Four years into a crackdown on high numbers of California students going unvaccinated because of claimed concerns over vaccine risks, new statistics from the 2018-2019 school year show that 10 percent or more of the students in 117 kindergartens and 5 percent or more of those at 1,500 other kindergartens do not have their required shots. But these students are able to attend school because their parents have succeeded in obtaining medical exemptions.

After a new law by Sen. Richard Pan, D-Sacramento, was enacted in 2015 that ended personal belief exemptions from vaccinations, the number of vaccinated kindergartners increased to above 95 percent on average. That’s the level seen as creating “herd immunity” from infectious diseases. This was treated as a success story by public health officials who supported Pan’s effort to respond to a Disneyland-based measles outbreak that was California’s worst in years. They expected the vaccination rate to keep going up as public health information campaigns emphasized their importance.

But the overall kindergarten vaccination rate in the state dipped to 94.8 percent in 2018-19, and to much lower at many schools. Aware of the sharp increase in medical exemptions on questionable grounds, this led Pan and Gov. Gavin Newsom to hash out a compromise under which state public health officials would automatically review such exemptions in two circumstances: when doctors issued five or more in a school year and in schools with vaccination rates less than 95 percent.

Senate Bill 276 has passed initial votes and is expected to be enacted by session’s end in September. But authorities in the Bay Area have already begun a crackdown after a San Jose Mercury-News report found that just five doctors issued at least one-third of all vaccine exemptions in eight of the region’s school districts.

Doctors responding to parents’ ‘market demand’

Experts say that these doctors are in effect responding to “market demand.” Thousands of parents – often affluent people who are skeptical about modern medicine and interested in alternative medicine – remain eager believers in discredited theories that vaccines are responsible for autism and other early childhood medical woes. They reject the representations of public health authorities.

Meanwhile, as CalWatchdog recently reported, California is one of the states most at risk of a measles outbreak caused by the combination of both unvaccinated children and the high level of air passengers from nations around the world such as the Philippines and Italy that have had measles epidemics because vaccination rates have dropped.

Public health officials believe it is just a matter of time until California has a measles outbreak as severe as the one based in Disneyland in the winter of 2014-15, in which at least 131 infections were reported.

UCLA warns many exposed to virus at food court

“In 2019, four outbreaks linked to patients with international travel have been reported in California,” the state Department of Public Health announced last week. As of July 10, the state had 58 confirmed measles cases and the U.S. had 1,109 measles cases. The national number is nearly triple the total seen in all of 2018.

This week, officials at UCLA are on edge after confirming that an individual who used the UCLA campus food court on July 2 and July 3 was infected with measles and potentially could have exposed thousands of people. The university says employees who may have been exposed cannot return to work until they prove they’ve been vaccinated.

Measles is one of the most highly infectious viral diseases, public health officials say. Before an effective vaccine became available in 1963, it killed millions of people worldwide each year. That fell to about 110,000 a year earlier this century after vaccines became widely available even in poor nations. 

But the World Health Organization said in April that the number of deaths appears to be steadily increasing worldwide since 2017, the last year for which full statistics were available.

The state Legislature’s push to tighten up vaccine requirements for K-12 students took a step forward last week even as public health officials acknowledged a British medical study that said travelers to the U.S. from nations with measles outbreaks were a major threat – not just unvaccinated children.

The Assembly Appropriations Committee voted 9-2 with four abstentions for a compromise version of Senate Bill 276, by state Sen. Richard Pan, D-Sacramento. It would require state health experts to examine medical vaccine exemptions coming from doctors who had issued five or more exemptions in a school year or from schools which had lower than the 95 percent vaccination rate seen as necessary to promote “herd immunity” in communities.

Pan, a physician, had weakened the bill at the behest of Gov. Gavin Newsom, who said that the original version that had already won state Senate approval was overly intrusive and bureaucratic. It would have required all medical exemptions to be examined by state officials. Pan had introduced the measure in response to medical exemptions going up by more than 400 percent for incoming kindergartners after personal belief exemptions were banned in 2016.

