HomeMy WebLinkAboutMINUTES - 05052015 - D.8RECOMMENDATION(S):
CONSIDER adopting a position on SB 277 (Pan) Public Health: Vaccinations, a bill that eliminates the personal
belief exemption and requires vaccination for school attendance except for those exempted for medical reasons.
FISCAL IMPACT:
No fiscal impact.
BACKGROUND:
At its April 2, 2015 meeting, the Legislation Committee (comprised solely of Supervisor Mitchoff, with Supervisor
Glover absent) directed staff to refer SB 277 to the Board of Supervisors for consideration and action.
California is suffering from an outbreak of measles that, as of March 2, 2015, has sickened 131 people statewide, and
sent 19 people to the hospital. Almost one quarter of those infected with measles are children younger than five. Last
year, whooping cough (pertussis) struck over 11,000 Californians, killing three infants. As of February 12, 2013,
California has recorded over 441 pertussis cases and one infant has died, who was less than three weeks old when
sickened. Contra Costa has thus far seen one case of measles in 2015.
Both measles and pertussis are highly infectious and can cause serious complications, including death. Those most at
risk are babies too young to get immunized and adults and children who, due to medical reasons including
chemotherapy and auto-immune disorders, cannot get vaccinated. Both are preventable by the use of vaccines.
Experts and health officials attribute the return of these diseases to the falling rates of vaccination. Too many parents
APPROVE OTHER
RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
Action of Board On: 05/05/2015 APPROVED AS RECOMMENDED OTHER
Clerks Notes:
VOTE OF SUPERVISORS
AYE:John Gioia, District I
Supervisor
Mary N. Piepho, District III
Supervisor
Karen Mitchoff, District IV
Supervisor
NO:Candace Andersen, District II
Supervisor
ABSENT:Federal D. Glover, District V
Supervisor
Contact: L. DeLaney, 925-335-1097
I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the
Board of Supervisors on the date shown.
ATTESTED: May 5, 2015
David Twa, County Administrator and Clerk of the Board of Supervisors
By: June McHuen, Deputy
cc:
D.8
To:Board of Supervisors
From:LEGISLATION COMMITTEE
Date:May 5, 2015
Contra
Costa
County
Subject:SB 277 (Pan) Public Health: Vaccinations
have chosen not to vaccinate their children due to misunderstanding of both the risks of vaccination and the
seriousness of these preventable diseases, and not all adults are fully vaccinated. Those who decline to vaccinate are
risking the health and lives of their children, neighbors and classmates. Data collected by the California Department
of Public Health shows that many elementary schools in the County have measles vaccination rates well below 94
percent (the rate needed to prevent the spread of the virus), with some schools, both public and private, with rates
below 50 percent.
Evidence from other states shows that that the best way to increase vaccination rates is to require immunizations for
school attendance.
If enacted, California would join only two other states -- Mississippi and West Virginia -- that permit only medical
exemptions as legitimate reasons to sidestep vaccinations.Currently, California is one of 19 states that allow
exemptions based purely on parents' personal or religious beliefs.
The bill has been a contentious issue where it has come up (Santa Cruz, Alameda, Berkeley City Council, a few
school districts). Alameda County voted to support the bill, however, as did Santa Cruz County. Santa Clara will also
likely be sending a letter of support.
BACKGROUND: (CONT'D)
Attachment 4 includes material that was distributed at the meeting of the Contra Costa Legislation Committee on
April 2.
SUMMARY: This bill removes the ability for parents to file a personal belief exemption from the requirement
that children receive vaccines for specific communicable diseases prior to being admitted to any private or public
elementary or secondary school, child care center, day nursery, nursery school, family day care home, or
development center.
STATUS :
Introduced: 02/19/2015
Last Amend: 04/22/2015
Disposition: Pending
Committee: Senate Judiciary Committee
Hearing: 04/28/2015 9:30 am, Rose Ann Vuich Hearing Room (2040)
EXISTING LAW :
Compulsory education
1. Provides that each child between the ages of 6 and 18 years is subject to compulsory full-time education, and
requires attendance at the public full-time day school or continuation school or classes for the full school day.
