With crucial votes due soon on a bill to make it more difficult for parents to get vaccine exemptions for their children, opponents are emphasizing a different criticism of the measure. Instead of continuing to focus on vaccine safety, they say one of its provisions is an ominous and unreasonable invasion of privacy.

Most of the attention paid to Senate Bill 276, by state Sen. Richard Pan, D-Sacramento, has dealt with its broad parameters. It would require the state Department of Public Health to review all vaccine exemptions at individual schools if fewer than 95 percent of students are immunized. That’s the minimum percentage that public health officials say is necessary for “herd immunity” from infectious diseases. The department would also investigate doctors who issue five or more exemptions in a year.

But Pan’s bill also requires parents seeking exemptions to provide their children’s medical records if public health officials choose to investigate whether exemptions were properly provided. A recent San Francisco Chronicle story noted how much this galled some parents.

“Who’s to say they won’t use that information for something else in the future?” Allison Serrao, an Orange County mother of three, told the newspaper. “It’s really scary to me as a parent. It crosses a lot of lines.”

‘Loophole’ blamed for shielding doctors

Supporters of the bill note that the state already deals with confidential medical records – such as by tracking sexually transmitted diseases – without problems. Some see the privacy complaints as an attempt to preserve what they consider a “loophole” that has let doctors who issued dubious exemptions off the hook.

That’s because under the 2014 law, also introduced by Pan, that ended “personal belief” exemptions – approved after a measles outbreak that began at Disneyland – parents can impede investigations. They can refuse to answer questions from investigators and decline to allow release of their children’s medical records.

In 2017, the Los Angeles Times reported on the phenomenon of scores of doctors being accused of authorizing invalid medical exemptions but almost never being punished.

As California Healthline reported last month, the state can sue for access to doctors’ medical records. This year, the state Department of Consumer Affairs – which oversees the California Medical Board – has sued to obtain records from two physicians in the Santa Rosa area and two in Sacramento.

Only one of nearly 200 complaints upheld

But such actions are relatively rare. As of early August, only one state physician out of the nearly 200 accused of wrongly writing exemptions over the last four years has faced sanctions, according to the Chronicle. And the only reason that officials were able to build a case against Dana Point pediatrician Bob Sears was because one of the parents of a child he gave an exemption to objected to the decision and provided investigators with medical records. That led to Sears being put on probation by the Medical Board in 2008.

Pan’s bill was approved 24-10 by the state Senate on May 22. In the Assembly, the bill was weakened after Gov. Gavin Newsom questioned whether it would set up an unwieldy bureaucracy. The modified version of SB276 passed the Assembly Health Committee 9-2 on June 20.

To become law, the modified bill must pass both the full Assembly and the Senate by Sept. 13, when the current legislative session ends. 

The vaccine fight is playing out as U.S. public health authorities struggle with measles outbreaks in New York and Washington states. The problem is even more severe in nations as varied as Italy, Israel and the Philippines. Worldwide, there has been a 300 percent increase in measles cases since last year.

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.

At stake was Senate Bill 277, signed into law by Gov. Jerry Brown on a wave of concern that “herd immunity” among California children was compromised by a growing anti-vaccination trend. Coauthored by state Sens. Richard Pan, D-Sacramento, and Ben Allen, D-Redondo Beach, SB277 “will require all children entering kindergarten to be vaccinated unless a doctor certifies that a child has a medical condition, such as allergies, preventing it,” as the Los Angeles Daily News summarized the law.

Missing the mark

After submitting signatures gathered in the hopes of meeting the legal threshold of adequate public support, organizers behind the would-be measure discovered that their numbers had fallen short: “They turned in some 228,000 signatures on petitions for a referendum to overturn the measure, far short of the number needed to qualify it for next year’s ballot,” as the Los Angeles Times reported. “Referendum supporters needed the signatures of 365,880 registered voters by Monday to place the measure before state voters in November 2016.”