But a recent study published in The Lancet Infectious Diseases journal suggests that state actions alone can’t protect residents in an era in which measles and other infectious diseases are surging around the world due to both vaccine skepticism and poor public health programs in First World nations.

3 California counties at high risk

The study used patterns of international travel in and out of the U.S. to determine which were the 25 counties most at risk of a measles outbreak in 2019. Cook County, Illinois – home to O’Hare Airport – was first. Three California counties made the list. Los Angeles County was second; San Mateo County (home to San Francisco International Airport) was 19th; and San Diego County was 25th.

One of the authors of The Lancet study – Johns Hopkins professor Lauren Gardner – told the Los Angeles Times that California’s vulnerability was inevitable in an era of mass air travel. “The places, in particular in California … are really high on the list mainly because of the sheer volume of travelers,” Gardner said. “It’s not just the fact that there are big airports, but those airports have a lot of incoming routes from countries having ongoing measles outbreaks.”

The Philippines has had a severe measles outbreak since February, with the most recent estimates of cases topping 33,000 – including nearly 500 deaths. The U.S. State Department and international health agencies also cite outbreaks in the Ukraine, Italy and Israel.

As of June 13, the U.S. had 1,044 confirmed measles cases this year, the most in a single year since 1992. The worst outbreaks have been in the New York City metro area and in southern Washington state, just across the Columbia River from Portland, Oregon.

While a 2014 outbreak traced to Disneyland in Orange County fueled the rise of concern about the renewed measles threat in the United States, California has not seen as severe an outbreak since then.

But researchers for The Lancet believe it is just a matter of time.

Despite furious opposition from parents who believe vaccinations are dangerous, a measure by state Sen. Richard Pan to tighten up vaccine exemptions passed an initial committee test last week on a 6-2 vote. Senate Bill 276 would make California only the second state – after West Virginia – to mandate that students can only be exempted from vaccinations on medical grounds with the permission of state public health officials.

Pan, a physician, introduced his bill after the Voice of San Diego reported in March that a single doctor had provided nearly one-third of all the medical exemptions granted in San Diego Unified, the state’s second-largest school district, since June 2015. Anti-vaccine activists share lists online of doctors around California that they consider friendly to their cause.

Medical exemptions have more than tripled statewide since the 2014-15 school year. That was the last year before Pan’s bill banning exemptions based on personal beliefs took effect.

Pan and other physicians say there is no conceivable explanation for the surge in medical exemptions outside of concluding that doctors are giving parents what they want without adequate medical justification. The Centers for Disease Control says fewer than 1 in 100 children have problems with impaired immunity or risk of severe allergic reactions that would justify medical exemptions.

Public health officials say at least 95 percent of the general population needs to be immunized against contagious diseases to create “herd immunity” that makes outbreaks unlikely. In the United States, immunization against measles was so common and effective that in 2000, it was declared to have been eradicated in the nation.

400,000 state students could face higher risk

While measles remains common in nations with poor health care – killing an estimated 100,000-plus people in 2017 – it had been rare in developed nations for decades. But over the past 11 years, skepticism about vaccine safety has been fanned online by new-age groups and several celebrities. They tout a discredited study published in 2008 in The Lancet, a British medical journal, that linked one of the most common childhood vaccinations to autism. That vaccination – the MMR (measles-mumps-rubella) – can have negative health side effects with a small percentage of children. But there’s never been a study finding its risks came anywhere near its benefits.

Nevertheless, anti-vaccination sentiment led to a tripling of measles cases in Europe from 2017 to 2018. In the United States, 2019 has seen the most cases in a single year this century, according to a CNN report last week. CNN said California was one of 22 states reporting a total of nearly 700 cases of measles.

Problems could get much worse in the Golden State. According to a Los Angeles Times analysis, immunization rates among kindergartners at 105 elementary schools are so low that “herd immunity” might not be intact. A report last week by the Health Officers Association of California said as many as 400,000 of the state’s 6.2 million K-12 students could face heightened risk of measles.