2. Requires parents and guardians to send the student to school for the full schoolday. (Education Code § 48200)
Required immunizations
3. Prohibits the unconditional admission of a student to any private or public elementary or secondary school,
child care center, day nursery, nursery school, family day care home, or development center, unless, prior to the
child’s first admission to that institution, the child has been fully immunized. The following are the diseases for
which immunizations shall be documented:
A. Diphtheria.
B. Haemophilus influenzae type b.
C. Measles.
D. Mumps.
E. Pertussis (whooping cough).
F. Poliomyelitis.
G. Rubella.
H. Tetanus.
I. Hepatitis B.
J. Varicella (chickenpox).
K. Any other disease deemed appropriate by the California Department of Public Health, taking into
consideration the recommendations of the Advisory Committee on Immunization Practices of the United
States Department of Health and Human Services, the American Academy of Pediatrics, and the American
Academy of Family Physicians. (Health and Safety Code § 120335)
4. Prohibits schools from unconditionally admitting or advancing any student to grade 7 unless the student has
been fully immunized against pertussis, including all pertussis boosters appropriate for the student’s age. Current
law provides that full immunization against hepatitis B shall not be a condition by which a school admit or
advance a student to the 7th grade. (HSC § 120335)
5. Authorizes school districts to permit specified licensed health practitioners to administer an immunizing agent
to a student whose parent or guardian has consented in writing to the administration of the immunizing agent. (EC
§ 49403)
Personal belief exemption
6. Provides that immunization is not required for admission to a school or other institution if the parent or guardian
files with the school a letter or affidavit that documents which immunizations have been given and which
immunizations have not been given on the basis that they are contrary to his or her beliefs.
7. Requires, beginning January 1, 2014, a form prescribed by the California Department of Public Health (CDPH)
to accompany the letter or affidavit.
8. Requires the CDPH form to include both of the following:
A. A signed attestation from the health care practitioner that indicates that the health care practitioner
provided the parent or guardian with information regarding the benefits and risks of the immunization and
the health risks of the communicable diseases to the child and the community.
B. A written statement signed by the parent or guardian that indicates that the signer has received the
information provided by the health care practitioner.
9. Authorizes schools or other institutions, when there is good cause to believe that the child has been exposed to
one of the communicable diseases, to temporarily exclude the child from attendance until the local
health officer is satisfied that the child is no longer at risk of developing the disease. (HSC § 120365)
Medical exemption
10. Provides that a child is exempt from immunization requirements if the parent or guardian files with the school
or other institution a written statement by a licensed physician to the effect that the physical condition of the child
is such, or medical circumstances relating to the child are such that immunization is not considered safe,
indicating the specific nature and probably duration of the medical condition or circumstances that contraindicate
immunization. (HSC § 120370)
Conditional admission
11. Authorizes a school or other institution to admit a child who has not been fully immunized against one or
more of the communicable diseases on condition that the child presents evidence that he or she has been fully
immunized against all of these diseases within time periods designated by regulation of the California Department
of Public Health (CDPH). (HSC § 120340)
12. Requires a school or other institution to exclude from further attendance any child who fails to obtain the
required immunizations within no more than 10 schooldays following receipt of the notice that the child does not
meet immunization requirements, unless the child is exempt for medical reasons or personal beliefs, until the
child provides written evidence that he or she has received another dose of each required vaccine due at that time.
Regulations require any child so excluded to be reported to the attendance supervisor or to the building
administrator. (California Code of Regulations (CCR), Title 17, § 6055)
Temporary exclusion
13. Authorizes a child for whom the immunization requirement has been waived, whenever there is good cause to
believe that he or she has been exposed to one of the communicable diseases, to be temporarily excluded from the
school or other institution until the local health officer is satisfied that the child is no longer at risk of developing
the disease. (HSC § 120365)
14. Requires county offices of education and school districts to exclude any student who has not been immunized
as required by the Health and Safety Code, and requires the school to notify the parent or guardian that they have
two weeks to supply evidence either that the student has been fully immunized, or that the student is exempted
from the immunization requirement. (EC § 48216)
15. Provides that an already admitted child who is subsequently discovered not to have received all the
immunizations which were required before admission or who is subsequently discovered not to have complied
with the requirements for conditional admission is to continue in attendance only if he or she receives all vaccine
doses for which he or she is currently due and provides documentation of having received such doses no later than
10 school days after he or she or the parent or guardian is notified. Regulations require a school or other institution
to notify the child or the parent or guardian of the time period (no longer than 10 school days) within which the
doses must be received. (CCR § 6040)
ANALYSIS:
This bill removes the ability for parents to file a personal belief exemption from the requirement that children
receive vaccines for specific communicable diseases prior to being admitted to any private or public elementary or
secondary school, child care center, day nursery, nursery school, family day care home, or development center.
Specifically, this bill:
1. Deletes the exemption from immunization requirements for personal beliefs and requirement that a parent or
guardian:
A. File a letter or affidavit stating which immunizations the child has not been given.
B. Also provide a form prescribed by the California Department of Public Health including both of the
following:
(1) A signed attestation from the health care practitioner indicating that the health care practitioner
provided information regarding the benefits and risks of the immunization and the health risks of the
communicable diseases to the child and the community.
