September 16, 2019
Area(s) of Interest: Public Health Advocacy
On September 9, 2019, Governor Newsom signed Senate Bill 276 into law, which will prevent fake medical exemptions and require state oversight of medical exemptions for vaccines required to attend public schools, private schools and day care centers.
The bill—authored by Senator and pediatrician Richard Pan, M.D., and sponsored by the California Medical Association (CMA)—will require physicians to submit information to California Department of Public Health (CDPH), including the physician’s name and license number and the reason for the exemption, which CDPH will check to ensure they are consistent with the Center for Disease Control’s guidelines or standard of care. The physician must also certify that they have examined the patient in person.
Additionally, CDPH will create and maintain a database of medical exemptions. CDPH will have the authority to revoke medical exemptions granted by licensed physicians if they are found to be fraudulent or inconsistent with the standard of care. This authority will give the state public health officer the tools necessary to contain and prevent further outbreaks of infectious disease.
“SB 276 makes California’s existing vaccination law stronger and will protect community immunity. This important legislation makes clear that California will not tolerate physicians who are practicing outside the accepted standard of care and will prioritize public health and protections for children,” said CMA President David H. Aizuss, M.D.
After working with the Governor’s office, Dr. Pan agreed to amendments contained in a separate measure, SB 714. Gov. Newsom also signed SB 714.
“The physicians of the California Medical Association want to thank lawmakers, and particularly Dr. Pan, for showing the leadership to protect public health and ensure physicians are doing their part to protect community immunity and offering high-quality, ethical care to their patients,” said Dr. Aizuss.
Following a measles outbreak in Disneyland in 2014, California legislators passed SB 277, also authored by Dr. Pan and sponsored by CMA, which eliminated all non-medical exemptions to the required vaccines for school entry. As a result of the implementation of SB 277, overall vaccination rates have increased sharply statewide since 2015.
However, California has also experienced a dramatic increase in the number of medical exemptions. Last year it had tripled (from 0.2 percent in 2015-16 to 0.7 percent in 2017-18). Data from this year shows the percentage has quadrupled to 0.9 percent. Low vaccination rates in certain pockets of the state have put children and communities at risk. More than 100 schools have a medical exemption rate over 10 percent, far beyond what should be expected.
This year has seen the greatest number of measles cases reported in the U.S. since 1992. In California, there have been 67 confirmed measles cases reported, including 38 outbreak-associated cases (4 completed outbreaks, 33 cases; 1 ongoing outbreak, 5 cases) as of as of September 11, 2019.
When measles spreads in a community with immunization rates below 94 percent, the protection provided by ‘community immunity’ is lost. This means that many people, are at risk of becoming infected, including those who cannot be immunized, infants, chemotherapy patients and people with HIV or other conditions.
“As the latest measles outbreak threatens the country’s elimination status, California acted to keep children safe at school by abolishing non-medical exemptions,” said Dr. Pan in a statement. “Unfortunately, a few unscrupulous physicians are selling inappropriate medical exemptions, and we need SB276 stop the corruption of medical exemptions that endanger children.”