Medical exemption abuse – hurting California’s vaccine uptake

Since the enactment of California’s SB277, which prevents parents from using religious or personal beliefs to excuse their children from vaccinations, has lead to much higher vaccine uptake rates in California schools. The law still allows medical exemptions, which are medically-related reasons for not vaccinating, such as allergies to ingredients in the vaccine. Unfortunately, this had led to medical exemption abuse in many schools in California.

In California, medical exemptions require a form signed by their doctor stating a valid medical reason for any child to not receive vaccines. Generally, less than 2-3% of children would have medical reasons to not be vaccinated. Moreover, most of these children would only be exempt from a few vaccines, not all of them.

Report on medical exemptions

The Los Angeles Times published an analysis of the medical exemption rates in schools throughout California. They found that even though the vaccination rate in kindergartens has risen from 90.2% in 2014 to 95.6% in 2017, the number of medical exemptions has tripled.

The LA Times reported that 10% or more kindergartners had medical exemptions in 58 schools last fall. Worse yet, the rate topped 20% at seven schools. (The LA Times has also provided a database of all California schools’ immunization statistics.)

Medical exemption abuse

According to Dr. James Cherry, a UCLA research professor and senior editor of the “Textbook of Pediatric Infectious Diseases”,

That’s just totally wrong. This idea of 20% having medical exemptions is nonsense, and certain doctors buy into that, but it’s wrong.

One of the problems with the medical exemptions is that they’re clustered in a small number of communities, such as wealthy liberal communities like Sonoma County. This puts the children at risk for outbreaks dangerous diseases like measles.

Medical exemptions for sale

There is no doubt that many, if not most, of these medical exemptions are valid. In fact, there may be parents who used personal belief exemptions in the past because it was easier to do than a medical exemption, and, once the new law was implemented, had to get a valid medical exemption.

California Senator Richard Pan (D-Sacramento), a pediatrician who co-wrote SB277, is concerned that some physicians are improperly writing medical exemptions for some children. He said,

It would be very unfortunate if there were physicians who’ve shirked their professionalism, and basically are trying to monetize their professional license by putting children at risk and betraying public health.

The unruffled Orac predicted back in 2015, soon after SB277 was signed into law, that there would be physicians who would sell medical exemptions to anti-vaccine parents:

Three weeks ago, I asked the question, Will SB 277 enrich antivaccine doctors? The answer is clearly yes, particularly for Dr. Bob Sears. From my perspective, he’s basically offering to sell medical exemptions to parents for $180 a pop, and he couldn’t be more blatant about what he’s doing if he tried. Indeed, I’m surprised just how closely my reader’s report aligns tightly with Dr. Bob’s advice posted on his Facebook page. The only differences were his more jocular manner and his demonstration that he’s thought about how to issue exemptions for sale without having the California Board of Medicine come after him. As far as I’m concerned, he’s become just like doctors who run prescription mills or sell prescriptions for medical marijuana. He has no honor.

But Bob Sears is just the most famous of the physicians who are selling out to the pseudoscience about vaccines. Another one, Dr. Kenneth P Stoller, who pushes the unscientific hyperbaric oxygen therapy, has a website dedicated to antivaccine nonsense.

Dr. Stoller writes on the home page of his website,

While SB 277 may be unconstitutional, that will be a matter for the courts to decide. Until then the law is the law. It is clear the intent of this new law is to make sure as many children as possible are fully vaccinated, but it is also clear that safety issues are also to be taken into account.

Now, why am I doing this, why am I helping families concerned about vaccine safety issues?

I am Pro-Informed -Consent. I am 100% Pro-vaccine safety. But what does that mean when the safety of the childhood schedule has never been validated, and there is no baseline data, either via prospective or retrospective studies. I want to know that vaccines are as safe as science can make them, but no one can truthfully say they are safe because safety has not been functionally validated , and the CDC seems to remove or disappear safety data they don’t like. Yet here we have this new law that requires physicians to tender an opinion on safety for a child to receive a medical exemption from vaccines…safe compared to what? The law doesn’t say!

Firstly, the courts so far seem to think that SB277 is completely constitutional. Of course, an anti-vaccine doctor shouldn’t pretend to be an attorney.

As for the third paragraph, the vaccine schedule is based on robust scientific evidence. Just because real science doesn’t cherry pick poorly designed studies that are published in predatory journals doesn’t mean the CDC removes safety data they don’t like.

Then  Dr. Stoller goes full ignorance with this statement:

To complicate matters most vaccines are now made in China that has no obligation to conform to FDA safety regulations (not to imply that the FDA itself follows its own regulations but that is another matter). Be that as it may, this is not a time to remove Informed Consent, but there is  a fear of Informed Consent becoming Informed Dissent by vaccine stake holders.

No no no. All vaccines available in the USA are manufactured in the USA, Canada or Europe. Wherever the vaccine is made, all vaccines must meet the stringent standards of the FDA with regards to all manufactured drugs. The FDA investigates and audits all manufacturing facilities for all drugs (and devices) that are marketed in the USA. What evidence does Dr. Stoller have that the FDA does not follow its own regulations? None.

Are Stoller and Sears the only ones pandering to the anti-vaccine rubbish? Absolutely not, they are just at the top of Google ranking for “medical exemptions in California.” There are many others.

There’s a  doctor near San Diego who has a whole page dedicated to how to get a medical exemption (although she does make it appear difficult to get).

Many anti-vaccine websites provide lists of California physicians who will write medical exemptions to vaccines. I am not going to link to them. I’m not going to support medical exemption abuse for vaccinations that protect our children.

Summary

SB277 has been an outstanding law that has pushed up the vaccination rate to over 95%, a target for the herd effect. However, there are worrisome areas of inordinately high medical exemption abuse that could make some schools and areas susceptible to outbreaks of vaccine preventable diseases.

There are physicians who claim that they are “pro vaccine, but…” It’s what follows the “but,” and then they try to make an unscientific case for not vaccinating children. Yes, there are children that require medical exemptions. But it should be done carefully, not sold over the internet.

Citations

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!