(2) A written statement signed by the parent or guardian that the signer has received the information
provided by the health care practitioner.
2. Exempts from immunization requirements a home-based private school if all of the students are residents of the
household or are members of a single family.
3. Expands existing annual notification requirements for school districts to include notification to parents or
guardians of the immunization rates for each of the required immunizations for the school in which a student is
enrolled.
SENATE COMMITTEE ON EDUCATION STAFF COMMENTS
1. Need for the bill. According to the authors, “In early 2015, California became the epicenter of a measles
outbreak which was the result of unvaccinated individuals infecting vulnerable individuals including children who
are unable to receive vaccinations due to health conditions or age requirements. According to the Centers for
Disease Control and Prevention, there were more cases of measles in January 2015 in the United States than in
any one month in the past 20 years. Measles has spread through California and the United States, in large part,
because of communities with large numbers of unvaccinated people. Between 2000 and 2012, the number of
Personal Belief Exemptions (PBE) from vaccinations required for school entry that were filed rose by 337%. In
2000, the PBE rate for Kindergartners entering California schools was under 1%. However, as of 2012, that
number rose to 2.6%. From 2012 to 2014, the number of children entering Kindergarten without receiving some
or all of their required vaccinations due to their parent’s personal beliefs increased to 3.15%. In certain pockets of
California, exemption rates are as high as 21% which places our communities at risk for preventable diseases.
Given the highly contagious nature of diseases such as measles, vaccination rates of up to 95% are necessary to
preserve herd immunity and prevent future outbreaks.”
2. Recent amendments. This bill was amended on April 9 to include amendments discussed and informally
adopted by the Senate Health Committee during the April 8 hearing. The amendments:
A. Exempt homeschools if all of the students are residents of the household or are members of a single
family.
B. Reinsert and relocate current law regarding the authority for schools to temporarily exclude a child with
a personal belief exemption when there is good cause to believe that child has been exposed to one of the
communicable diseases.
3. Vaccine safety and related issues. This bill was heard by the Senate Health Committee on April 8. Please
refer to the Senate Health Committee analysis for information regarding vaccine safety, the entities that
recommend vaccines, the measles outbreak, and laws in other states.
4. Vaccination rates and community immunity. According to the United States Department of Health and
Human Services, “when a critical portion of a community is immunized against a contagious disease, most
members of the community are protected against that disease because there is little opportunity for an outbreak.
Even those who are not eligible for certain vaccines, such as infants, pregnant women, or immunocompromised
individuals, get some protection because the spread of contagious disease is contained. This is known as
‘community immunity.’"
According to California Department of Public Health (CDPH’s) 2014-15 Kindergarten Immunization Assessment
Results, the statewide immunization coverage remained above 92% for each vaccine for all schools since last
year. However, CDPH’s school level data files show that many individual schools have much lower rates of fully
immunized students.
http://www.cdph.ca.gov/programs/immunize/Pages/ImmunizationLevels.aspx
The authors and proponents express concern about localized vaccination rates, rather than statewide rates. Some
opponents of this bill suggest it would be more appropriate to provide additional resources and/or compliance
incentives in geographic areas where community immunity levels have not been achieved.
5. Compulsory education, public health and personal rights. Current law requires each child between the ages
of 6 and 18 years to attend school for the full schoolday, and requires parents to compel children to attend school.
Truancy laws provide various levels of intervention and punishment for both students and parents.
The United States Supreme Court has ruled that states may use their “police power” to require vaccinations,
including vaccinations for children entering schools. http://fas.org/sgp/crs/misc/RS21414.pdf
The American Civil Liberties Union writes with concerns to this bill: “Unlike other states, public education is a
fundamental right under the California Constitution. (Serrano v. Priest, 5 Cal.3d 584 (1971); Serrano v. Priest, 18
Cal.3d 728 (1976).) Equal access to education must therefore not be limited or denied unless the State
demonstrates that its actions are “necessary to achieve a compelling state interest.”
The issues of police power, compelling state interest, and other legal matters may be more appropriately
considered by the Senate Judiciary Committee. Considering the jurisdiction of the Senate Education Committee,
this Committee may wish to consider issues specific to the role of schools in providing a safe and appropriate
educational opportunity for each student.
6. What options will parents have? It appears that, if this bill were to become law, parents or guardians who do
not vaccinate their children as required by the Health and Safety Code would be limited to homeschooling or risk
violating truancy laws.
This bill affects private schools. The State compels each student to attend school and provides opportunities for
attendance at public schools. Should this bill be limited to public schools to enable attendance at private schools
that may choose to enroll students who are not fully vaccinated?