Fears about measles are playing out in dramatic fashion in Los Angeles. At UCLA and Cal State-Los Angeles, more than 1,000 students and staff members were either quarantined in their dorms and offices or sent home late last week. Those affected have been unable to satisfy administrators that they have been properly vaccinated.

At least 325 students and staffers subsequently established they had gotten their shots. But the two colleges’ decisions could be widely copied in coming weeks and months if measles keeps spreading in the U.S.

It was the last committee stop for the bill, which passed the Senate and now will be up for an Assembly floor vote.

 

SB792, by Sen. Tony Mendoza, D-Artesia, would require vaccination for whooping cough, measles and influenza for all day care workers.

 

The only exemption for a whooping cough or measles immunization would be a physician’s note that exempts individuals for whom the vaccination would not be safe.

 

Day care workers who do not want to get the influenza vaccine, though, just need to fill out a form to become exempt from the requirement.

 

The bill also reiterated the need for evidence of being free of tuberculosis — known as “clearance” —  among day care workers, which already is required by law.

No crowds of protesters for this legislation

But unlike with legislation mandating that students get vaccinations before being allowed in school — a law signed by Gov. Jerry Brown that ended nearly all exemptions and was criticized by, among others, the Washington Post editorial board — this bill is generating little controversy and enjoys bipartisan support. It was lobbied for by the Health Officers Association of California, the Child Care Law Center, the March of Dimes California chapter, and other groups that promote children’s interests, and faced criticism only from those who consider vaccinations dangerous.

Republicans who objected to the school vaccination bill as an attack on parental rights have accepted Mendoza’s argument that this is a common-sense measure to protect children and a reasonable job requirement for someone who works with young kids.

The measure passed the Senate on a 34-3 vote in May.

Before passing the Assembly Appropriations Committee on a 16-1 vote Wednesday, it won approval on a 6-1 vote in the Assembly Human Services Committee and on a 16-1 vote in the Assembly Health Committee.

If the bill is adopted by the full Assembly and signed by the governor, it will take effect Sept. 1, 2016.

Proponents of the bill say the passage is a victory for science and public health, while opponents decry the bill’s infringement upon parental rights.

Assemblywoman Melissa Melendez, R-Lake Elsinore, said in a prepared statement that the issue at hand with SB277 was not “whether or not you support vaccines” but “about the freedom to make our own choices as citizens”:

“I am concerned this legislation is yet another overreach of the state trying to dictate how we live our lives. As a mother, I made the choice to have my children vaccinated because I believe that was right for my family. By denying the ability for parents to choose what is right for their children, we are robbing Californians from one of their most essential liberties. This is not about vaccines; it is about whether or not the government should be telling us how to raise our children.”

But during the Assembly hearing, Assemblywoman Lorena Gonzalez, D-San Diego, said, “As a mother, I understand that the decisions we make about our children’s health care are deeply personal. While I respect the fundamental right to make medical decisions as a family, we must balance out with the fact that none of us has a right to endanger others. SB277 strikes a balance.”

“This isn’t just about Disneyland,” said Assemblywoman Catharine Baker, R-San Ramon, referring to the measles outbreak that occurred last year. “And this isn’t just about the need to make sure we wait for a crisis.”

Assemblyman Mike Gatto, D-Glendale, voiced his opposition to the bill, calling it a “slippery slope” and said it sets a precedent where the state could mandate nearly anything “in the name of the common good, protecting others and stopping an outbreak.” He emphasized that the Legislature is “tasked with drawing lines” and said SB277 does not demonstrate where the line for medical necessity “reasonably ends to justify a law.”

A statewide poll from the Public Policy Institute of California released earlier this year revealed that more than two-thirds of California adults support barring unvaccinated children from attending public schools.

The bill now heads to the governor’s desk.

Senate Bill 792 is authored by Senator Tony Mendoza, D-Artesia, and according to the text of the bill, “would prohibit a day care center or a family day care home from employing any person who has not been immunized in accordance with the schedule for routine adult immunizations.” Currently, licensed child care workers do not have any immunization requirements, but must have a TB clearance and a health report.

