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Pediatricians to Debate Nonmedical Vaccine Exemptions for School Entry :

August 9, 2017

Editor's note: The 2017 AAP National Conference & Exhibition will take place from Sept. 16-19 in Chicago.

The 2014-’15 measles outbreak linked to Disneyland in California stoked the debate over whether religious and personal exemptions from school vaccine requirements should be allowed.

More than 100 people around the country and in Canada contracted measles in the outbreak believed to be caused by a visitor who caught the disease overseas and then visited the amusement park while infectious. Among those who fell ill were infants too young to be vaccinated and some who were not vaccinated due to personal beliefs, according to the California Department of Public Health.

The outbreak prompted some states, including California, to consider whether nonmedical exemptions from school vaccine requirements should be allowed.

The issue will be debated by Richard Pan, MD, MPH, FAAP, a member of the AAP Council on School Health, and Aviva Katz, MD, MA, FAAP, immediate past chair of the AAP Committee on Bioethics, during a point-counterpoint session titled “Vaccine Exemptions for School: Personal, Religious, All, or None? (D2044).” The session will be held from 8:30-9:30 am Sunday, Sept. 17.

Dr. Pan is a California state senator who authored a law (SB 277) that eliminated personal belief exemptions from school vaccine requirements in his state. The law took effect on July 1, 2016. Dr. Katz is associate professor of surgery at the University of Pittsburgh School of Medicine and director of the Consortium Ethics Program at University of Pittsburgh.

After the Disneyland outbreak, Dr. Pan said he spoke with many parents concerned about their children contracting vaccine-preventable diseases, especially youngsters who could not be vaccinated due to medical conditions or receipt of immunosuppressive therapy.

“Every child has the right to be safe and healthy, and every child needs to be safe in their school and their community,” Dr. Pan said. “That was a reason I authored SB 277, which has raised vaccination rates to levels not seen since 2001 in California.”

Dr. Katz maintains there is a place for personal exemptions from state vaccine requirements.

“I will be taking the position that decisions about proceeding with childhood vaccination fall within the spectrum of medical decision-making that we allow families,” she said. “While we strongly disagree as pediatric care professionals with either deferring vaccination or delaying or altering the vaccination schedule, outside of the occurrence of an epidemic, the risk associated with this act does not rise to the level of mandating vaccination without an opportunity for exemptions.”

Dr. Pan pointed out that the California law does not force parents to get their children vaccinated but rather restricts unvaccinated children from attending public schools. These children still can get an education through homeschooling or independent study from the public school system.

“If someone makes a choice to put other people’s children at risk because they have beliefs that are not supported by science about vaccines, then there’s a consequence to protect those children,” Dr. Pan said.

Dr. Katz said she favors less restrictive methods to increase vaccination rates.

“Altering access to exemptions, making exemptions more difficult to obtain and linking exemptions to receiving education can potentially decrease the use of personal exemptions and could be instituted rather than a blanket removal of all nonmedical exemptions,” she said.

For more stories on educational sessions and events at the 2017 AAP National Conference & Exhibition in Chicago, visit To register for the conference, visit


The original version of this article included incorrect information about the California law that eliminated personal belief exemptions from school vaccine requirements. The law applies to public and private schools.


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