7. Reasonable timeline? This bill will become effective on January 1, 2016, if it becomes law. Will schools
immediately require students to be fully vaccinated, or will existing personal belief exemptions be valid for the
remainder of this school year? Will students who have no vaccinations have enough time to catchup to full
vaccination? The author may wish to consider a phased-in approach.
8. Fiscal impact. To the extent that parents remove their children from public schools, this bill could impose
significant costs on school districts, as a portion of school funding is based on average daily attendance. However,
to the extent that students are not absent due to illnesses, this bill could create cost savings to school districts.
9. Personal belief exemption. Children with a personal belief exemption are not necessarily without any
vaccines, but likely are not fully vaccinated.
According to California Department of Public Health (CDPH’s) 2014-15 Kindergarten Immunization Assessment
Results, the statewide percentage of personal belief exemptions had consistently increased annually among all
reporting schools until 2014-15, when there was a 19% decrease compared with last year. While public school
personal belief exemption rates decreased by 21% (from 2.92% to 2.31%), private school personal belief
exemption rates decreased only 9% (from 5.88% to 5.33%).
http://www.cdph.ca.gov/programs/immunize/Documents/2014-15%20CA
%20Kindergarten%20Immunization%20Assessment.pdf
California’s personal belief exemption covers all beliefs, including religious; there is not a separate exemption
specific to religion. Therefore, this bill eliminates the ability of parents or guardians to seek exemption from
immunization requirements based on religious beliefs.
Governor Brown included a signing message related to AB 2109 (Pan, Ch. 821, 2012), which reads in part:
"I am signing AB 2109 and am directing the Department of Public Health to oversee this policy so parents
are not overly burdened in its implementation. Additionally, I will direct the department to allow for a
separate religious exemption on the form. In this way, people whose religious beliefs preclude vaccinations
will not be required to seek a health care practitioner’s signature."
It is unclear whether California Department of Public Health (CDPH) is working to develop a separate religious
exemption.
10. Medical exemption. Current law exempts from immunization requirements children whose parent or guardian
have filed with the school or other institution a written statement by a licensed physician to the effect that the
physical condition or medical circumstances are such that immunization is not considered safe. Some opponents
maintain that a medical exemption is very difficult to obtain, especially if the medical concern is not overtly
severe. The decision whether to grant a medical exemption from immunizations is at the discretion of each
physician. It is unclear if guidelines for physicians are available.
11. Vaccination requirements. The Centers for Disease Control and Prevention recommend a schedule of
immunizations for children from birth through age 18.
http://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-schedule.pdf
The California Department of Public Health (CDPH) determines which immunizations children must have, and at
what age, before being unconditionally admitted to a private or public school or licensed child care program.
For child care: http://www.shotsforschool.org/child-care/
For K-12 schools: http://www.shotsforschool.org/k-12/
12. Hepatitis B. Some opponents of this bill question the need for the Hepatitis B vaccination, and point to the
right of attendance for students who are infected with HIV. According to the Centers for Disease Control and
Prevention, children can become infected by contact with blood and body fluids through breaks in the skin such as
bites, cuts, or sores; by contact with objects that have blood or body fluids on them such as toothbrushes, razors;
by having unprotected sex; and by sharing drug needles. Is there a reasonable analogy between allowing the
attendance of a student infected with HIV and allowing the attendance of a student who has not been fully
vaccinated against Hepatitis B? Do parents need to worry about students being exposed to Hepatitis B while at
school or child care?
13. Reporting. This bill requires school districts to include in the annual notification to parents at the beginning of
the schoolyear the immunization rates for each of the required immunizations for the school in which a student is
enrolled. Schools and licensed child care providers annually submit rates of immunizations to the CDPH. Data
submitted includes the rates for each required vaccine, personal belief exemptions, permanent medical
exemptions, and conditional entrants.
http://www.cdph.ca.gov/programs/immunize/Pages/ImmunizationRatesatCaliforniaSchools.aspx
The authors may wish to consider instead requiring the annual notification to parents to include a link to the
CDPH website and a date when the current data will be available on CDPH’s website.
14. Related and prior legislation.
RELATED LEGISLATION
SB 792 (Mendoza, 2015) prohibits a person from being employed at a day care center or family day care home, if
that person has not been immunized against influenza, pertussis, and measles. SB 792 is scheduled to be heard by
the Senate Health Committee on April 15.
PRIOR LEGISLATION
AB 2109 (Pan, Ch. 821, 2012) requires, beginning January 1, 2014, a separate form prescribed by the California
Department of Public Health (CDPH) to accompany a letter or affidavit from a parent or guardian to exempt a
child from immunization requirements on the basis that the immunization is contrary to beliefs of the child’s
parent or guardian.