A press release issued by Senator Mendoza’s office noted that the Centers for Disease control declared measles was eliminated in 2000:

However, from December 28, 2014 to February 20, 2015, there have been 117 confirmed cases of measles in California according to the CDC. The outbreak likely originated from a traveler who became infected overseas with measles and visited Disneyland in Anaheim, California while contagious. Since that time, additional cases emerged, including a Bay Area Rapid Transit (BART) passenger with measles who travelled from Millbrae to San Francisco, potentially exposing more than 1500 riders.

“One child’s death is one too many, especially when it may be preventable. With the recent deadly outbreaks of measles and influenza, we must do everything in our power to protect California’s children who spend time in day care,” said Senator Mendoza in the release. “SB 792 will require all day care center and day care home personnel to be vaccinated. This is not just a common sense solution, but makes scientific sense.”

The bill now goes to the State Assembly for consideration.

“In requiring vaccinations as a prerequisite for enrolling children in school, detractors said, the bill would legalize institutional discrimination,” the Sacramento Bee reported.

According to the Associated Press, some lawmakers warned “it could unconstitutionally create a second-class by depriving unvaccinated children of an adequate education.”

Fierce opposition

Bipartisan support for Senate Bill 277, which would scrap the Golden State’s personal belief exemption and require immunization for school admittance, has remained strong. But although the Senate Health Committee recently cleared the bill in a 6-2 vote, the addition of the discrimination objection gave new force to opposition leveled by anti-vaccination parents and groups.

As a result, SB277 has stalled, only to return once legislators are convinced that the new questions have been conclusively answered.

State Senator Richard Pan

The bill’s sponsors, state Sens. Richard Pan, D-Sacramento, and Ben Allen, D-Santa Monica, have weathered criticism before. As CalWatchdog.com noted previously, party affiliations have been a poor guide to how Californians have responded to the vaccination controversy: Some Republicans have strongly supported tightening exemptions, while others haven’t, and Democrats have ranged from supporting the status quo to advocating an end to all exemptions.

But in recent weeks, the two Senate Democrats have faced a barrage of criticism from parents and activists able to fight the bill’s progress in public. This week, Pan and Allen took to the editorial page of the Fresno Bee to defend SB277.

“We respect the very personal decisions that parents have to make for their children,” they wrote. “But all children deserve to be safe at school, and the personal belief exemption is now endangering the

State Senator Ben Allen

public. Senate Bill 277 will not remove a parent’s choice to vaccinate his or her child. However, choice brings with it responsibility, and under the measure, parents who decide not to vaccinate will have to home-school their children.”

Parental threats

As the San Jose Mercury News observed, SB277 began to take fire from objectors who threatened to deprive schools of enrollment money:

“Parents like San Jose resident Elaine Shtein are being encouraged to bring a son or daughter to stand with them before the eight-member Senate Education Committee on Wednesday with a warning: If the bill passes, they pledge to yank their children out of public and private schools, and home-school them, something they believe will deprive both the state and private school systems of money for every student enrolled.”

According to the Mercury News, education analysts suspected that the impact on school budgets would be relatively marginal. But regardless of how little money schools lose, the prospect of a constitutional challenge to SB277 was enough to spook lawmakers into sending Pan and Allen back to the drawing board.

A “smarter approach”

Although Pan and Allen proceeded with some care in crafting a simple but focused bill, they nevertheless failed to anticipate the level of difficulty they faced in legislating tighter vaccination rules. Pro-vaccination critics warned that Sacramento’s strategy has ineptly fostered a legislative environment, turning each committee hearing on the elimination of the personal belief exemption into a media opportunity for absolutist anti-vaccine groups.

“A smarter approach would be to retain a narrow personal belief exemption in states that already have one and avoid the kind of polarizing fight that California is now having,” wrote Brendan Nyhan at the New York Times. “These states could tighten exemption rules as experts recommend to more appropriately strike the balance between parental choice and the health needs of the community. Given the potential risks that unvaccinated children pose to the community, the process of obtaining an exemption can be rigorous and demanding.”

