Medical Association accused the head of the chiropractors of encouraging the bill’s opponents to stalk CMA lobbyists. The head of the chiropractors’ group said he never did any such thing. But it shows just how high tensions are around this bill.

We also don’t know what Governor Brown will do if the bill passes the legislature. For one thing, Brown created the religious exemption. He added it to the law that made it harder for parents to opt out of vaccinating their kids. So if SB 277 gets to his desk, it will be interesting to see how he reacts to a bill getting rid of it.



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