SB 614 (Kehoe, Ch. 123, 2011) authorizes a student in grades 7- 12 to conditionally attend school for up to 30
calendar days beyond the student’s first day of attendance for the 2011-12 school year, if that student has not been
fully immunized with all pertussis boosters appropriate for the student’s age if specified conditions are met.
AB 354 (Arambula, Ch. 434, 2010) allows CDPH to update vaccination requirements for children entering schools
and child care facilities and adds the American Academy of Family Physicians to the list of entities whose
recommendations CDPH must consider when updating the list of required vaccinations. AB 354 requires students
entering grades 7-12 to receive a TDaP booster prior to admittance to school.
SB 1179 (Aanestad, 2008) deleted CDPH’s authority to add diseases to the list of those requiring immunizations
prior to entry to any private or public elementary or secondary school, child care center, day nursery, nursery
school, family day care home, or development center. SB 1179 failed passage in the Senate Health Committee.
AB 2580 (Arambula, 2008) required students entering grade 7 to be fully immunized against pertussis.
AB 2580 was held on the Senate Appropriations Committee’s suspense file. SB 676 (Ridley-Thomas, of 2007)
required students entering grade 7 to be fully immunized against pertussis. SB 676 was held on the Assembly
Appropriations Committee’s suspense file. SB 533 (Yee, 2007) added pneumococcus to the list of required
immunizations for children.
SB 533 was vetoed by the Governor, whose veto message read:
While I am a strong proponent of prevention and support efforts to improve vaccine rates for children, I am
unable to sign this bill as California’s public health experts believe it is not needed. The Department of
Public Health can already require that young children receive the pneumococcal vaccine. California’s
vaccine experts have not established a mandate as they believe it is not needed. Approximately 86 percent
of children are already being vaccinated under a voluntary system.
SUPPORT(As of April 10; most are specific to the prior version of the bill):
California Association for Nurse Practitioners
California Chapter of the American College of Emergency Physicians
California Coverage & Health Initiatives
California Medical Association
California Primary Care Association
California School Boards Association
California School Nurses Organization
CAPG
Children Now
Children’s Defense Fund-California
County Health Executives Association of California
Health Officers Association of California
Kaiser Permanente
Los Angeles County Board of Supervisors
Reed Union School District
The Children’s Partnership
Vaccinate California
Numerous individuals
OPPOSITION(As of April 10; most are specific to the prior version of the bill):
Association of American Physicians and Surgeons
AWAKE California
California Chiropractic Association
California Coalition for Health Choice
California Nurses for Ethical Standards
Californians for Freedom of Choice
Educate Advocate
Homeschool Association of California
National Autism Association of California
Pacific Justice Institute
ParentalRights.Org
Plumas Charter School
Safe Minds
Standing Tall Chiropractic
The Canary Party
Unblind My Mind
Numerous individuals
CONSEQUENCE OF NEGATIVE ACTION:
Contra Costa County would not have a position on the bill.
CLERK'S ADDENDUM
Speakers: Jacques Corriveau, M.D., American Academy of Pediatrics; Kirsten Branch, resident of Danville
(handout attached); Christina Dunham; Shawna McCreery-Garvin, resident of Brentwood; Michelle Tryner,
resident of Antioch; Jake Tryner, resident of Antioch; Joshua Tryner, resident of Antioch; Ryan Tryner,
resident of Antioch; Brent Tryner, resident of Antioch; Amy Van Linge, resident of Oakley; Julie Figueroa,
resident of Brentwood; Andrea Pacheco, resident of Walnut Creek; Summer Van der Westhuyzen; Amy Alfieri,
resident of Sacramento; Hannah Henry, resident of Napa; Leah Russin, Vaccinate California; Elan Ford,
resident of El Cerrito; Amy Keyishian, resident of Richmond;
Supervisor Andersen noted that in it's current form SB 277 provides no option for religious exemption and
therefore she will not be in support.
ATTACHMENTS
Attachment 1: Bill Text
Attachment 2: Mercury News Story
Attachment 3: Handouts
AMENDED IN SENATE APRIL 22, 2015
AMENDED IN SENATE APRIL 9, 2015
SENATE BILL No. 277
Introduced by Senators Pan and Allen
(Principal coauthor: Assembly Member Gonzalez)
(Coauthors: Senators Beall, Block, De León, Hall, Hertzberg, Hill,
Jackson, Leno, McGuire, Mitchell, Stone, Wieckowski, and Wolk)
(Coauthors: Assembly Members Baker, Chiu, Cooper, Low, McCarty,
Nazarian, Rendon, Mark Stone, and Wood)
February 19, 2015
An act to add Section 48980.5 to the Education Code, and to amend
Sections 120325, 120335, and 120370 of, and to repeal Section 120365
of, the Health and Safety Code, relating to public health.
legislative counsel’s digest
SB 277, as amended, Pan. Public health: vaccinations.
