As California’s Vaccination Rates Fall, Medical Exemptions Rise

On March 4, 2018, a 15-year-old boy returned to Silicon Valley from a trip to Europe with a fever, cough, rash and other symptoms of measles. Over the ensuing four weeks, the virus spread to six others, including siblings, classmates and fellow Boy Scouts members.

Santa Clara County public health officials traced hundreds of contacts in 10 California counties and Nevada from those seven local patients, six of whom lacked immunity because of parents who chose not to vaccinate them during childhood. Of the un-inoculated, two—a 7-year-old boy and his 4-year-old brother—were granted identically broad medical exemptions by the same doctor hundreds of miles from home despite having no underlying health issues that would make them ineligible for immunization.

The Centers for Disease Control and Prevention (CDC), which labeled them patients “F” and “G” in a study of the outbreak, pointed to the pair as bellwether of a troubling trend. That is, California’s vaccination rates continue to fall as medical exemptions climb.

A few years ago, in response to a measles outbreak that began in Disneyland, California enacted Senate Bill 277, which banned parents from opting out of legally mandated vaccines based on personal beliefs. The good news: it worked. The rate of families citing personal beliefs to skip vaccines went from 2.4 percent to zero. However, the years since have seen a steady rise in the number of medical exemptions, which are usually granted to children with serious health conditions such as immune system disorders.

Before SB 277 became law in 2016, just about 0.2 percent of students statewide got a permanent medical exemption. Since the personal belief standard was nixed, the physician-granted exemptions have more than tripled to 0.9 percent this past school year, according to new data from the California Department of Public Health.

Last fall, 94.8 percent of California kindergartners received all their shots, a drop from 95.6 percent in the prior school year. That may seem inconsequential, but it brings the state below the 95 percent threshold the CDC considers necessary to prevent outbreaks through herd immunity. The figures also vary wildly by ZIP code, ranging from less than 20 percent in one Los Angeles suburb to 99 percent in Santa Cruz County farm country.

In Santa Clara County, the rate rests at a safe 97.3 percent.

But no community exists in a silo. And the upward trending medical-exemption rates fuel fears that some doctors are contributing to immunity gaps by giving parents a loophole to skirt the state’s strict vaccination standards.

California lawmakers have responded by advancing a bill that would tighten up rules for clinician-granted exemptions. Under SB 276, authored by pediatrician-turned-state Sen. Richard Pan (D-Sacramento), public health officials would deem whether the underlying health condition cited by a doctor in a vaccination exemption meets federal standards.

In a letter endorsing Pan’s proposed law, Santa Clara County Executive Jeff Smith—a trained physician—said unscrupulous doctors pose a threat even to jurisdictions like his own that manage to maintain safe immunity rates.

“Overall vaccination rates sharply increased to more than 95 percent statewide after California implemented your Senate Bill 277 in 2016, which abolished the personal belief exemption in California,” he wrote. “For the 2017-18 school year, 96.7 percent of all kindergarten students in Santa Clara County received their required vaccinations. However, despite this success, some physicians have been able to circumvent the spirit of the law by issuing inappropriate medical exemptions when families are willing to pay, rather than reserving these exemptions for children with true medical contraindications.”

Last year’s outbreak in Santa Clara County was only made worse because of dubious health exemptions, Smith explained.

Widely accepted federal guidelines say such exemptions should be exceedingly rare, reserved for children with documented allergies to vaccine components or whose immune systems are critically compromised. Garden-variety allergies and asthma are no reason to skip the shots, according to the CDC. Per the same agency, neither is autism.

But those are just guidelines, and California law does not require doctors to follow them. So when parents motivated by misguided fears about the safety of vaccines, many doctors will go along with it—for a price.

In response to growing concerns about unvaccinated kids, however, the state recently resolved to investigate schools with “biologically unlikely” rates of medical exemptions. Doctors identified by state health officials as having signed off on questionable exemptions will be referred to the California Medical Board for investigation.

State health authorities estimate that SB 276 would disqualify as much as 40 percent of the 11,500 exemption requests doctors field each year in California. That’s welcome news to public health officials as they grapple with what the CDC calls one of the worst years for U.S. measles cases in a quarter-century.

