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.

Is Kevin de Leon’s ammo bill legal?

Democrats in the Legislature pushed through a gun-control measure last week that is almost certain to be challenged in court — where it’ll have a tough time surviving — all for the sake of what some claim is a political grudge.

The Legislature passed 11 bills in all, six of which were signed into law by Gov. Jerry Brown and the rest vetoed. But one is fraught with peril as it circumvents the Elections Code by amending a November ballot initiative regulating ammo sales. 

The difference between how the bill, sponsored by Senate President Pro Tempore Kevin de León, D-Los Angeles, and the ballot measure, sponsored by Lt. Gov. Gavin Newsom, regulate ammo sales is not substantial. But Democrats have had a hard time providing legal justification for going around Section 9034 (c) in the Elections Code, which says the Legislature does not have the authority to “alter the initiative measure… .”

CalWatchdog has more.

In other news:

• Now that he’s been stripped of his committee assignments and been slapped with a three-year restraining order against his estranged wife, is there a path to victory for Assemblyman Roger Hernandez, D-West Covina, in his run for Congress? The Sacramento Bee has more. 
• San Diego Republicans are critical of a Democratic state lawmaker awarding a Veteran of the Year honor to her boyfriend, reports The Sacramento Bee. Must be something in the water in Sacramento, as another lawmaker in May gave a Small Business of the Year award to her brother’s new political strategy firm.
• California was the sixth largest economy in the world last year in terms of GDP, according to World Bank data. The San Jose Mercury News has more. 
• A non-profit group is challenging California’s vaccination law, which went into effect last week. The Orange County Register has more.

November ballot fills out with 17 measures…

Good morning, happy Friday and welcome to July!

Voters have been warned for a while to be prepared for a seemingly never-ending series of ballot measures, and on Thursday the secretary of state released the final list of what initiatives qualified.

Seventeen total. And while voters will read and learn more as the campaigns unfold between now and Election Day, we put together a quick reference guide for your reading and learning pleasure.

The guide includes an increased tobacco tax, a repeal of the death penalty, a sped-up death penalty process, gun control, Legislature transparency, plastic-bag ban referendum, and so much more.

CalWatchog has more. 

In other news:

• Lawmakers can still get measures on the November ballot, which one senator is hoping to do with a $3 billion bond for low-income housing. The Los Angeles Times has more. 
• The Legislature sent 12 gun-control bills to Gov. Jerry Brown today, where it’s unclear how many he’ll sign. But we’ll know shortly as he’s headed out on vacation afterwards. The Sacramento Bee has more. 
• The state’s controversial vaccination law takes effect today, and it’s causing some people to move away, writes The San Jose Mercury News. 
• The San Bernardino County Sun explains why CA regulators want more money to improve air quality.

Assembly:

• Gone ’til August.

Senate: 

• Gone ’til August.

Gov. Brown:

• Headed for a European vacation.

Tips: matt@calwatchdog.com

Follow us: @calwatchdog @mflemingterp

New followers: @michaelkapp @ethnicphysician

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.

Senate Bill 277 “requires almost all California schoolchildren to be fully vaccinated in order to attend public or private school, regardless of their parents’ personal or religious beliefs,” as the San Jose Mercury News reported.

“‘We are going to have a referendum to ask the public to put a hold on the law,’ said Palo Alto resident Christina Hildebrand, president and co-founder of A Voice For Choice. ‘We will continue to fight this — we are not going away,’ said the mother of two unvaccinated children.”

The prospect of a legal challenge was quickly downplayed by one of the bill’s coauthors, state Sen. Richard Pan, D-Sacramento. “The courts have been very clear that you don’t have a right to spread a communicable disease, that there’s a public interest in keeping our communities safe from disease,” he said, according to the Sacramento Bee.

So-called “herd immunity” has been hard to maintain in recent years in some parts of the state. As the Associated Press noted, “suburban areas have seen a decline in immunizations in the past decade, with some schools having immunization rates near 50 percent. Herd immunity for measles is between 92 and 94 percent, according to the U.S. Centers for Disease Control and Prevention.”

A tipping point

The new law made California’s inoculation rules among the nation’s strictest. Only Mississippi and West Virginia also bar religious and personal exemptions while maintaining a narrow allowance for medical excuses. (“Unvaccinated children without a medical exemption would have to be home-schooled or study in small, private homeschooling groups,” Reuters noted.)

But as is often the case with California, the state’s about-face on vaccines was set upon by critics and supporters as a potential bellwether and momentum-shifter for similar regulations across the country.

Capturing an emerging consensus in the realm of health policy, Wired characterized the situation as a “historical inflection point.”

“If public health researchers and politicians can look carefully at the state of the state’s vaccination rates and disease numbers before and after SB277 is enacted, they’ll get a powerful tool to either support more bans of these exemptions — several of which are on the table in other states right now — or drive the United States toward different, perhaps more effective strategies to reduce vaccine-preventable disease.”

Pan himself lent his support to the idea that other states should follow where he has led California. “Asked if he thought California’s action would spark similar changes in other states, Pan said Brown’s swift action on the bill will send a ‘strong signal’ across the country,” reported the Mercury News. “Neither California nor any other state ‘wants to continue to see [outbreaks] happen in their neighborhoods,’ Pan said.”

A reversal for Brown

Supporters of California’s now-obsolete exemptions had put faith in Gov. Brown, who ensured not long ago that Golden State parents could claim a religious objection to vaccinating their children. “Brown’s decision to sign the bill marks an about-face for the former seminarian who three years ago opposed eliminating the religious exemption for school vaccines,” Reuters observed.

In 2012, signing prior legislation “requiring parents to consult a health professional before declining vaccinations for their schoolchildren,” Brown set up a special carve-out for those claiming an exemption on account of religious beliefs.

“In his signing statement Tuesday, the Democratic governor noted that the bill exempts children whose family medical histories lead a physician to recommend against immunization,” according to the Sacramento Bee. “But unlike in 2012, the former Jesuit seminarian said nothing about religion.”

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.

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.”