Has the California legislation to eliminate nonmedical vaccine exemptions for school entry done what it was supposed to do—i.e. encourage more children to be vaccinated since they could not refuse on the basis of a nonmedical exemption? That was the question investigated by Mohanty et al (10.1542/peds.2018-1051) in a new study involving semi-structured telephone interviews done over two months in 2017 with health officers and immunization staff from local health jurisdictions in the state. Sadly, what was discovered was not necessarily what legislators may have hoped would happen when they passed this legislation. For example, investigators learned of medical exemptions being agreed to for non-scientifically-justified or non-evidence based contraindications for vaccinating—such as a family history of allergies or autoimmune diseases. The authors of this study also learned of physicians charging fees of several hundred dollars to sign off on “medical” exemptions to prevent children whose families used to seek nonmedical exemptions from being vaccinated. Sadly, the study also notes a substantive increase in granting of medical exemptions after the bill passed that called for an end to non-medical exemptions. Since there is no standardized review process in place in California to review requests for medical exemptions, abuse of what is a medical exemption appears to be in abundance. So what do we do about this?
We asked California State Senator Dr. Richard Pan and law professor Dr. Dorit Reiss (10.1542/peds.2018-2009) to provide a commentary given their active involvement in the passage of this legislation. Their commentary makes a strong case for empowering public health officers to be given the authority to take action for unwarranted medical exemptions by removing the privilege from those physicians who abuse it or by requiring physicians to file their medical exemptions with public health vaccine personnel so that the number of unwarranted medical exemptions could be addressed. Give both this worrisome study and important commentary your best shot by reading both—especially if you live in a state that has passed non-medical exemption laws and don’t want to see medical exemptions being increased inappropriately as they appear to be in California.
