A California lawmaker on Tuesday made substantial changes to his contentious vaccine bill after Gov. Gavin Newsom and other state officials raised concerns that the measure was too strict and gave too much power to bureaucrats to decide which children could skip their routine shots.
State Sen. Richard Pan (D-Sacramento) amended his measure, SB 276, to broaden the eligibility for children's medical exemptions from vaccines — and narrow the circumstances under which state public health officials would review those exemptions.
At the same time, the measure still would make it easier for the Medical Board of California to investigate and sanction physicians who write medical exemptions that don't conform with accepted medical standards.
"These amendments ensure this bill protects the doctor-patient relationship, strengthens the state's ability to target doctors who abuse the medical exemption process and gives state public health officials the tools to identify and protect schools and communities where herd immunity is in danger," said Mark Ghaly, secretary of California's Health and Human Services Agency, in a statement on behalf of Gov. Newsom’s administration.
The Assembly Health Committee will consider the measure Thursday at a hearing likely to draw large crowds of anti-vaccine activists to the state Capitol.
More than 1,040 people have been sickened by measles nationally so far this year, including 52 confirmed in California, in the biggest outbreak since 1992.
California already has some of the strictest vaccine laws in the country under a measure implemented in 2016 that banned vaccine exemptions based on religious and personal beliefs. Under that law, children can be exempted only on medical grounds, and those who don't have their shots or an exemption are barred from attending schools.
Since then, medical exemptions have jumped, particularly in places that had high rates of religious and personal belief exemptions in the past.
New state data shows that the percentage of California kindergartners who had all their recommended shots fell for the second straight year, largely due to an increase in medical exemptions written by doctors.
Doctors currently have broad authority when granting medical exemptions, and some have signed dozens of them. A recent investigation by the news site Voice of San Diego found that just one physician was responsible for one-third of all medical exemptions in that county since June 2015. The Medical Board of California, which oversees physician licensing, is currently investigating more than 100 complaints alleging questionable medical exemptions.
Pan, a pediatrician, aimed to crack down on this practice with his bill. The original version would have granted the California Department of Public Health ultimate authority to approve or reject all medical exemptions, a change that critics — including Newsom — feared would mark too great an interference in the doctor-patient relationship.
Under Pan's amendments, the public health department would automatically review exemptions for children at schools where more than 5% of students aren't immunized, and from doctors who had written more than five medical exemptions in a calendar year.
The changes also broaden the guidelines on who qualifies for a medical exemption. Doctors would be able to take into account family medical history, among other considerations. At the May meeting of the medical board, members expressed concern about the bill's previously narrow exemption guidelines.
Exemptions should be rare, according to the Centers for Disease Control and Prevention. They are typically reserved for children with severely compromised immune systems, like those being treated for cancer or those who are allergic to a vaccine component or have previously had a severe reaction to a vaccine.
While the amended bill provides more leeway on the exemption process, it also clarifies some penalties doctors could face. Doctors facing investigations by the Medical Board of California or the Osteopathic Medical Board of California would not be allowed to write new exemptions until those investigations were resolved, and state officials could temporarily bar a doctor from writing exemptions if they determine the doctor "poses a risk to the public's health."
Parents would be able to appeal rejected exemptions. But under the amendments, the appeals process would be overseen by an independent panel appointed by the secretary of California's Health and Human Services Agency.
Pan's measure has the strong support of the medical establishment. It was co-sponsored by two powerful doctor associations, the American Academy of Pediatrics, California, and the California Medical Association.
In recent months, opponents of vaccine mandates have shown up by the hundreds to public hearings in the state Senate and at a meeting of the state's medical board to speak out against the law.
The amendments address many of the concerns they have raised, though some zealous opponents of vaccine mandates have said that no amendments would mollify their concerns about the measure.
This KHN story first published on California Healthline, a service of the California Health Care Foundation.
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 This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.
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