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Study: Some California families obtaining questionable vaccine exemptions following law change :

October 29, 2018

Some California families are using questionable medical claims to skirt requirements that schoolchildren are vaccinated, a new study found.

Medical exemptions to the mandates have increased since state officials voted in 2015 to get rid of personal belief and religious exemptions.

“If medical exemption rates continue to rise, portions of California will remain susceptible to vaccine-preventable outbreaks,” authors wrote in “Experiences With Medical Exemptions After a Change in Vaccine Exemption Policy in California," (Mohanty S, et al. Pediatrics. Oct. 29, 2018, https://doi.org/10.1542/peds.2018-1051).

California state Sen. Richard J. Pan, M.D., M.P.H., FAAP, led a hard-fought legislative battle against vaccine opponents to pass the 2015 law. Afterward, kindergarten vaccination rates rose from 93% to 95%. However, medical exemptions also saw a 250% spike from 0.2% to 0.7%, according to the study.

Researchers interviewed staff from 35 of 61 local health jurisdictions in California to ask about the impact of the law. Some reported seeing questionable conditions listed as medical reasons for not vaccinating such as a family history of allergies or autoimmune disorders, which federal health officials do not consider contraindications. They also reported some physicians charging $150 to $300 fees for medical exemptions. In some cases, non-pediatric physicians were signing off on them.

Because the law does not require health officials to review or track exemptions, most only saw them when a school wanted to discuss specific cases or patterns, and one jurisdiction was sued when it tried to track them. Officials said they were frustrated by their lack of authority.

Since the exemption law took effect, the California Medical Board has received 60 complaints, but most were closed without a violation being found or deemed to have insufficient evidence to pursue them, researchers found.

Dr. Pan and Dorit Rubinstein Reiss, L.L.B., Ph.D., wrote in a related commentary that disciplining physicians is difficult if patients don’t cooperate, and they called for public health officers across the country to have more power to review and track exemptions.

“Mandating vaccination for school is an effective strategy to prevent outbreaks,” they wrote. “This protection is undermined when unscrupulous physicians monetize their license and abuse the authority delegated to them from the state by granting unwarranted MEs (medical exemptions). Public health officers need the information to identify these physicians and the authority to withdraw their ability to grant MEs and to invalidate unwarranted MEs to protect children and public health.”

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