Efforts to meet the requirements were bedeviled by the shoestring character of the operation. “While the campaign deployed paid signature gatherers in the final stretch before the deadline, it was largely a volunteer effort,” according to the Sacramento Bee, “a tough task given that successful initiative campaigns typically cost millions of dollars.”

Citing internal documentation, the Bee noted that some California counties weren’t represented at all in the final tally. “Organizers in six counties did not submit any signatures by the deadline, according to an initial survey of raw data from the California secretary of state’s office. While the organizers’ spreadsheet contains estimates for large population centers like Orange County, Los Angeles County and Riverside County, they did not have an estimate for 16 counties in addition to the six the secretary of state said did not submit signatures,” the paper reported.

Raising allegations

But one of the foremost political figures behind the movement to restore the personal belief exemption to mandatory child vaccinations alleged that the signature-gathering effort had fallen victim to foul play. “The leading proponent of the effort, former Republican Assemblyman Tim Donnelly, said in an email Monday that volunteers were coerced and threatened while collecting signatures,” according to the Associated Press. “Donnelly did not return repeated messages inquiring about the effort’s chances but said in his email that he was proud of the volunteers who worked on the campaign ‘whatever the outcome is.'” Donnelly said the push “was sabotaged from without and within by powerful forces from its very inception, but we never gave up and we never gave in.”

Although Donnelly had gained notoriety of late as an outspoken gubernatorial candidate, his charges have yet to faze supporters of the stringent vaccination mandate. In remarks to KOVR Sacramento, Pan said he supported “the right to pursue a referendum,” according to the Daily News. But Pan also told reporters he was “sure the voters of California are not interested in letting a privileged few take away the rights of all Californians to be safe from preventable disease,” the AP noted.

Plan B

As the deadline for submitting signatures neared, some anti-vaccination activists created what could be a second opportunity to accomplish objectives similar to the hoped-for referendum. In a recent message posted to Facebook, the group announced that they had filed for a so-called Parental Rights Constitutional Amendment Initiative. “The measure was filed now in part because the filing fee for initiatives is going up Jan. 1 from $200 to $2,000,” the post said, according to the Los Angeles Times. “Supporters have six months to collect signatures for an initiative, far longer than 90 days provided for a referendum.”

A state audit report in December 2014 chronicled the California Department of Health Care Services’ years of dental neglect of California’s low-income and disabled residents, including more than 5 million children. “Health Care Services’ information shortcomings and ineffective actions are putting children enrolled in Medi-Cal – child beneficiaries – at higher risk of dental disease,” the report said.

More than 12.5 million low-income and disabled Californians receive health coverage from Medi-Cal. The program has a $94 billion budget; $1.3 billion of which goes to Denti-Cal.

Lack of Denti-Cal Providers

The biggest problem for Denti-Cal patients, particularly those in rural areas, is lack of access to a dentist. Fifty-five percent of California counties may have “an insufficient number of dental providers willing to accept new Medi-Cal patients,” the audit said. That includes five counties, which may not have any Denti-Cal providers, and 11 other counties that have Denti-Cal providers but they are not accepting new Denti-Cal patients.

The reason is that dentists lose money treating Denti-Cal patients. California’s reimbursement rates for 10 common dental procedures averaged $21.60 in 2012, according to the audit. That’s only 35 percent of the national average of $61.96 in 2011. California has not raised its dental reimbursement rates since 2000.

The result has been a depressed level of dental care for low-income California residents compared to the rest of the nation. Only 44 percent of the 5.1 million children enrolled in Denti-Cal received dental care through the program in 2012-13, the audit said. The national average utilization rate was 47.6 percent of patients, ranging from a low of 23.7 percent in Ohio to a high of 63.4 percent in Texas.

