California vaccination rate down – linked to fake medical exemptions?

The California vaccination rate had been slowly growing since the implementation of SB277 in 2016, which eliminated the broadly abused personal belief exemptions to vaccines for students. Unfortunately, anti-vaccine parents abused the law by getting mostly fake medical exemptions (see Notes) to vaccines, which seems to have exploded over the past year or so.

In fact, the California Medical Board had put one of the more famous anti-vaccine pediatricians, Dr. Bob Sears, on probation for abusing vaccine medical exemptions and other issues. In 2016, the Executive Director of the Medical Board of California, represented by the office of the California Attorney General, then headed by Kamala Harrisbrought a complaint against Dr. Sears (pdf).

And in June 2019, a complaint against Dr. Sears was brought by Kimberly Kirchmeyer, executive director of the Medical Board of California, which alleges that Sears signed vaccine medical exemptions for two siblings. Those children did not have medically-recognized contraindications for any vaccines, based on their medical records.

Dr. Sears is merely the tip of a huge iceberg of physicians and other medical professionals signing off on fake medical exemptions – many of these physicians charge exorbitant fees for this “service.” There are several Facebook groups where anti-vax parents share information about these physicians who lack any concern for the long-term health of children. 

As a result of this ongoing abuse, the California legislature proposed SB276, which puts some stricter controls on medical exemptions. Essentially, SB276 states that the physician writing the exemption would have to submit a copy to the California Department of Health, 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.

SB276 won’t eliminate all abuse, but it should help.

Unfortunately, until SB276 is passed by the legislature and signed into law by the governor, the misuse of medical exemptions continues. And that might have led to a decrease in the California vaccination rate.

California vaccination rate – bad news

The Los Angeles Times reported that California vaccination rate for kindergarten students has dropped for the second straight year. They examined data from the California Department of Health, and reported the following:

  • The kindergarten vaccination rate in California dropped to 94.8% in 2018-19 from 95.1% in 2017-18 and 95.6% the previous year.
  • The school districts with the most medical exemptions were L.A. Unified, Capistrano Unified, and San Diego Unified. The rate of medical exemptions in Capistrano Unified — a smaller district in Orange County — was 10 times higher than that of L.A. Unified’s.
  • About 1,500 schools in California had kindergarten vaccination rates below 95%.
  • At 117 schools, 10% or more of the kindergartners were not immunized because their doctors had excused them from vaccines.
  • At 17 schools, 30% or more of the kindergarten class had medical exemptions on file.
  • Overall, .9% of kindergartners had medical exemptions in 2018-19, up from .7% in 2017-18 and .5% the previous year.

A 95% vaccination rate is generally considered the line above which the herd effect, so if the rate drops below that level, the risk of localized outbreaks or epidemics of diseases, like measles,  can occur.

It appears that about 20% of unvaccinated children resulted from medical exemptions. At first, that may seem to be a minor issue, and it might not be if the medical exemptions were distributed evenly across California. Then, the focus should be on reaching that 4% or so that are unvaccinated for all kinds of reasons.

But, these medical exemptions are not equally spread out, which the LA Times made clear in a couple of graphics.

California vaccination rate

As you can see, medical exemptions skyrocketed in private schools. We’ll get back to that point after this next graphic.

As you can see, the lowest vaccination rates are clustered in certain areas. Moreover, the counties with the highest rates of medical exemptions are in four counties, two of which, Sonoma and Santa Cruz counties, are among the wealthiest in the country.

Also, this:

Among kindergartners, schools with high medical exemptions rates tend to be Waldorf schools, which have come under scrutiny in California for their relatively low vaccination rates. Waldorf Schools practice a holistic approach to learning and are based on the philosophy of Austrian thinker Rudolf Steiner, who was critical of many aspects of medicine during his era, the late 19th and early 20th centuries.

