California lawmakers have passed a bill that would prohibit parents from using personal or religious beliefs to get around school vaccination requirements for their children, marking an important first step towards expanding immunization coverage in a state that has been plagued by vaccine-preventable disease outbreaks.
The bill, SB 277, would make California the third state in the country to eliminate religious and personal vaccine exemptions. It follows the recent measles outbreak linked to Disneyland, which spread and sickened more than 150 people in the United States. The outbreak was traced back to an infected person that visited the amusement park, and spread rapidly mainly by children whose parents chose not to vaccinate them, a study concluded, prompting lawmakers to reconsider the state’s broad criteria for exemption.
“We got a snapshot with what happened at Disneyland how bad it could be,” said Assemblywoman Lorena Gonzalez, of San Diego. “Do we wait until we have a full-fledged crisis to protect the most vulnerable?” she asked as she presented the bill to the California Assembly last week, where it passed 0n a 46-30 vote.
The state Senate gave final approval Monday afternoon with a bipartisan 24-14 vote, sending the bill to Gov. Jerry Brown. Though the governor hasn’t indicated whether he will sign the bill, he said through a spokesperson Monday that he “believes that vaccinations are profoundly important and a major public health benefit,” and will give the bill close consideration. If passed, the law will come into effect on January 1, 2016.
All U.S. states require vaccinations for children entering school unless they have a medical reason to avoid the shots. Most states also allow parents to opt out if their religion bans the protective procedure and about 20 states, including California, allow for broader personal beliefs exemptions, which in recent years have been used by parents who fear a now-debunked link between vaccines and autism, or cite other unfounded worries about the health effects of children receiving shots.
In California, exemptions based on personal belief have risen dramatically in recent years. At least 27 counties in the state now have kindergarten immunization rates that are too low to confer herd immunity (below 92-94 percent), and in some individual schools and districts, more than half of children are not vaccinated. Hoping to prevent another Disneyland-like outbreak, lawmakers are now working to address these gaps in immunization coverage.
“We hope and expect we will be a model to get us back to where we should be, which is that cases of measles and other preventable diseases do not need to be something we live with,” said State Senator Richard Pan, a pediatrician who wrote the bill, The New York Times reports.
‘We have to worry about the next outbreak’
Contrary to what some opponents have claimed, the proposed law is not a universal requirement for vaccination. The mandate only applies to children attending public or private schools in California. It would require them to be immunized according to the Center for Disease Control and Prevention guidelines, which recommend vaccinations for diseases like measles, polio, whooping cough and chickenpox. Exemptions for medical reasons, such as allergic reactions and weak immune systems, will still be allowed. Parents retain the right to opt-out for non-medical reasons, but if they do, their unvaccinated child would have to study at home or in an “independent study program” outside of a classroom.
“Anybody with a legitimate medical reason for not getting vaccinated can go to a doctor and get a medical exemption,” said state Sen. Ben Allen, D-Santa Monica, the bill’s co-author. “For the rest, we ask you please get your kid get vaccinated. It’s important for public health. It’s important for public safety, and it’s actually really important for those who can’t get a vaccine.”
Allen is referring to the concept of herd immunity, a form of indirect protection from infectious disease that occurs when a large percentage of a population is immunized against a given disease, thereby providing a measure of protection for individuals who have not developed immunity, whether due to young age, compromised immune function, or medical ineligibility for vaccination. When a large enough number of people choose to forgo immunization, however, herd immunity starts to break down, letting disease spread and putting vulnerable children and adults in harm’s way.
The consequences of herd immunity breakdown are well documented. For example, a 2008 study found that clusters of non-medical exemptions from vaccination played a significant role in the whooping cough outbreaks that have flared up in the U.S. over the last two decades. “Geographic pockets of vaccine exemptors pose a risk to the whole community,” researchers concluded in the American Journal of Epidemiology.
“We have to worry about the next [outbreak],” Pan said. “The goal of the bill is to get our immunization rates high enough so people don’t have to worry about themselves and their children getting preventable diseases.”
‘Children die of these diseases’
Though the bill passed with bipartisan support, there was significant opposition from anti-vaccine parents, many of whom gathered on the Capitol steps to protest the vote. Reuters reports that Senator Pan had to be given extra security as he received death threats from anti-vaccine activists. Such opposition has managed to kill similar bills introduced in the wake of the Disneyland outbreak, including one in Oregon.
“People in the opposition say they want children to get these diseases naturally,” Pan said. “But children die of these diseases. They become paralyzed. They develop brain damage. This is not something I would wish on anybody’s child.”
Those supporting the bill ensured their voices were also heard. Rhett Krawitt, a seven-year-old leukemia survivor, delivered a petition with over 30,000 signatures to the governor on Wednesday. For nearly four years, Rhett faced a constant, heightened risk of contracting common vaccine-preventable diseases — a side effect of his chemotherapy, which ravaged his immune system and rendered him ineligible for immunization. His parents were nervous to enroll him in school, as even a minor infection could have turned deadly without an immune response to fight it.
Over the past several months, Rhett has given multiple speeches to state lawmakers and community groups on the importance of vaccines — even though, as ABC News reports, he usually needed a chair to reach the podium microphone. “Vaccines save lives,” Rhett said in a speech last week, before delivering his petition to the governor. He concluded his speech with an impassioned declaration: “My name is Rhett and I give a damn!”
Supporters of the bill, of course, also have science on their side. Research has shown that vaccination rates are significantly lower in states with broader vaccine exemption criteria. Not surprisingly, rates of vaccine-preventable diseases are also far higher in these states — according to one study, states with lax exemption policies have whooping cough rates up to 90 percent higher than states with more rigorous exemption criteria.
The U.S. isn’t the only country taking action to protect its citizens from vaccine-preventable diseases. In April, the Australian government enacted a “no jab, no pay” policy under which welfare payments can be withheld from parents who fail to have their children immunized. The move came a month after the death of a 4-week-old baby from whooping cough, a disease against which he was too young to be vaccinated.
Update: Gov. Brown signed SB 277 into law on Tuesday.