Little Hoover Commission examines program

Denti-Cal’s problems were the focus of a Sept. 24 hearing by the state watchdog agency the Little Hoover Commission. The commission took up the issue at the request of Sen. Richard Pan, D-Sacramento, who is a pediatrician, and Assemblyman Jim Wood, D-North Coast, who is a retired dentist. “Millions of low-income Californians on Denti-Cal are suffering because the promise of dental coverage by the state is not being fulfilled by Denti-Cal,” they said in an April 6 letter to the Commission.

Pan kicked off the four-hour hearing noting that one third of Californians are covered by Medi-Cal, and pointing out that tooth decay is preventable with regular dental care. “Unfortunately, every indication is that the Denti-Cal program has been neglected for decades – it is broken,” said Pan.

He’s made phone calls on behalf of Medi-Cal patients having trouble finding a dentist. “I shared their frustration when I … couldn’t reach a dentist to get them dental care,” he said.

The problem has been going on for years. In 2008 only one-fifth of the children in Sacramento County’s Denti-Cal program actually received dental care, Pan said. “It was clear that DHCS did not seem to exercise very much oversight or knew what was happening – or not happening actually – to our children in that time.”

DHCS has not, as required by law, annually reviewed its reimbursement rates “to ensure the reasonable access to dental services by Medi-Cal beneficiaries,” the audit said. The department also has not complied with its pledge to annually compare Denti-Cal’s performance with results from national and statewide surveys. Denti-Cal “thought another division was responsible for completing the dental metrics in the monitoring plan,” the audit said.

Blame placed on low reimbursement rates

Pan, along with several other industry experts testifying at the hearing, said that reimbursement rates need to be increased to make it worthwhile for dentists to take on the extra work. Reimbursement is so low that some dentists find it is less burdensome to directly provide charity care to poor patients rather than going through Denti-Cal and dealing with its paperwork and other bureaucratic hurdles.

“When you have payment rates that do not adequately cover practice expenses, there’s pressure on providers then to make that up – if they are going to be viable – to perform high volumes and particularly more highly paid services and procedures,” Pan said. “The department then responds, when they see this higher volume, to create even more barriers to payment, which drives out more providers. And basically who are you left with? People who have figured out how to work the system to do high volumes just to keep the practice viable.”

Similar testimony was provided by numerous dental professionals. All of which put the woman representing the Denti-Cal program – Rene Mollow, DHCS deputy director of Health Care Benefits and Eligibility – on the hotseat.

“I first do want to acknowledge the challenges that we’ve had in the program and to represent the commitment … in working through and making sure we do improve the management and administration of the program,” said Mollow. “I think, based upon responses that we have made to the state auditor, we have demonstrated our commitment to making the improvements.”

She said there’s been a lot of discussion on reimbursement rates. She also acknowledged that the problems are more extensive, including cumbersome paperwork requirements. For example, the Denti-Cal application for dentists is 40 pages long. Denti-Cal preauthorization, based on documentation including x-rays, is often required before some procedures are allowed to be performed. Several professionals also complained about the ratcheting up of anesthesiology regulations.

But Mollow sought to put a positive spin on the situation.

“We pride ourselves on ensuring program integrity while also ensuring access to services and maintain the viability of the program given the expenditures of the program and the population that we do serve,” she said. “We do recognize the challenges with the administrative processing in terms of claims and provider enrollment. We are looking at ways to do some streamlining.”

Pressure for specific solutions

Commissioner David Beier asked Mollow about the audit. “Did you view that as a three-alarm or four-alarm fire that required an urgent response?” he said.

Mollow responded, “Yes, the audit raised concerns. But the findings of the audit were things we were already working on. So these were things based upon the administrative simplification, issues with provider enrollment, all of the things people were raising to us as concerns.”

Beier wanted to hear more specifics about corrective measures. “In your testimony there’s a lot of ‘looking ats’ and ‘considering,’” he said. “What are the major changes that have been implemented in almost a year since the audit?”

