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.

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.