California becomes third state to remove religious and personal vaccine exemptions

California’s generous vaccination exemptions are no more after Governor Jerry Brown (D) signed SB-277 on June 30, 2015, eliminating religious and personal exemptions to vaccinations required for children to attend school. The controversial legislation stemmed from the notorious measles outbreak traced to Disneyland. According to the LA Times, state Senator Richard Pan (D-Sacramento), also a pediatrician, has received death threats for his role as an author of the bill. The fate of the legislation was somewhat uncertain after the California Assembly passed the bill on June 25, 2015, as Brown was against the removal of religious exemptions three years prior.

Measles outbreak

The CDC reported 668 cases of measles in the U.S. in 2014, a record number since measles was declared eliminated in 2000. From January to June 26, 2015, 178 cases had been reported. In a report issued February 20, 2015, 125 cases of measles with rash occurring between December 28, 2014, and February 8, 2015, were linked to Disneyland. Among those, 110 were California residents and 49 were unvaccinated, with 47 having unknown or undocumented vaccination status.

California controversy

Brown stated that he believed science has established a clear link between vaccination and protecting the safety of children. He noted that “no medical intervention is without risk,” but stated that vaccinations protect the community. Supporters point to eroding herd immunity and protecting those who cannot be vaccinated for health reasons or due to age, such as 7-year-old Rhett Krawitt, who urged lawmakers to pass the bill as he could not be vaccinated during leukemia treatments. While California is the 32nd state to remove exemptions based on personal and moral beliefs, it is only the third to remove religious-based exemptions.

Those opposing the bill cited religious concerns, fears over health risks, and a belief that pharmaceutical companies seeking profits were behind the push for the legislation. Some of the health-related fears stem from a long-debated possible connection between the measles, mumps and rubella (MMR) vaccine and autism. This connection, now largely considered debunked by scientists, stemmed from a study published in a British medical journal by a physician that lost his medical license after an investigation revealed that the physician misrepresented or changed the medical histories of all of the patients involved in the study. Due to the pervasive beliefs among the public that the MMR vaccine may cause autism, a large study involving over 95,000 children was prompted. The results of the study found no link between receiving the MMR vaccine and an increased risk of autism and was published in the Journal of the American Medical Association (JAMA) on April 21, 2015.

Similar legislation

California joins West Virginia and Mississippi in having extremely strict vaccination rules. The New York Times noted that these two states have other health issues and are among the poorest, yet have incredibly high vaccination rates for children entering kindergarten, with Mississippi at 99.7 percent and West Virginia at 96 percent. These states, and now California, provide that only children with significant medical issues barring them from safely receiving vaccinations are exempt. The Mississippi Department of Health requires a licensed physician to submit a letter to the department requesting the medical exemption. In the event that a vaccine-preventable disease is present or is threatening the community, any children not vaccinated for that disease will be excluded from school. Similarly, the West Virginia Department of Health and Human Resources requires a physician to submit a medical exemption request, which is reviewed by an Immunization Officer.