By April 2019, officials confirmed 40 measles cases in California—four of which traced to Santa Clara County. Nationally, by the same time this year, at least 704 cases had been documented in 22 states, marking the largest number of cases reported since the disease was all but wiped out in 2000.

Smith said the stakes are too high to let Pan’s bill die.

“Without reshaping California’s process to require state-level public health approval of all medical exemptions, like the provisions set forth in SB 276, we risk continuing to see the number of cases and outbreaks rise and leaving individuals who are too young to be vaccinated, or who have a medical condition that prevents them from being vaccinated, vulnerable,” he wrote. “We also risk losing the community immunity we’ve built thus far and which we continue to build that keeps all our residents safe and healthy.”

That should go without saying.

But scientifically baseless controversy over one of the single greatest advancements in modern medicine—one that saved at least 10 million lives from 2010 to 2015, per the World Health Organization—requires experts these days to state the obvious.

“Vaccination protects individuals and their families, and it also protects the entire community, including babies too young to be vaccinated,” Santa Clara County Public Health Officer Dr. Sara Cody wrote in an email to San Jose Inside. “Thankfully there are safe, effective, and widely available vaccines that prevent serious illnesses.”

Jennifer Wadsworth is the news editor for San Jose Inside and Metro Silicon Valley. Email tips to [email protected]. Follow her on Twitter at @jennwadsworth.

14 Comments

  1. > In response to growing concerns about unvaccinated kids, however, the state recently resolved to investigate schools with “biologically unlikely” rates of medical exemptions. Doctors identified by state health officials as having signed off on questionable exemptions will be referred to the California Medical Board for investigation.

    So, who at the California State medical bureaucracy is investigating the medical exemptions granted to the ONE MILLION illegal immigrants crossing the U.S. southern border EVERY MONTH?

    It looks to me like California’s sanctuary cities are granting medical exemptions by enticing and encouraging the illegal alien vaccination scofflaws.

    Start by arresting and locking up every major and city council member and county supervisor who has supported sanctuary cities and the illegal immigration CRISIS.

  2. Well Said Mr. Bubble,
    On top of that I feel the news media is largely to blame for this hysterical belief that vaccination might cause autism and other illnesses in young children, It might also cause Alzheimer’s in people that live to a ripe old age because the survived all these human spread epidemics.

    As someone that was old enough to have survived the Polio epidemic of the 1950’s and had friends that didn’t or were crippled by it, mussels ,mumps, chicken pocks I had all of those, no vaccine available at the time. I still have scars from them. Don’t be fools unless you know for sure you or your kids are going to have a bad reaction get it done. Pray that someone invents a vaccine that will prevent these new and old diseases coming across that open boarder.

  3. @SJOUTSIDETHEBUBBLE You’re making unsupported assumptions and trying to change the topic.

    a) You assume that those crossing the border, legally or otherwise, haven’t been vaccinated.

    b) The article is about vaccinations for children, which are monitored at the school and district level, whether children are here legally or not.

    c) Note the reference to Santa Cruz County farm country, that’s Watsonville, Corralitos, etc. There’s a reason that all of Santa Cruz County isn’t referenced and it’s because the reported rates for the more affluent areas are lower, especially in private schools.

    If you’re worried, might be worth checking this from the CATO institute https://www.cato.org/blog/migrant-caravan-central-america-vaccination-rates

    Or check the WHO (World Health Organization) data directly. You’ll find that the US is not the leader in immunization rates and that maybe you should be more worried about those that are here as opposed to those that are coming.
    https://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=MEX

    Is there a problem at the Southern Border, Yes. Are vaccination rates it? No.
    Are you really suggesting that we shouldn’t fix the problem of rouge docs here because there’s a different problem somewhere else?

    • > @SJOUTSIDETHEBUBBLE You’re making unsupported assumptions and trying to change the topic.

      You’re right, We should only talk about the issues that you want to talk about,

      And, we should always double check our assumptions first.

      What was your issue again?

      And, were you assuming that vaccinations are always same?

