California recently passed a new law eliminating the "personal belief" exemption for vaccines, which means anti-vaxxer parents can no longer send their unvaccinated kids to public schools. While advocates are hopeful it will mean a boost in vaccinations rates, anti-vaxxers are already looking for loopholes and stopgaps, and making plans the fight the law to the bitter end.
"The parents in California are not going to go quietly into that good night," said David Pergamit, a California chiropractor who believes some vaccines are unsafe and advocates for the right for parents to choose whether or not their child is vaccinated.
The new law transformed California's vaccine requirements into some of the strictest in the country, joining West Virginia and Mississippi as the only states to not allow a religious or personal belief exemption for vaccines. Beginning January 1 of next year, the only way kids can attend public school in California is if they are up-to-date on their ten required shots or if they have a medical exemption (all states allow for medical exemptions). They can also attend, in some cases, if they have an existing personal belief exemption (more on that below).
"There is no way people are going to get a medical exemption for this."
In some states, a medical exemption can be granted through any doctor's note indicating the child should abstain from vaccinations. But in California, the requirements are bit tighter. The new law allows doctors to use family history as a consideration for medical exemption, but for the most part it's only granted in extreme cases. To get medical exemption, the family must file documentation from a licensed physician that specifically outlines why the child is abstaining from the required vaccinations, and only a handful of reasons are accepted.
"If you're immune-compromised—you're getting chemotherapy for your cancer, or you're getting significant immune-suppressant therapy for chronic diseases, or you're less than six months of age—that would be a reason not to get vaccinated," explained Dr. Paul A. Offit, the director of the Vaccine Education Center at the Children's Hospital of Philadelphia and author of multiple books about the anti-vaccination movement. "That's not most people. It's certainly not most children."
Offit added if you have had a previous allergic reaction or have a known allergy to certain vaccine ingredients, such as gelatin, you could be medically exempt from at least some vaccines. Other than that, you're out of luck. But couldn't parents track down some sympathetic doctors to cook up a medical exemption for their kid?
"There is no way people are going to get a medical exemption for this. I guarantee it," Pergamit told me over the phone. "I think the MDs are afraid of what will happen if they sign a waiver."
Instead, Pergamit has been advising patients who don't want to vaccinate their kids to take advantage of a small grandfathering rule in the new law. If a child has already obtained exemption for personal beliefs by January 1 next year, then they don't have to get up-to-date on shots until they enter the next grade span. Grade spans include preschool, kindergarten to grade six, and grade seven through high school.
Pergamit is a member of the California Chiropractic Association, a group that was strongly opposed to the new law. Pergamit told me he and his colleagues were feeling "complete disbelief and frustration" over the new law and that he believed politicians were persuaded by big pharma to enact the new rules. But he said those opposed to mandatory vaccinations aren't backing down.
"I don't think it will ever see the light of day. I don't think it will withstand a constitutional challenge at all," Pergamit said.
But the Supreme Court already considered the constitutional nuances of mandatory vaccinations more than 70 years ago with a landmark ruling that decided religious exemption from vaccines was not a constitutional right.
"The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death," the decision read.
In fact, for decades there were only medical exemptions allowed in many states. As more vaccines were discovered and added to the requirements in the 70s and 80s, parents started to push back, prompting most states to enact either a religious exemption, a personal belief exemption, or both. Recently, Vermont also passed a law to remove its personal belief exemption, but kept its religious exemption. Mississippi and West Virginia are the only states that have never had a religious or personal belief exemption, and they're also home to some of the highest vaccination rates in the country as a result.
California's new law was designed to counteract the anti-vaccinations movement, which has had a noticeable impact on vaccination rates around the country and is routinely identified as the main contributing factor to recent outbreaks and re-emergences of diseases that had previously been all but eliminated from society. This includes measles, an outbreak of which spread through California last year, infecting 125 people. Just last week, a woman died of measles, the first US death from the disease in more than a decade.
While the vast majority of Californian schoolchildren are vaccinated, the dip in rates threatens herd immunity: the critical mass of people required to keep a disease from spreading and affecting those people who can't be vaccinated, like the the 12 babies who contracted measles in California during last year's outbreak.
Even if the law stands, it will do little good if school boards aren't being closely monitored, said Michelle Meyer, a bioethicist at Mount Sinai's Union Graduate College-Icahn School of Medicine who studies the intersection of bioethics, law, and public health.
"Where the rubber will hit the road is really how it's enforced," Meyer said. "One option [for anti vaccination parents] would be to find a school where they have a sort of wink-wink, nod-nod approach to enforcing these exemptions."
Meyer pointed to schools in New York, where there is only a medical and religious exemption. Schools there have final say in deciding whether or not to accept a religious exemption, resulting in certain schools having shockingly low vaccination rates as word spread about anti-vaxx sympathetic schools.
"Parents talk, especially like-minded parents talk, and they probably seek out schools that are catering to that kind of mindset," Meyer said. "I think the new statute is an excellent step in the right direction, but for it to really be effective you're going to have to ensure it really is enforced."
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