According to Pan’s website, the bill “will repeal the personal belief exemption that currently allows parents to effectively opt their child out of vaccines in our schools.” Under the exemption, “a parent may choose to opt their child out of school vaccine requirements that bi-partisan legislative majorities passed to protect students.”

As the Sacramento Bee reported, the vaccination issue has roiled California in unexpected ways, with “anti-vaxxers” cutting across familiar ideological and political categories. “I’m a registered Democrat, but that could possibly change,” one parent told the paper. “I could never be with a party that mandates, and takes away freedom from people.”

But Republicans have been wary of championing residents seen as directly responsible for the outbreak of major diseases. Some GOP officeholders in Sacramento have begun to reverse their earlier support of California’s relatively broad personal belief exemption, which extends beyond a carveout for religious beliefs. Others have reaffirmed a measured commitment to both vaccination and parental choice.

According to the Los Angeles Times, however, the bill would nevertheless extend some political cover to conservatives whose constituents favor close parental control of medical choices:

“The legislation does not address children who are completely home-schooled. It would still allow children to avoid vaccination for medical reasons including allergic responses and weak immune systems. The mandate only applies to children attending public or private schools.”

Democratic divisions

Perhaps surprisingly, Republicans may have already felt the worst of the political awkwardness — while Democrats face more internal disagreement. As the Wall Street Journal reported, “Dr. Pan wrote a 2012 law that went into effect last year that required a consultation with a health care practitioner to obtain the personal belief exemption. Gov. Jerry Brown added an exemption based on religious beliefs upon signing that law.”

Now, Brown’s office has indicated the governor is open to erasing the personal belief exemption.

Both California’s U.S. Senators, Democrats Barbara Boxer and Dianne Feinstein, also have urged their fellow party members to consider eliminating the religious-belief exemption. In a letter to California Health and Human Services Secretary Diana Dooley and other officials, the senators set out an uncompromising position:

“California’s current law allows two options for parents to opt out of vaccine requirements for school and daycare: they must either make this decision with the aid of a health professional, or they can simply check a box claiming that they have religious objections to medical care. We think both options are flawed, and oppose even the notion of a medical professional assisting to waive a vaccine requirement unless there is a medical reason, such as an immune deficiency.”

What’s more, Boxer and Feinstein went after parents who sought modified or delayed vaccination schedules even for preschool children — a move that could unsettle the swift but fragile bipartisan consensus forming around the Pan-Allen bill.

As BuzzFeed reported, the response among Democrats has not been as crisp and confident as Boxer and Feinstein might have hoped:

“Several liberal lawmakers unequivocally said parents should vaccinate their kids. But when pressed further on the state laws that allow parents to skip vaccinating their children if they have a medical, religious, or ‘personal belief’ reason not to do so, their answers became less clear.”

Nationally prominent California Democrats, from Rep. Maxine Waters to House Democratic Leader Nancy Pelosi, couched their language in a way that steered clear of Boxer and Feinstein’s vaccination absolutism.

The office of California Attorney General Kamala Harris — who hopes to replace Boxer in the Senate — declined to answer any questions about Harris’s own stance.

But a new investigation suggests which parents are actually more likely to seek vaccination waivers for their kids.

The scientists, technologists, and engineers who populate Silicon Valley and the California Bay Area deserve their reputation as innovators, building entire new economies on the strength of brains and imagination. But some of these people don’t seem to be vaccinating their children.

A Wired investigation shows that some children attending day care facilities affiliated with prominent Silicon Valley companies have not been completely vaccinated against preventable infectious diseases. At least, that’s according to a giant database from the California Department of Public Health, which tracks the vaccination rates at day care facilities and preschools in the state. We selected more than 20 large technology and health companies in the Bay Area and researched their day care offerings. Of 12 day care facilities affiliated with tech companies, six — that’s half — have below-average vaccination rates, according to the state’s data.

And those six have a level of measles vaccination that does not provide the “herd immunity” critical to the spread of the disease. Now, this data has limitations — most critically, it might not be current. But it also suggests an incursion of anti-science, anti-vaccine thinking in one of the smartest regions on Earth.

