All Commentary
Thursday, June 13, 2019

California Seeks to Strip Doctors of Authority to Grant Kids Medical Exemptions for Vaccinations

With approximately 6,700,000 children enrolled in public and private schools in California, Senate Bill 276 could have far-reaching implications.

Photo by Ani Kolleshi on Unsplash

Imagine taking your two-month-old daughter in for her scheduled vaccines. Imagine watching as she begins to convulse soon after receiving her shots and then continues to experience seizures over the next few days. You might want to make sure she never receives a particular vaccine again. You might decide not to give her any more vaccines at all. You might also decide to delay vaccines for her siblings or to forego them altogether. These are all understandable responses to a frightening situation that any parent can relate to.

Under current California law, you would be able to do all of these things, and your daughter could still attend school (though good luck finding a doctor who will grant you a medical exemption given the official persecution of those who do).

But that will come to an end if Senate Bill 276 is passed.

Bill 276 Limits Medical Exemptions

The bill, which moved through the California Senate last month, seeks to eliminate the role of doctors in granting medical exemptions for vaccines required for school attendance, giving the authority to the California Department of Public Health (CDPH) instead.

SB 276 would also limit valid medical exemptions to only the handful of contraindications (conditions that make the administration of a drug or medical treatment inadvisable) recognized by the CDC, for each individual vaccine, ignoring family history (other than altered immunocompetence), genetic factors, and the vast majority of adverse events recognized by the vaccines’ own manufacturers and the FDA. If the bill passes, California will become the only state in which all school vaccine exemptions are restricted to this very narrow criteria.

The bill’s author, Senator Richard Pan, whose political career has been heavily funded by pharmaceutical companies, began his crusade to strip parents of the right to make medical decisions for their children in 2012. His AB 2109 required parents to get a doctor’s signature in order to obtain a personal belief exemption from any of the vaccines required for school.

Pan—himself a pediatrician—revealed his disdain for the doctor-patient relationship in 2018, when he wrote:

[G]ranting [Medical Exemptions] to legally required vaccines is not the practice of medicine but of a state authority to licensed physicians…. Essentially, physicians are fulfilling an administrative role….

Back when he was pushing AB 2109, he framed the issue in terms of providing parents with information about vaccines—as if that information had been heretofore unavailable and required government mandate in order for parents to access it.

Only three years later, Pan declared that requiring parents to have a doctor sign off on their vaccine exemptions was not enough. Claiming that “parents are speaking up and letting us know that current laws are not enough to protect their children,” Pan decided that exemptions based on personal or religious beliefs had to be removed. He proposed a bill—SB 277—that would eliminate both of these exemption options.

At the time, Pan assured parents that exemptions based on medical criteria would remain in place and would not be interfered with:

“If a physician feels that there is a genetic association in a sibling, a cousin, some other relative, it’s not safe for a vaccine, then they can provide a medical exemption for that vaccine—there is no limitation,” said Pan, during SB 277 hearings.

Now, four years after the passage of SB 277, and with a degree of mendacity that is frankly awe-inspiring, the Sacramento Bee reports that Pan

… is prepared … to close what he considers a loophole that SB 277 inadvertently created. “I have dedicated my career to keeping children and our communities safe and healthy,” Pan said, whose statement on the issue says some doctors are “monetizing their exemption-granting authority and profiting from the sale of medical exemptions.”

After participating in a media campaign that demonized doctors for doing exactly what the new law allowed them to and what Pan explicitly promised they would be allowed to do, Pan proposed a new bill: SB 276, which would put the power to grant medical exemptions into the hands of government bureaucrats.

Limiting the Criteria for Exemptions

Under SB 276, health authorities would only be permitted to grant exemptions based on the very narrow list of “Contraindications and Precautions” from the CDC. So, while in the past parents could get medical exemptions based on criteria such as seizures, encephalitis, a fever over 105 degrees, or collapse after a previous vaccine, they will no longer be able to if SB 276 is passed into law.

Limiting exemptions to the CDC guidelines represents a dramatic departure from medical-exemption policies of the past, as well as from Senator Pan’s explicit promise in 2015, which left the determination in the hands of doctors. It is also in conflict with the medical experiences of thousands of families, and in many cases, with FDA recommendations regarding known reactions.

For example, here is what the FDA says about Infanrix, a DTaP vaccine: If a child has experienced seizures within three days of receiving a pertussis-containing vaccine, or a fever of 105°F or higher, collapse or shock-like state, or persistent, inconsolable crying for three hours or longer, within 48 hours of receiving a pertussis-containing vaccine, “the decision to give INFANRIX should be based on potential benefits and risks.”

The CDC guidelines say something very different. Under a section titled “Conditions incorrectly perceived as contraindications or precautions to vaccination (i.e., vaccines may be given under these conditions)” [emphasis mine] and in direct contradiction of the FDA’s guidelines, the CDC declares that the following are not contraindications for the DTaP vaccine:

Seizures within three days of a previous dose (of DTP or DTaP); Fever, collapse or shock-like state, or persistent, inconsolable crying for three hours or longer, within 48 hours of a previous dose.