(1) Existing law prohibits the governing authority of a school or other
institution from unconditionally admitting any person as a pupil of any
public or private elementary or secondary school, child care center, day
nursery, nursery school, family day care home, or development center,
unless prior to his or her admission to that institution he or she has been
fully immunized against various diseases, including measles, mumps,
and pertussis, subject to any specific age criteria. Existing law authorizes
an exemption from those provisions for medical reasons or because of
personal beliefs, if specified forms are submitted to the governing
authority. Existing law requires the governing authority of a school or
other institution to require documentary proof of each entrant’s
immunization status. Existing law authorizes the governing authority
of a school or other institution to temporarily exclude a child from the
97
school or institution if the authority has good cause to believe that the
child has been exposed to one of those diseases, as specified.
This bill would eliminate the exemption from immunization based
upon personal beliefs. This bill would except pupils in a home-based
private school and students enrolled in an independent study pursuant
to specified law from the prohibition described above of all of the
school’s pupils are residents of the household or are members of a single
family. above. The bill would narrow the authorization for temporary
exclusion to make it applicable only to a child whose documentary
proof of immunization status does not show proof of immunization
against one of the diseases described above. The bill would make
conforming changes to related provisions.
(2) Existing law requires the governing board of a school district, at
the beginning of the first semester or quarter of the regular school term,
to make certain notifications to parents or guardians of minor pupils
including, among others, specified rights and responsibilities of a parent
or guardian and specified school district policies and procedures.
This bill would require the governing board of a school district to
also include in the notifications provided to parents or guardians of
minor pupils at the beginning of the regular school term the
immunization rates for the school in which a pupil is enrolled for each
required immunization. By requiring school districts to notify parents
or guardians of school immunization rates, the bill would impose a
state-mandated local program.
(3) The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the state.
Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these statutory
provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
The people of the State of California do enact as follows:
line 1 SECTION 1. Section 48980.5 is added to the Education Code,
line 2 to read:
line 3 48980.5. The notification required pursuant to Section 48980
line 4 shall also include the immunization rates for the school in which
97
— 2 —SB 277
line 1 a pupil is enrolled for each of the immunizations required pursuant
line 2 to Section 120335 of the Health and Safety Code.
line 3 SEC. 2. Section 120325 of the Health and Safety Code is
line 4 amended to read:
line 5 120325. In enacting this chapter, but excluding Section 120380,
line 6 and in enacting Sections 120400, 120405, 120410, and 120415, it
line 7 is the intent of the Legislature to provide:
line 8 (a) A means for the eventual achievement of total immunization
line 9 of appropriate age groups against the following childhood diseases:
line 10 (1) Diphtheria.
line 11 (2) Hepatitis B.
line 12 (3) Haemophilus influenzae type b.
line 13 (4) Measles.
line 14 (5) Mumps.
line 15 (6) Pertussis (whooping cough).
line 16 (7) Poliomyelitis.
line 17 (8) Rubella.
line 18 (9) Tetanus.
line 19 (10) Varicella (chickenpox).
line 20 (11) Any other disease deemed appropriate by the department,
line 21 taking into consideration the recommendations of the Advisory
line 22 Committee on Immunization Practices of the United States
line 23 Department of Health and Human Services, the American Academy
line 24 of Pediatrics, and the American Academy of Family Physicians.
line 25 (b) That the persons required to be immunized be allowed to
line 26 obtain immunizations from whatever medical source they so desire,
line 27 subject only to the condition that the immunization be performed
line 28 in accordance with the regulations of the department and that a
line 29 record of the immunization is made in accordance with the
line 30 regulations.
line 31 (c) Exemptions from immunization for medical reasons.
line 32 (d) For the keeping of adequate records of immunization so that
line 33 health departments, schools, and other institutions, parents or
line 34 guardians, and the persons immunized will be able to ascertain
line 35 that a child is fully or only partially immunized, and so that
line 36 appropriate public agencies will be able to ascertain the
line 37 immunization needs of groups of children in schools or other
line 38 institutions.
