In a growing number of states, parents can no longer refuse to immunize their children due to conflicting “personal beliefs”—at least not if they want their children to attend school. California recently joined West Virginia and Mississippi in requiring a medical exemption from a physician to permit a child to enter school without being immunized. Gov. Jerry Brown signed the controversial bill, SB277, last month.
Most of us rejoice, yet there is still reason to worry that exemptions will proliferate along with preventable diseases. Particularly if doctors feed their patients’ fears and offer easy exemptions with few questions asked.
The overall immunization rate in California is high, but many schools have dangerously low immunization rates. A Hollywood Reporter story last year highlighted schools in tony areas like Santa Monica with immunization rates near 25%, lower than those in South Sudan.
Vaccines have been a hot topic since 1855, when Massachusetts began requiring them for schoolchildren. England had more stringent laws: The Compulsory Vaccination Act of 1853 required all infants born in England and Wales to be immunized against smallpox, unless they were considered medically “unfit.” This became the first “medical exemption” for vaccines.
Others objected to the mandate itself—and so began the antivaccination movement, long before actress Jenny McCarthy spewed her views on national television. A clause to the Compulsory Vaccination Act, created in 1898, allowed for “conscience” exemptions, eventually leading to the term “conscientious objector” for those abstaining from military service. In 1898 alone, 200,000 conscience (or, shall we say, personal belief) vaccine exemptions were granted in the United Kingdom.
In California exemptions are now up to the doctors, as parents must get approval from their physician. A legitimate medical exemption might be given for a child who has a weakened immune system, either due to a congenital condition or to chemotherapy or long-term steroid use.
A second reason for an exemption might be that the child had a serious allergic or other adverse reaction to an earlier vaccine. But serious, life-threatening reactions, such as seizures or severe rashes, are extremely rare, about one in every 100,000 doses. (The death rate from measles, by the way, is closer to one in 1,000 cases.)
Pockets of California residents are in an uproar over SB277; a few hundred rallied against the bill in San Diego in April. They would prefer to not immunize their children, or to design custom schedules on the medically dubious theory that the recommended schedule is unsafe. There is no evidence for this.
Unvaccinated children are themselves at risk, but they also put other children at risk, too. The more exemptions are given, the larger the gaps in herd immunity, and the more outbreaks of preventable diseases. Children with cancer who cannot be safely given the recommended course of vaccines, for instance, are among the most vulnerable to others’ so-called personal decisions.
Along with these California residents are California doctors who share in their uproar.Dr. Jay Gordon of Santa Monica, for example, testified against the bill; he has called the bill “disgracefully arrogant” and said parents “must participate in all health-care decisions for their children.” He is not alone, and these doctors will certainly stand by their patients.
Who will monitor the high volume of medical exemptions? Will doctors who opposed SB277 be allowed to dole out faux medical exemptions to their patients? In that sense, the California bill is an improvement, but antivaccination fear-mongers will continue to find a workaround.
Dr. Shapiro, director of pediatric ear, nose and throat at Mattel Children’s Hospital, is a professor of head and neck surgery at UCLA.