But before you reach any broad conclusions, watch out. People who understand math will see a flaw that makes the Wired report open to questions about overkill and exaggeration. Consider this sentence:

Of 12 day care facilities affiliated with tech companies, six — that’s half — have below-average vaccination rates, according to the state’s data.

So if you have 12 day-care facilities, how many would one logically expect to have below-average rates? That would be six — six below average, six above average.

Are vaccination rates awful at some tech firms’ day-care center? Wired makes that case about the facility run by iconic Pixar. But based on the numbers the magazine cites, its broader indictment of Silicon Valley doesn’t appear to hold up.

A 2012 law, designed to keep children vaccinated, forced parents seeking exceptions to receive counseling and a signature from doctors or other health care professionals. But a carve-out applied by Gov. Jerry Brown allowed those with an objection rooted in personal beliefs to skirt the regulation.

The so-called “anti-vax” movement, which has attracted the attention of politicians since the past decade, has developed largely in response to concerns that the ingredients of many popular vaccines could contribute to autism.

Over the years, officeholders from New Jersey Gov. Chris Christie to President Barack Obama have weighed in, sometimes tentatively, on the debate. Now events in California have sharpened battle lines and made opposing sides more strident.

Dangerous trends

Although California’s initially small population of unvaccinated or more slowly vaccinated children escaped the notice of regulators and activists, a recent increase to more sizable numbers has raised eyebrows and alarms. “State records show more than 13,000 kindergartners in California are unvaccinated because of either personal or religious beliefs,” the San Jose Mercury News reported, with under half without vaccination at some private schools. Thousands more children in other grades, the paper concluded, had also skipped vaccines.

These trends were visible as early as the onset of the previous school year. In September, the Los Angeles Times reported that “parents are deciding against vaccinating their kindergarten-age children at twice the rate they did seven years ago, a fact public health experts said is contributing to the reemergence of measles across the state and may lead to outbreaks of other serious diseases.”

According to state data cited by the Times, the percentage of kindergartens with at least 8 in 100 unvaccinated children had more than doubled over the same time period. The Times observed the 8 percent threshold “is significant because communities must be immunized at a high rate to avoid widespread disease outbreaks. It is a concept known as herd immunity, and for measles and whooping cough at least 92 percent of kids need to be immune, experts say.”

But in a recent follow-up report, the Times noted that vaccination rates had actually climbed in 2014, “Statewide, the rate of vaccine waivers for kindergartners entering school in the fall declined to 2.5 percent in 2014 from 3.1 percent in 2013. Bigger declines were seen in districts with some of the larger vaccine exemption rates.”

Culture war politics

For activists and analysts weighing in on the trends, however, last year’s dip in waivers isn’t enough to bring calm to the cultural storm. The “anti-vax” movement has attracted strong critics on the political right and left, each of which recognizes familiar stereotypes of their cultural opponents among the country’s vaccine rejectors. For conservatives, self-entitled upper-middle-class hipster parents are to blame; for liberals, scorn is directed at what they consider superstitious anti-science Christians.

As for medical professionals themselves, worry has centered around the elevated risk of outbreak for serious, painful diseases. Steven Salzberg, a biomedical engineer at Johns Hopkins, issued a typical warning several years ago concerning the spread of whooping cough. His frustration this year reflects a broad consensus among doctors that at least some vaccines are essential:

“Most of the anti-vax crowd have no scientific training or expertise, which might explain (but doesn’t excuse) their complete ignorance of the science. Over the past 15 years, dozens of studies involving hundreds of thousands of people have shown convincingly that neither vaccines nor any of the ingredients in them are linked to autism. Vaccines are not only safe, but they are perhaps the greatest public health success in the history of civilization.”

If pressure for increased regulation builds, “vaxxers” and “anti-vaxxers” may well be obliged to negotiate, with some vaccines becoming mandatory and others being regulated according to more or less restrictive timetables.

But on both sides, the appetite for compromise is weak. In one quote making the rounds in the media, a mother unwilling to let her child get a measles inoculation told the New York Times she’d rather her daughter “miss an entire semester” than receive one shot.