By mandating the CDC standard for determining medical exemptions, California’s SB 276 would force parents and doctors to disregard a great many of the FDA’s warnings about specific vaccines.

“Too Many” Medical Exemptions?

According to the Los Angeles Times, California public health officials have estimated that under the proposed bill, 40 percent of those seeking a medical exemption would be denied, and opponents of the bill say the number would be even higher.

Senator Pan’s assertion is that this is necessary because, after the passage of SB 277, which removed both religious and personal belief exemptions, many of the parents who would otherwise have used one of these (easier to file) exemptions are now seeking medical exemptions. He further asserts:

Medical exemptions have more than tripled since the passage of SB 277… It is clear that a small number of physicians are monetizing their exemption-granting authority and profiting from the sale of medical exemptions.

He is right that the number of medical exemptions has risen since 2015: from 0.2 percent of students entering school to 0.9 percent. (Total exemptions though, are down, from 2.6 percent to 0.9 percent.) But given what we know about vaccine injury, what should we expect the number of medical exemptions to be?

It’s not an easy question to answer. There are no good estimates of the number of vaccine injuries per dose or per recipient. Those who promote vaccines as “safe and effective” like to claim that vaccine injuries are “one in a million.” But that figure refers only to severe anaphylactic allergic reactions to vaccines.

The figure does not include such things as recurring seizures (the risk of seizures from the MMR vaccine, for example, has been found to be five times the risk of seizures from pre-vaccine measles), encephalopathy, Guillain-Barre Syndrome, or other conditions listed as reportable events in the Vaccine Adverse Event Reporting System (VAERS). Nor does it include events for which there is evidence of an association with vaccines, but which are not included in the list of VAERS-reportable events, such as SIDS.

The Vaccine Adverse Event Reporting System was put in place to record adverse reactions to vaccines. However, it suffers from serious underreporting, with possibly as few as 1 percent of events being reported.

An investigation conducted between 2006 and 2009 found that adverse reactions were reported for 2.6 percent of 1.4 million doses given to 376,452 individuals. However, the report did not distinguish between minor and more serious reactions, nor did it show how many individuals experienced reactions.

By law, the determination of whether a child should have a medical exemption is made at a doctor’s discretion.

Critics of adverse event reporting also note that the reported events are not confirmed as having been caused by a vaccine. This is true, but it is not relevant to the question of how many medical exemptions we might expect to see.

The test of whether a family has a good reason—based solely on past adverse reactions—to decline vaccines is not whether or not that past experience has been proven to have been a vaccine injury (something that is difficult at best to prove) but whether the parents have good reason to think it is. Even the FDA asserts this standard, warning that caution should be used if certain events followed closely after vaccination in the past—not only if those events were proven conclusively to have been caused by the vaccine.

The reality is that we simply do not have a good estimate of how many people experience serious adverse events related to vaccines. But neither does Senator Pan. His assertion that a 0.9 percent medical exemption rate is too high, and represents medical fraud, is based on absolutely nothing.

How Many People Need Medical Exemptions?

Moreover, whatever that number may be, it still does not provide a complete accounting for those who have good reason to avoid vaccines. It would represent only those who have themselves experienced an adverse event and would not include, for example, siblings, or those with known genetic conditions that might make them more vulnerable to vaccine injury.

Vaccines come with risks, including the risk of death and lifelong disability. Nobody denies this—all that is in contention is the extent of that risk.

And even including these groups does not give an accurate representation of how many parents might reasonably seek medical exemptions from vaccines. Why not? Because this standard is predicated on the belief that only those who have already suffered harm from a vaccine (or can show that they are genetically more predisposed to suffer harm) have the right to decline them.

But this is completely false. Vaccines come with risks, including the risk of death and lifelong disability. Nobody denies this—all that is in contention is the extent of that risk. But even if that risk is minuscule, nobody has the right to force a parent to subject their child to it. Not even (ostensibly) to “protect the herd.” And no parent knows whether their child will be one of those injured by a vaccine until they have actually been injured by one.

There is something very deeply wrong with a society that demands of parents that they first injure their children before they are allowed to decline a medical procedure. Indeed, there is no place for mandated medical procedures at all in a free society. Unfortunately for the rest of us, those who are promoting this kind of legislation have as little interest in a free society as they have in telling the truth.

Senator Pan presents this bill as if its purpose is to enforce an existing standard that is currently being abused. But that is false, as no such standard exists. By law, the determination of whether a child should have a medical exemption or not is made at a doctor’s discretion. What SB 276, in fact, seeks to do is to impose a standard—and a very restrictive one at that. With approximately 6,700,000 children enrolled in public and private schools in California, this bill has far-reaching implications—and the potential to hurt a lot of families.