Mollow responded, “We’ve looked at improving upon our contract oversight and management of the fiscal intermediary. We have required the provision of the beneficiary and provider outreach plans. We are now working with stakeholder review of those plans. We are working with stakeholders on beneficiary and provider performance metrics. We have a very robust process in place.”

Influx of new patients

Also robust is the number of new patients coming into the Medi-Cal program due to changes in federal and state laws that expand coverage. An additional 2.7 million Denti-Cal patients – perhaps as many as 6.4 million – are expected to be added in the coming years. “[That] make[s] us question whether California will have enough available dental providers to meet the needs of Medi-Cal beneficiaries,” the audit said.

Sen. Anthony Cannella, R-Ceres, who is also a Little Hoover commissioner, was unconvinced by Mollow’s assurances that the department is on top of the problems.

“I just think that it doesn’t seem like we are taking this as serious as we should when we have people with real needs,” he said. “And these have real consequences. Children that have problems with their teeth, it’s a stigma that they carry for the rest of their lives. So we are creating more and more problems that I think can be solved pretty easily.”

Commission Chairman Pedro Nava quizzed Mollow about why her department hasn’t fixed the problems or sought help from the Legislature. Mollow responded that changes must first go through the regulatory process. That didn’t satisfy Nava.

“As a former legislator, this is where I would say to the department, ‘Where the hell you been?’” he said. “In a nice way. The push to make the change should come from the department. Because the last thing you want is an uneducated legislator deciding they want to fix it. Because then there’s unintended consequences that the Little Hoover Commission has to come back in and look at five years later.

“One of the things that ought to happen when you leave here is to meet and talk about your legislative package and come up with a bipartisan legislative proposal. Without some movement on the legislative front, you don’t want us coming back and asking, ‘How come you ain’t done it yet?’”

The commission plans to release a report to the Legislature on the Denti-Cal problems and recommendations for solutions.

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.

Sweeping changes

As CalWatchdog.com previously reported, state Sens. Richard Pan, D-Sacramento, and Ben Allen, D-Santa Monica, had to rewrite key passages of the bill’s language in order to head off potential constitutional challenges to its treatment of kids without the specified vaccinations.

The bulk of the original bill remained intact, however, sweeping away California’s longstanding and generous rules permitting parents to keep their children vaccine-free. “Several Republican senators tried to stall the bill by introducing a series of amendments that would have reinserted the religious exemption and required labeling of vaccine ingredients,” according to the Sacramento Bee. But Democrats moved swiftly to shut them down.

For some critics, barring unvaccinated children from public school remained a bone of contention. “It’s clear that a large portion of concerned parents will likely withhold their children from public schools because of their concerns or lack of comfort from the vaccination process,” said GOP state Sen. John Moorlach, according to the Christian Science Monitor.

But some carveouts were set to remain. “The legislation only addresses families that will soon enroll their children in school,” as Newsweek observed. “Under the proposed law, children who aren’t currently immunized are not required to get vaccinated until seventh grade. The law still allows families to opt out due to medical reasons, such as a history of allergies to vaccines and inherited or acquired immune disorders or deficiencies.”

The so-called grandfather clause represented a major concession to parents’ groups, which had succeeded in stalling Pan and Allen’s legislation once before. Now, as the San Jose Mercury News reported, “more than 13,000 children who have had no vaccinations by first grade won’t have to get their shots until they enter seventh grade. And nearly 10,000 seventh-graders who today aren’t fully vaccinated may be able to avoid future shots because the state does not always require them after that grade.”

Regulatory momentum

Despite the lenience built into the advancing legislation, the pro-vaccine logic that propelled it has already increased momentum for an even more assertive approach to enforcing inoculation.

As KQED News has noted, “two other vaccine-related bills are making their way through the Legislature a bit more quietly. One would require preschool and child care workers to have certain vaccinations; another seeks to improve vaccination rates for 2-year-olds.”

“If SB792 becomes law, California will be the first state in the country to require that all preschool and child care workers be immunized against measles, pertussis and the flu.”

