The state that grabbed headlines with its Disneyland-based measles outbreak early this year again demanded the nation's attention on June 30 -- this time, for moving to protect its population from similar outbreaks -- when California Gov. Jerry Brown signed into law SB 277(leginfo.legislature.ca.gov), which requires vaccination of all children in school or daycare, except for exemptions a physician determines are medically necessary.
After signing the legislation, Brown said in a statement(gov.ca.gov) that "the science is clear that vaccines dramatically protect children against a number of infectious and dangerous diseases. While it is clear that no medical intervention is without risk, the evidence shows that immunization powerfully benefits and protects the community."
Brown explained that the legislature amended the bill to exempt a child from immunizations if the child's physician concludes that there are "circumstances, including but not limited to, family medical history, for which the physician does not recommend immunization …"
"Thus, SB 277, while requiring that schoolchildren be vaccinated, explicitly provides an exception when a physician believes that circumstances -- in the judgment and sound discretion of the physician -- so warrant," he concluded.
- On June 30, California Gov. Jerry Brown signed into law legislation that requires vaccination of all children in school or daycare, except for exemptions physicians determine are medically necessary.
- When it comes to exemptions for valid medical reasons, family physicians hold the key under the new law.
- It isn't anticipated that the new vaccine mandate will affect how California family physicians approach vaccination or stock their vaccines.
Family Physicians Gave Key Support
Although West Virginia and Mississippi may have beaten California to the punch in passing tough laws on mandatory vaccination -- disallowing exemptions for religious or philosophical beliefs -- the Golden State is arguably the most high-profile state to do so to date. And the California AFP (CAFP) was a strong supporter of the legislation from its inception.
Family physician Carla Kakutani, M.D., who practices near Sacramento and is a past CAFP president and current CAFP Legislative Affairs Committee chair, told AAFP News that through its political action committee (PAC), the CAFP supported the election of the bill's leading advocate, Sen. Richard Pan, M.D., D-Sacramento.
Pan had a special interest in this legislation because he previously had worked as a pediatrician in Philadelphia during a measles outbreak that killed nine people. The Disneyland measles outbreak led him to pitch the idea of a vaccination-requirement bill to his legislative colleagues.
Kakutani said when Pan championed removing personal and religious exemptions from the vaccination mandate, the CAFP fully supported him with a "go big or go home" approach to the situation.
"The success of this bill, however, was due in large part to the strong advocacy by CAFP leaders and members across the state who supported it," Kakutani said. "This was an excellent example of the way that in AAFP chapters, our state and national PACs help get legislators elected who will tackle the issues we care about. Then we need ongoing grassroots advocacy work by our members to get specific bills passed."
The CAFP encouraged its members, along with any outspoken and supportive patients, to call their legislative representatives with messages supporting the bill. The organization also worked with a coalition of interested parties, including the California Medical Association, to get the bill passed.
And to encourage any hesitant lawmakers to get on board as the legislation approached the finish line, bill proponents drafted amendments to permit unvaccinated children an option to participate in multifamily home schools and also to offer school materials to children of parents who want them to learn through independent study.
What Does This Mean for Family Physicians?
Kakutani said California has some pockets of population where the penetrance of immunizations is too low to keep the herd immunity up.
"So we've seen significant outbreaks of pertussis and measles, and this has been slowly growing over the past five to 10 years," she said.
Part of this trend, Kakutani said, is due to the skepticism that exists in some circles about vaccines, which she attributes to patients not fully understanding the severity of related illnesses because most people have never seen them in their communities.
She added that she's also heard stories about immunization gaps being driven by convenience, where schools have used exemption letters to fast-track getting kids in school who are not up-to-date on their shots.
Hopefully, said Kakutani, the new vaccination mandate will lead to more opportunities for physicians to discuss vaccines with patients and make them more comfortable with these key preventive tools.
"A lot of parents are hesitant because they haven't sat down with someone they trust to hear the other side of the story -- the positives about vaccines," she said. "I tell my families that I have my kids completely vaccinated, and I've been giving vaccines in my office for 20-plus years. I wouldn’t suggest vaccination if it wasn't in everybody's best interest."
When she describes the power of vaccines, Kakutani said she tells families that when she was an intern in the early '90s in Modesto, Calif., she would admit kids with meningitis a couple of times a week. But later in her residency, the Haemophilus influenzae Type b (Hib) vaccine was released to fight Hib disease, which is the leading cause of bacterial meningitis in children younger than age 5. Many children received the Hib vaccine soon thereafter.
"It was like a light switch turned off," Kakutani said. "Within three years, we stopped seeing kids with meningitis because they weren't getting sick anymore. It was really amazing. So you don’t have to go back to polio to find evidence that vaccines really do make a huge difference."
Kakutani said she doesn't anticipate the new vaccine mandate will affect how California family physicians approach vaccination or stock their vaccines, because she doesn't think most offices will see a sizeable influx of new patients needing shots.
When it comes to exemptions for valid medical reasons, family physicians hold the key under the new law. Kakutani said the most common type of exemption would be if a child has an immune deficiency, including a temporary immune deficiency such as while undergoing chemotherapy.
"Also, if there's a significant family history of immunization reaction, then that is a place where a physician and a family could really decide what would be the best for that particular child," she said.
As for other states that seek to follow California's lead in mandating vaccines, Kakutani said the state's experience "should give hope to anybody out there in other states who have been wanting to tackle this problem that with a strong coalition explaining the science and getting the support of concerned parents, you can make this happen despite the loud minority opposing it."
She added that there was no doubt that family physicians played a significant role in helping push this movement in the state along. For example, a CAFP member got permission from a family to tell the legislature and media statewide the story of their child who is dying from post-measles complications.
"It was really powerful," Kakutani said. "So as family physicians, we can band together with other people to tell their stories to make change."
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