    • I think the bigger issue is that white and wealthy families can live by a different set of rules than the rest of the country. We see it in white wealthy parents bribing their spawn into elite colleges. We see it in white governance that sends the most novice and inexperienced teachers to schools with children of color reserving their most qualified teachers for the White schools! And of course we see it in how the white and wealthy circumvent vaccination rules! They are entitled, selfish, and greedy! That is the root cause issue and the world that we are living in and have lived in for a long time!

    • Mr. Trever and Mr. Conrad,
      May I suggest that you join the Border Patrol and shake hands and kiss everyone coming through the fence if your so confident in your positions, or maybe try a homeless encampment along I 680. I’d be interested in how you feel in two weeks!

  4. The “illegal immigrant” vaccination exemption:

    https://www.infowars.com/u-s-cities-overwhelmed-with-numbers-of-illegal-migrants-arriving-from-ebola-stricken-countries/

    “Large groups of migrants are arriving from the Democratic Republic of the Congo, which has been hit by one of the biggest ebola outbreaks in history, with 2,000 recorded cases in the last 10 months.”

    “Border Patrol officials said that 500 people from African countries had been arrested by Border Patrol’s Del Rio Sector in Texas alone in the six days after May 30.

    Hundreds of the migrants are being sent to a city-owned shelter in San Francisco.”

  5. There is no vaccine for Ebola, it’s in trials still. And the article you referenced doesn’t say anything about people being unvaccinated or sick, only that they come from a place with Ebola.

    Still happy to agree that there’s a problem at the border, but it has nothing to do with vaccination rates and doesn’t mean that we shouldn’t protect children and other vulnerable people here now from unscrupulous doctors.

    • > Still happy to agree that there’s a problem at the border, but it has nothing to do with vaccination rates and doesn’t mean that we shouldn’t protect children and other vulnerable people here now from unscrupulous doctors.

      “To a man with a hammer, everly problem looks like a nail”.

      Translation:

      Since you think you know how to solve the vaccination problem, you want to focus on that because you have a vaccination hammer.

      The open borders and all the diseases and drugs flowing into our society unchecked and unaddressed is a MUCH, MUCH bigger problem.

      At the end of the day, with out of control epidemics of ebola, typhus, beri beri, leprosy and everything else under the sun, worrying about vaccination rates is like worrying about poison ivy.

  6. I think the bigger issue is that white and wealthy families can live by a different set of rules than the rest of the country. We see it in white wealthy parents bribing their spawn into elite colleges. We see it in white governance that sends the most novice and inexperienced teachers to schools with children of color reserving their most qualified teachers for the White schools! And of course we see it in how the white and wealthy circumvent vaccination rules! They are entitled, selfish, and greedy! That is the root cause issue and the world that we are living in and have lived in for a long time!

    • > And of course we see it in how the white and wealthy circumvent vaccination rules! They are entitled, selfish, and greedy! That is the root cause issue and the world that we are living in and have lived in for a long time!

      Well, if the “root cause” of the world’s problems is “whiteness”, then the solution is obvious: abolish whiteness.

      Bill, you’re an ignorant bigot. You should probably request a refund for your college diploma.

      • Ad hominem attacks are the last refuge in argumentation of a scoundrel. In case you haven’t heard, skin color really does make a difference in the USA! White folk have always had privilege in our society in both explicit and implicit ways! We fought a civil war over the ultimate white entitlement over slavery! We still live with the legacy today. We are so not a color-neutral society yet!

  7. Anthrax vaccine adsorbed (AVA)

    https://en.wikipedia.org/wiki/Anthrax_vaccine_adsorbed

    “Much controversy ensued due to the FDA infractions, the mandatory nature of the program, and to a public perception that AVA was unsafe — possibly causing sometimes serious side effects — and might be contributing to the highly politically charged malady known as “Gulf War syndrome”. Hundreds of service members were compelled to leave the military (some of them court-martialed) for resisting the inoculations during the first six years of the program.”

    . . .

    “Side effects of AVA were found to be ”comparable to those observed with other vaccines regularly administered to adults”. ”

    . . . .

    “Owing to the controversy surrounding the administration of the vaccine to military personnel, however, some 6,000 US Postal Service employees balked at this, preferring to take their chances with the risks of residual anthrax spores in the workplace.”

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