State action could reduce vaccines

California, like every other state, requires school-age children to obtain various vaccinations against childhood diseases. However, California also currently has a mechanism called a “personal belief exemption,” or PBE, that allows parents to opt their children out of mandatory vaccines simply by printing out a form and signing it.

Evidence suggests that some parents have based their decision not to vaccinate their children on misinformation or lingering misperceptions about vaccines. Many other parents opted their children out not because they objected to vaccinations at all, but simply because signing the form was easier than making an appointment for the vaccines or because they forgot to get their children vaccinated before school started.

Decreasing rates of vaccination among some California populations jeopardize the health of the entire community, particularly children and those with compromised immune systems. Vaccinations only work as a disease-prevention tool if a critical mass of people are vaccinated – a concept often called “herd immunity” – and parents who choose not to vaccinate their children are not only exposing their children to disease, but all California children.

It should not be easy for parents to opt their children out of vaccinations and parents should have accurate information to make informed decisions about vaccinating before exercising a personal belief exemption.

For example, new research suggests that the 2010 whooping cough outbreak in California — the worst in 50 years — may have been fueled, at least in part, by clusters of parents who refused to vaccinate their children.

In an effort to increase child vaccination rates, the California Assembly last year passed Assembly Bill 2109, which required that parents seeking to opt their children out of mandatory vaccinations have a health professional sign a form saying the parents were provided with information about the risks and benefits of vaccines.

Assemblymember Richard Pan, a Sacramento-based pediatrician, authored the bill, which passed the Assembly with broad bipartisan support, and which was sponsored by the Health Officers Association of California, the California Medical Association, the California Immunization Coalition, and the American Academy of Pediatrics.

Although Governor Brown signed the bill, he directed the Department of Public Health to include a separate religious exemption that would allow people to side-step the important conversation about the risks and benefits of vaccines by simply checking a box, in effect rendering AB 2109 completely ineffective at stopping so-called convenience exemptions.

It should not be easy for parents to opt their children out of vaccinations and parents should have accurate information to make informed decisions about vaccinating before exercising a personal belief exemption.

While a parent or guardian may have genuine religious objections to medicine and vaccinations, there is no infringement of personal or religious freedom in simply receiving information about the risks and benefits of vaccines. If a parent does not want their child immunized, they can opt out after receiving information as designated by the law. Creating an opt-out mechanism that side-steps this important conversation between health care professionals and patients creates a new opportunity for convenience exemptions and undercuts the intent of Assembly Bill 2109.

The current economic climate and California budget crisis have led to drastic cuts in public health spending. If the Governor is not willing to establish disease prevention as a high priority by committing additional public health dollars, he should at least not further tie the hands of health professionals by undermining the efficacy of vaccines, a critical and existing tool that does not cost the state additional funding to develop.

When the Department of Public Health issues the final personal belief exemption form, a separate religious exemption that allows parents to side-step a conversation with a health care professional should not be included. The stakes for California children are too high.
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Ed’s Note: Bruce Pomer is the Executive Director of the Health Officers Association of California, which represents the physician health officers in California’s 61 city and county jurisdictions.