97
SB 277— 3 —
line 1 (e) Incentives to public health authorities to design innovative
line 2 and creative programs that will promote and achieve full and timely
line 3 immunization of children.
line 4 SEC. 3. Section 120335 of the Health and Safety Code is
line 5 amended to read:
line 6 120335. (a) As used in this chapter, “governing authority”
line 7 means the governing board of each school district or the authority
line 8 of each other private or public institution responsible for the
line 9 operation and control of the institution or the principal or
line 10 administrator of each school or institution.
line 11 (b) The governing authority shall not unconditionally admit any
line 12 person as a pupil of any private or public elementary or secondary
line 13 school, child care center, day nursery, nursery school, family day
line 14 care home, or development center, unless, prior to his or her first
line 15 admission to that institution, he or she has been fully immunized.
line 16 This subdivision does not apply to a pupil in a home-based private
line 17 school if all of the pupils are residents of the household or are
line 18 members of a single family. or a pupil who is enrolled in an
line 19 independent study pursuant to Article 5.5 (commencing with
line 20 Section 51745) of Chapter 5 of Part 28 of the Education Code.
line 21 The following are the diseases for which immunizations shall be
line 22 documented:
line 23 (1) Diphtheria.
line 24 (2) Haemophilus influenzae type b.
line 25 (3) Measles.
line 26 (4) Mumps.
line 27 (5) Pertussis (whooping cough).
line 28 (6) Poliomyelitis.
line 29 (7) Rubella.
line 30 (8) Tetanus.
line 31 (9) Hepatitis B.
line 32 (10) Varicella (chickenpox).
line 33 (11) Any other disease deemed appropriate by the department,
line 34 taking into consideration the recommendations of the Advisory
line 35 Committee on Immunization Practices of the United States
line 36 Department of Health and Human Services, the American Academy
line 37 of Pediatrics, and the American Academy of Family Physicians.
line 38 (c) Notwithstanding subdivision (b), full immunization against
line 39 hepatitis B shall not be a condition by which the governing
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line 1 authority shall admit or advance any pupil to the 7th grade level
line 2 of any private or public elementary or secondary school.
line 3 (d) The governing authority shall not unconditionally admit or
line 4 advance any pupil to the 7th grade level of any private or public
line 5 elementary or secondary school unless the pupil has been fully
line 6 immunized against pertussis, including all pertussis boosters
line 7 appropriate for the pupil’s age.
line 8 (e) The department may specify the immunizing agents that
line 9 may be utilized and the manner in which immunizations are
line 10 administered.
line 11 (f) This section shall become operative on July 1, 2012.
line 12 SEC. 4. Section 120365 of the Health and Safety Code is
line 13 repealed.
line 14 SEC. 5. Section 120370 of the Health and Safety Code is
line 15 amended to read:
line 16 120370. (a) If the parent or guardian files with the governing
line 17 authority a written statement by a licensed physician to the effect
line 18 that the physical condition of the child is such, or medical
line 19 circumstances relating to the child are such, that immunization is
line 20 not considered safe, indicating the specific nature and probable
line 21 duration of the medical condition or circumstances that
line 22 contraindicate immunization, that child shall be exempt from the
line 23 requirements of Chapter 1 (commencing with Section 120325, but
line 24 excluding Section 120380) and Sections 120400, 120405, 120410,
line 25 and 120415 to the extent indicated by the physician’s statement.
line 26 (b) When there is good cause to believe that a child whose
line 27 documentary proof of immunization status does not show proof
line 28 of immunization against a communicable disease listed in
line 29 subdivision (b) of Section 120335 has been exposed to one of those
line 30 diseases, that child may be temporarily excluded from the school
line 31 or institution until the local health officer is satisfied that the child
line 32 is no longer at risk of developing or transmitting the disease.
line 33 SEC. 6. If the Commission on State Mandates determines that
line 34 this act contains costs mandated by the state, reimbursement to
line 35 local agencies and school districts for those costs shall be made
line 36 pursuant to Part 7 (commencing with Section 17500) of Division
line 37 4 of Title 2 of the Government Code.
O
97
SB 277— 5 —
http://www.mercurynews.com/health/ci_27562696/measles-outbreak-california-bill-would-end-all-vaccination
Page 1 of 2 Mar 28, 2015 01:51:53PM MDT
In this Thursday, Jan. 29, 2015 photo, a pediatrician
holds a dose of the measles-mumps-rubella (MMR)
vaccine at his practice in Northridge, Calif. (AP
Measles outbreak: California bill would end all vaccination
loopholes except medical
By Tracy Seipel and Lisa M. Krieger Staff writers
Updated: 02/20/2015 06:27:16 AM PST MercuryNews.com
SACRAMENTO -- In a move that could give California one of the nation's toughest vaccine laws, two state
senators Thursday introduced legislation that would eliminate most exemptions that allow parents to avoid
requirements to vaccinate their children.