Waldorf Education (sometimes called Steiner Schools) rely upon a discredited philosophy of anthroposophy, a pseudoscience that pushes some rejected ideas on child development. Dr. David Gorski once wrote about this woo, which claims that “medicine based purely on material science is limited to explaining an illness solely on the basis of the laws of physics and chemistry”:

I’m sorry. I can’t help but interject here that (they say) this as though it were a bad thing. Personally, though, I’m curious as to how we can explain illness not based on the laws of physics and chemistry. Unfortunately, PAAM is more than happy to tell us how anthroposophic medicine is “more ambitious” than us mere practitioners and proponents of science-based medicine. I suppose it is, casting off, as it does, all those inconvenient laws of physics and chemistry that took hundreds of years to discover and understand

In other words, these Waldorf schools would, of course, have low vaccination rates, because they reject science-based medicine.

The cute kitten has nothing to do with vaccines, but who doesn’t enjoy a cute kitten photo? Photo by Kim Davies on Unsplash.

California is going after fake medical exemptions

According to an article in the Sacramento Bee:

The California agency that regulates doctors is investigating at least four physicians for issuing questionable medical exemptions to children whose parents did not want them immunized.

The Medical Board of California’s investigations are unfolding amid the nation’s worst measles outbreak in more than a quarter-century, as California lawmakers consider controversial legislation to tighten the requirements for exempting children from the vaccinations required to attend schools and day care centers.

Last month, the Department of Consumer Affairs, which oversees the medical board, sued in state court to obtain medical records for patients of Sacramento-area pediatricians Dr. Kelly Sutton and Dr. Michael Fielding Allen.

In the past nine months, the board also has sought patients’ records in connection with two Santa Rosa physicians under investigation for writing allegedly inappropriate exemptions.

Dorit Rubinstein Reiss wrote about one of those physicians, Ron Kennedy, who attempted to prevent the Medical Board of California from getting medical records as part of an investigation into false medical exemptions. 

California is trying to protect its children from dangerous and deadly diseases. Good!

Joshua Tree National Park. It has nothing to do with vaccines, but it is another iconic California photo. Photo by Elliott Engelmann on Unsplash.

Still, SB277 worked

In an article published in the respected peer-reviewed journal JAMA, the authors found that the rate of kindergarteners who had missed required vaccines fell from 9.84% in 2013 to 4.83% in 2017, two years after the implementation of SB277. 

Furthermore, there was also a statistically significant drop in the chance of “within-school” contact among kindergarteners without up-to-date vaccines. It dropped from 26.02% in 2014 to 4.56% in 2017.  

Given the 95% goal for the California vaccination rate to assure adequate herd effect in children, California is right at the goal, so making sure there is no abuse of the medical exemptions is extremely important for the health and safety of California’s kids.

All about the California vaccination rate

But there’s another point to be made about the fact that the exemption rate is so high in wealthy California counties and expensive private schools – white privilege.

These parents think they are better than the rest of us. They think that their children are somehow superior to the rest of us so they don’t need to be vaccinated. They believe that they are somehow smarter than legions of scientists who know that the safety and effectiveness of vaccines are settled science. 

Here’s hoping that SB276 is passed and these medical exemption abuses end immediately. And let’s hope that the physicians who are pushing their “beliefs” over scientific facts regarding vaccines are punished.

Notes

For those of you who are unfamiliar with the terminology surrounding exemptions, here’s a brief overview. Personal belief exemptions, like religious exemptions, allows parents to invent just about any reason they want to not have their children vaccinated. Maine, California, West Virginia and Mississippi have eliminated these types of exemptions. However, all states allow what is called a medical exemption, that is, a legitimate medical issue that could make a vaccine problematic for a child or adult. The CDC provides a list of accepted medical exemptions, based on scientific evidence, for each vaccine available in the USA. Other countries’ public health officers provide similar precautions.

In general, these medical exemptions fall into the following three categories

  • The child’s immune status is compromised by a permanent or temporary condition. For example, the child might have a congenital condition leading to an impaired immune system. Or, the child might take medications, such as chemotherapy or steroids, that impair the immune system. In either case, vaccination could be harmful to the child’s health.
  • The child has a serious allergic reaction to a vaccine component.
  • The child has had a prior serious adverse event related to vaccination.

However, I need to be clear on this point – the CDC does not establish what is a legitimate medical exemption. States regulate this, although they look to the CDC for guidance. California, for example, uses the CDC guidelines, but they are more likely to investigate physicians who issue a large number of medical exemptions, sometimes without even seeing the patient.

Citations



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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!