Supporters of the ratcheted-up regulation sought to head off more controversy by downplaying the invasiveness and inconvenience of their approach. “We certainly aren’t out to arrest people who aren’t vaccinated,” said Kat DeBurgh, executive director of the Health Officers Association of California, a group that sponsored SB792. “We wanted to make this just like any other violation of code that an inspector would look for. If you don’t remediate, then there is a fine to the day care center.”

At the same time, pro-vaccination analysts have speculated that the Golden State will save money the more it ensures vaccination. Referring to a recent study showing that Iowa’s health care spending would double if it added a personal belief exemption, Tara Haelle suggested that California’s “health care cost savings would be far more substantial” once its exemption was eliminated, although, she conceded, “no thorough analyses are currently available.”

“It’s a lack of respect,” House Minority leader Nancy Pelosi said of why Republicans continue to press for restrictions on reproductive rights and undermine what she described as “choice issues.” “Respect for our judgment, our dignity, respect for our sentiment of responsibility.”

Yet, marginalized activists who support maintaining a personal belief exemption from mandatory vaccinations say that Democratic lawmakers aren’t respecting their right to choose. Opponents of Senate Bill 277 protested outside of the Anaheim Convention Center Saturday, with homemade signs and loud chants echoing the party’s position on health choice. Rather than gain acceptance from a party that champions marginalized groups, opponents of SB277 found themselves facing derisive comments from convention delegates.

“They (California Democrats) are definitely being hypocritical on this issue,” said Aaron Mills, a member of the California Coalition for Health Choice. “Democrats usually champion for the minorities. When it comes to this group, it’s “just go away and stop complaining.”

He added, “You can’t force somebody to take a product with known risks. … I don’t really feel compelled to vaccinate my day-old infant for a sexually transmitted disease.”

SB277: Reframing the debate

The debate over California’s immunization requirements began in January, following a measles outbreak at Disneyland, which coincidentally is just down the block from this weekend’s convention. As of March, California public health officials had confirmed 133 measles cases since December, according to National Public Radio.

The Disneyland measles outbreak encouraged Senator Richard Pan, D-Sacramento, to introduce SB277, a bill to end the personal belief exemption which gives parents the power to opt-out of mandatory vaccinations for schoolchildren.

For months, opponents of the legislation have stumbled in their public rhetoric and legislative strategy. Some of the bill’s opponents tracked – arguably stalked – a lobbyist throughout the Capitol. Lawmakers and their staff members were inconvenienced by lengthy committee hearings. This past Thursday, the bill passed the state Senate on a 25-10 vote, with only two Democrats opposed.

However, at this weekend’s California Democratic Party state convention, concerned parents refined their argument to a message of choice.

“Are you aware that California Senate Bill 277 is moving its way through legislation right now that will remove your right to choose on vaccines?” reads a flyer distributed by protestors. “Where there’s a risk, there must be choice!”

Another handout asks, “Are California Democrats a party of choice or force?”

Both of those messages mirror the words of the California Democratic Party’s official platform, which states, “We proudly and vigorously support a woman’s right to choose how to use her mind, her body and her time.”

Democratic Senators prioritize public safety over choice

State Senator Ben Allen, D-Santa Monica, a principal co-author of the bill, has argued that public safety should trump choice.

“The high number of unvaccinated students is jeopardizing public health not only in schools but in the broader community,” Allen said in a press release earlier this year.” We need to take steps to keep our schools safe and our students healthy.”

Allen’s arguments don’t sit well with some Democrats, who see it as government intervening in their personal health decisions.

“Never in a million years did I think my fellow Democrats would vote to take away my constitutional rights as a parent,” read one Democratic woman’s homemade sign. “Vaccination decisions are between a parent and their doctor, not the government. Opposition to SB277 will not go away even if it passed.”

During Saturday’s rally, supporters of the personal belief exemption chanted, ” We’re not going away! We’re not going away!” Yet, some Republicans are hoping that the issue could drive parents to leave the Democratic Party. A few members of the California Republican Assembly set up a table near the rally with a sign indicating their support for parental rights.

