California legislature advanced SB276 – tightening vaccine exemption

The California legislature advanced SB276, sending it to Governor Gavin Newsom for his signature. SB276 would crackdown on unethical medical exemptions for vaccines, which the anti-vaccine religion has abused in response to SB277, a 2015 law that eliminated personal belief exemptions to vaccination for children entering school.

On 3 September 2019, the bill passed by an overwhelming 47-17 vote in the strongly Democratic-controlled Assembly. It was sent to the California Senate, which previously passed the bill but the Assembly added amendments that required a revote. On 4 September, the California Senate approved the bill by another overwhelming 28-11 vote

Like with SB277, Senator Dr. Richard Pan, MD led the effort to get the California legislature to pass SB276. 

In response to the vote, the anti-vaccine nutjobs utilized their predictable litany pseudoscientific and illogical rhetoric making all kinds of laughable claims. Along with a few hate-filled violent metaphors, of course.

Let’s take a look at the bill and some other updates to the political machinations surrounding it.

California Assembly vote on SB276 on 3 September 2019.
California legislature advanced SB276
California Senate vote on SB276 on 4 September 2019.

 

What is SB276?

As I mentioned above, SB276 simply adds some restrictions to medical exemptions to vaccinations which some doctors were abusing. It created a “market” for these medical exemptions which became a loophole for anti-vaccine parents. The California Medical Board started to bring complaints against physicians that were caught doing this. 

The amended SB276 adds very strong provisions in response to any physician writing a medical exemption. Some of these provisions are:

  1. The physician writing the exemption needs to actually see the child in person. They can no longer do this online or by phone, which made it easy for anti-vaccine parents to find someone to write the exemption, usually for a large fee (see Note 1).
  2. Physicians writing these exemptions who are not the child’s treating physician need to notify the primary care physician for the child. 
  3. The physician writing the exemption must clearly address each contraindication applicable to each vaccine for the child. Currently, physicians would make blanket exemptions to all vaccines, despite the guidelines for contraindications are quite detailed for each vaccine. 
  4. These physicians must certify, under pain of perjury, that the information in the exemption form is accurate. 
  5. The bill provides that parents must agree in advance to release medical records of their children for whom a medical exemption is requested. This makes it easier for the California Medical Board to investigate fake exemptions.
  6. Physicians can no longer charge for filing a medical exemption, although they can charge for the examination of the child
  7. Finally, the bill gives the California Department of Health powers to stop accepting exemptions from a physician who poses a risk to public health or who has a pending accusation before the California Medical board related to immunizations.

Professor Dorit Rubinstein Reiss, a frequent contributor to this blog, wrote in detail about some changes to SB276 which were requested by Governor Newsom in June. Here are a couple of excerpts from her commentary:

I will say now that while SB276 makes concessions, I think overall it is a better, and stronger system, which preserves legitimate medical exemptions and correctly focuses on the doctors writing fake exemptions as the source of the problem, and creates tools to deal with them. And at any rate, the Governor expressed willingness to sign the amended bill – and a signed bill is better than a vetoed one.

In terms of concessions, the main concession of the bill was to remove the ex-ante general review process. In the original version, every medical exemption would have to be reviewed before it is approved. In the new version, a physician would have to submit a copy of the exemption to the department, and the department would create a system to review medical exemptions from schools with less than 95% immunization rates or doctors who submitted more than 5 exemptions.

So a medical exemption for a child in a school with high rates, whose physician only grants a very rare exemption, will not be reviewed.

I think this is a reasonable compromise for SB276. It creates criteria to identify problem spots – problem schools and problem doctors – but saves concerns and efforts for those in non-trouble spots. Yes, it may mean that some children will not face oversight, but there are other measures to oversee problem doctors, and limiting oversight to problem spots would probably already happen in practice, because of scarce resources.

In both cases, if an exemption was found invalid the amended bill creates an appeal process. It also clarifies that the officer will be “clinically trained.”

It also broadens the grounds for exemptions: where previously only CDC contraindications and precautions could be valid, no other grounds could be allowed if they are “consistent with the relevant standard of care.”

California legislature advanced SB276 – Newsom responds

Unfortunately, Governor Newsom has signaled that he wants further amendments, although none of us are clear on what that may be. Melody Gutierrez, a reporter for the LA Times who has been following SB276 posted this tweet:

From a 10,000 meter view, I’m really concerned about only one item – “no penalty of perjury for doctors.” The problem has been that fake medical exemptions are plainly fake. They were mostly written in bad faith (at a minimum) or to further the anti-vaccine beliefs of the parents. 

However, we aren’t 100% sure what Governor Newsom wants to be changed in SB276. And according to another LA Times reporter Taryn Luna, Senator Pan, and Governor Newsom are working out the details for a separate bill.

Apparently, Governor Newsom is not as positive about vaccines as most of the Democrats in the state. We’ll see how this turns out, and either Professor Reiss or I will update you, once we have better information.

California legislature advanced SB276 – anti-vaxxers whine

As expected, the anti-vaccine crackpots did their crackpotting in person and online in response to the passing of SB276. Ms. Guttierez commented about the response from the anti-vaxxers:

I guess these anti-vaxxers don’t quite understand how Democracy works. You know, something about electing representatives who try to do the best that they can do for citizen’s public health. Of course, most of the no votes came from Republicans who aren’t especially concerned about the public health of Californians.