If enacted, California would join only two other states -- Mississippi and West Virginia -- that permit only
medical exemptions as legitimate reasons to sidestep vaccinations.
The clamor around the elimination of the "personal belief exemption" has been growing in California since a
measles outbreak started in mid-December, when 39 people who visited or worked at Disneyland
contracted the virus.
Currently, California is one of 19 states that allow exemptions based purely on parents' personal or
religious beliefs.
Senate Bill 277 does not specifically address the religious
exemption. But if passed as now drafted, the bill would end all
"personal belief exemptions," including religious exemptions,
said Sen. Richard Pan, a Sacramento Democrat and
pediatrician who co-authored the bill with Sen. Ben Allen,
D-Redondo Beach.
"There is no religious exemption in the statute," Pan told this
newspaper Thursday. But he indicated that might change as
the debate over the legislation plays out over the next several
months. "I'm certainly open to the discussion about the
necessity and the nature of any proposed religious
exemption."
That could come through "the legislative process or the governor himself, if he wishes to be engaged early
on," Pan said. "It's up to him."
When Pan, then an assemblyman, carried a bill in 2012 aimed at tightening vaccine policy, Gov. Jerry
Brown signed it. But he directed state health officials to maintain the ease of religious exemptions.
Asked if Brown believes that the issue of religious exemptions needs to be revisited, Jim Evans, a
spokesman for the governor, would only say that "the governor believes that vaccinations are profoundly
important and a major public health benefit and any bill that reaches his desk will be closely considered."
The highly infectious measles virus -- once virtually eliminated in the U.S. -- has now infected 162 people in
17 states, including at least 119 Californians.
The current struggles over vaccine policy have raised tensions between advocates of public health and
individual liberty. The Association of American Physicians and Surgeons, an Arizona-based libertarian
doctors' group, says that compulsory vaccination overrides the rights of parents.
Keith Howe, 59, a San Jose chiropractor, has long opposed efforts to impose vaccinations requirements.
http://www.mercurynews.com/health/ci_27562696/measles-outbreak-california-bill-would-end-all-vaccination
Page 2 of 2 Mar 28, 2015 01:51:53PM MDT
Keith Howe, 59, a San Jose chiropractor, has long opposed efforts to impose vaccinations requirements.
He said when Pan introduced his legislation in 2012, "I sent him a scathing letter saying this is not
Communist China and he is not Mao Zedong. He is violating the Constitution and the Bill of Rights."
But Dorit Reiss, a professor and vaccine law expert at UC's Hastings College of the Law in San Francisco,
said eliminating both religious and personal belief exemptions "would be a dramatic improvement over
what we have now."
Courts, she said, have established the right of a state to compel individuals to receive a vaccination -- and
they've also upheld local government mandates that require vaccinations as a prerequisite for enrolling in
school, she said.
Lawyers and vaccine experts caution against preserving the religious exemption while eliminating personal
belief exemptions.
"It would be a terrible mistake," Reiss said. "We don't allow religions to put children at risk for other
reasons."
She added that courts have also ruled that there is no constitutional right to offer exemptions based on
religious grounds. Indeed, Reiss added, lower courts have ruled that such exemptions may be
constitutionally suspect if they discriminate against people who have nonestablished religious beliefs
against vaccination.
Critics of religious exemptions to vaccination also argue that parents could easily transform their secular
anti-vaccination sentiment into a religious belief. They note that numerous websites offer relevant biblical
quotations to include in letters of petition for exemption. Others offer mail-order religious groups, such as
the Congregation of Universal Wisdom, headquartered in New Jersey.
Both Pan and Allen said they are aware of the potential to abuse a religious exemption. Pan said there is no
major religion that "actually explicitly prohibits vaccination that we are aware of," although he said some
leave the decision to individual ministers.
The call to consider eliminating the religious exemption has also been pushed by California's two U.S.
senators, Dianne Feinstein and Barbara Boxer.
Along with other colleagues, they recently introduced legislation to ensure that all children in Head Start
and Early Head Start programs nationwide are fully vaccinated unless they have been exempted for
medical reasons.
Vaccine exemptions have been available since 1961, when California first required all public school
teachers and students to be inoculated against polio. But there has been a surge in their popularity in
recent years. From 2000 to 2014, the rate of parents seeking exemptions tripled, from 0.77 percent to 2.5
percent -- or one in every 40 kids.
Contact Tracy Seipel at or 408-920-5343. Follow her at .tseipel@mercurynews.com Twitter.com/taseipel
Contact Lisa M. Krieger at or 650-492-4098.lkrieger@mercurynews.com