SB277 Opponents: Don’t call us anti-vaxxers

In addition to their frustration with Democrats abandoning “choice,” opponents of SB277 say that the party’s elected officials are being disrespectful to their cause by using the pejorative term, “anti-vaxxer.”

“This media stigma that is attached to it,” Mills, a member of the Democratic Party and opponent of mandatory vaccination, explained why he objected to the term. “It might be the most loathed group in the country. It’s definitely a minority group that no one looks fondly upon.”

According to Google search trends, there has been a dramatic spike in use of the term since the Disneyland measles outbreak. So, what should people call them?

“We’re not anti-anything,” Mills said. “We’re for health choice.”

California Democratic Party: Health Choice Rally

As CalWatchdog reported previously, supporters of SB 277 discovered that its original wording could be interpreted as unconstitutionally depriving some children of an education.

Last month, the ACLU began raising the constitutional alarm. Kevin G. Baker, legislative director of the ACLU of California’s Center for Advocacy and Policy, wrote the bill’s sponsors to suggest some possible alternatives, according to the Los Angeles Times: 

“In his letter, Baker suggested that a 16-month-old state law, AB 2109, should be given more of a chance to work before taking such a drastic step. That legislation requires health professionals to discuss the benefits and risks of immunization with parents before they are allowed to file belief exemptions, and it has already led to an increase in vaccination rates.“

Lawmakers, however, did not respond. Rather than taking such a circuitous path, they focused on honing SB 277 to a point where the force of the constitutional objections could simply be blunted. The core provisions of SB 277 went unchanged as legislators retooled its language. Co-authored by state Sens. Richard Pan, D-Sacramento, and Ben Allen, D-Santa Monica, the bill “would eliminate personal belief and religious exemptions for vaccines, and unvaccinated children could not attend public or private school in California,” as the San Jose Mercury News noted. Students barred from school attendance would, under the bill’s requirements, be homeschooled.

Narrow changes, big consequences

To evade the possibility of selective educational discrimination, however, Pan and Allen rewrote the bill to permit broader access to educational resources for unvaccinated kids. Summarizing the changes, California Healthline reported that one new provision allowed them to “enroll in private home-schooling programs that serve multiple families, rather than programs that serve just one family,” while another enabled them to “[p]articipate in independent study projects that are overseen by school districts but do not include classroom time.”

Moreover, a small but significant carve-out was created to allay some persistent concerns about the scope of legislative authority over vaccination. Legislators tweaked the bill “to include a new provision that would limit vaccinations to only those 10 vaccines currently required by California Department of Public Health,” according to the Bee. “Parents would be allowed to obtain a personal belief exemption for any vaccine added in the future.” Under state law, the personal belief exemption has been understood to encompass the religious belief exemption.

Although the changes impacting private schooling and independent study made the more immediate difference in terms of the bill’s prospects, the vaccine-limiting provision carried much greater legal significance. Critics of the bill had argued strenuously against eliminating California’s religious and personal belief exemptions altogether, without regard to changes in medical opinion or future legislative requirements.

More hurdles

Although SB 277 in amended form has now cleared the Senate Education Committee and will find stronger support as it heads to the Senate Judiciary Committee, further changes were predicted before its final form takes shape. “Several senators said additional amendments will likely be needed as the bill moves forward to ensure that unvaccinated kids are not denied the education guaranteed to them by the California Constitution,” according to the San Francisco Chronicle. “Several lawmakers said they would like to see more school options for those who aren’t immunized, other than home school and independent study.”

Additionally, the Chronicle reported, the bill may need approval by the Senate Appropriations Committee before moving to the full Senate, and requires five affirmative votes in the Judiciary Committee to proceed. “The five Democrats on the committee,” however, “are either supporters of the bill or have previously voted in favor of it.”