Thanks to my fellow blogger, Vincent Iannelli, MD, at Vaxopedia, has been tracking some of the more ridiculous posts, memes, and claims from the anti-vaxxers in response to the passing of SB276. Here are a choice few:

California legislature advanced SB276

That comment is referring to Senator Pan and California State Assemblymember Lorena Gonzalez whose nephew is immunocompromised:

His doctor said no, he can’t have live vaccines, so no, he can’t be immunized against measles or chicken pox. Every time he is not in the hospital, he wants to be in school, but those diseases could kill him. Definitely put him back in the hospital. These are the children, the truly medically fragile children that we are trying to prevent from getting these diseases and why it’s so important.

So, the anti-vaxxers are claiming that Assemblymember Gonzalez has some secret loophole for a medical exemption. In fact, her nephew deserved this medical exemption, because it is completely legitimate. These are facts that are not within the realm of the delusions of anti-vaxxers.

 

Well, I’m guessing that most Democrats (and Republicans) are thoroughly vaccinated. No need to do it forcibly.

And now for that violent imagery that is the standard in the anti-vaccine world. 

So there you go, revolution and the 2nd amendment from a bunch of anti-vaccine nutjobs. These people, denying the settled science of vaccine safety and effectiveness, think that they need a revolution employing the 2nd amendment to bring guns for violence. 

Around 90% of children are vaccinated – this would be the lamest revolution ever. But that won’t stop the hate-filled violent rhetoric of these buffoons. 

Regardless of these crackpots, let’s celebrate that the California legislature advanced SB276 to protect the children of the state. This is a positive moral choice, so rare in government these days. 

Update 6 September 2019

As I mentioned two days ago, it appeared that Governor Newsom was waffling on signing SB276, despite being passed by overwhelming (and potentially veto-proof) majorities in both the Assembly and Senate. I am involved in several groups focused on vaccinations in California, and there was massive consternation about his lack of signature. 

Nevertheless, according to LA Times’ Melody Gutierrez, Senator Dr. Pan (I know that’s not how one should address him, but just to make it clear that he is a physician first and California Senator tied for first) and Gov. Newsom have come to an agreement to get SB276 signed into law:

Key California lawmakers agreed to scale back a bill to tighten rules for school vaccine exemptions after Gov. Gavin Newsom raised last-minute concerns, but the deal is likely to be met with fierce opposition from protesters who had hoped the governor’s apprehension signaled trouble for Senate Bill 276.

The agreement between state Sen. Richard Pan (D-Sacramento) and Newsom calls for the governor to sign Senate Bill 276, which has already passed the Legislature, and for revisions to be placed in SB 714, which would still need approval by the Assembly and Senate by Sept. 13.

The changes include Newsom’s proposal to grandfather in all existing medical exemptions before Jan. 1, with critics worried this would create a potential rush for new vaccine exemptions.

I’m not happy about the ability to grandfather medical exemptions. However, according to Ms. Guttierez, there was a provision of the bill that limits the length of time that these new exemptions would be allowed:

New medical exemptions would be required when a child enters kindergarten, seventh grade or changes schools. By adding that provision, permanent medical exemptions would no longer be valid throughout a child’s K-12 education. Temporary medical exemptions that currently allow a doctor to use his or her discretion as to the length of time they remain valid would be limited to one year under the deal reached Friday.

Moreover, the medical exemption will be invalidated if a physician is subject to a future disciplinary action from the California Medical Board with respect to exemptions. And that board has been strongly in support of SB276, and they are aggressively pursuing actions against many physicians who are doling out these inappropriate medical exemptions.

Governor Newsom will sign SB276 once SB714 is passed by both houses and reaches his desk. I’m not sure when that will happen, but it needs to happen before 13 September 2019.

I think in a perfect world, SB276 would be implemented as is, but compromise is sometimes necessary for a political system, even if that system is run by very liberal Democrats across the board. 

Nevertheless, California appears to be heading for one of the most strict vaccination requirements for school-age children in the whole country. And this is a moral law.

And guess what? The anti-vaccine religion is whining again, even though Gov. Newsom backed down on his original promise (back in June 2019) to sign the amended SB276 – the new SB714 slightly weakens SB276, giving the anti-vaxxers some things they wanted. Obviously, all they want is to get rid of vaccines and make diseases great again, so anything short of that makes Newsom an enemy of theirs.

Personally, I’m not happy about Newsom. But I also don’t embrace the Nirvana fallacy – I’ll take good enough over nothing any day of the week. And SB276/714 is more than good enough. 

Notes

  1. The ability to “buy” a medical exemption goes to a point that I make constantly about anti-vaxxers – it’s almost exclusively about white privilege. Just look at photos of these protestors! Moreover, most anti-vaxxers believe that either their children are superior to the rest of us or that their amazing organic, gluten-free, alkaline-water lifestyle makes vaccines unnecessary. Unfortunately for these ignorant fools, viruses and bacteria aren’t very selective – they don’t care if you live in poverty or a wealthy liberal neighborhood in Marin County, they will harm everyone.
The Original Skeptical Raptor
Chief Executive Officer at SkepticalRaptor
Lifetime lover of science, especially biomedical research. Spent years in academics, business development, research, and traveling the world shilling for Big Pharma. I love sports, mostly college basketball and football, hockey, and baseball. I enjoy great food and intelligent conversation. And a delicious morning coffee!