On June 30, 2015, California’s Gov. Jerry Brown signed into law Senate Bill 277 (SB277), which tightened requirements so that parents could no longer opt out of vaccinating their children if they were attending state licensed schools, daycares, and nurseries.
Dr. Richard Pan (D-Sacramento), a pediatrician, sponsored the legislation, which quickly became a nationwide litmus test on the debate over personal liberty versus public health in the aftermath of the large, 2014 multi-state measles outbreak linked to Disneyland. The SB277 immunization requirements apply to students first admitted to school, child care, or entering seventh grade and took effect on July 1, 2016. West Virginia and Mississippi are the only other states that do not allow non-medical exemptions.
Looking at the data so far, the number of vaccine holdouts is declining. The California Department of Public Health reported that 92.9 percent of all kindergarten children had received all required immunizations in the 2015–2016 school year, an increase from the previous year of 2.5 percentage points. This significant improvement in one year may be due to an earlier change in the law that required those desiring a personal belief exemption (which SB277 now prohibits) to visit with a doctor prior to obtaining the exemption to discuss the benefits and risks of immunizations and the risks of vaccine-preventable diseases.
One can infer that maybe some of the anti-vax parents were not so entrenched in their beliefs when it took additional effort to remain unvaccinated. Physicians, scientists, and public health experts see this increase in vaccine adoption as a win for herd immunity and disease outbreak prevention. The mandate is likely to increase the uptake of vaccines even further and will decrease California’s chances of having the next big outbreak.
While the American Academy of Pediatrics and nearly all of the 66,000+ pediatricians it represents have lauded the efforts by Dr. Pan and others (including Democratic co-sponsor Sen. Ben Allen, the son of a polio survivor), opponents feel the California law has overstepped a parent’s right to health and education choice. Several candlelight vigils, marches to the capital in Sacramento, and even a referendum attempt to overturn the law, as well as a recall election for Dr. Pan’s Senate seat (both of which ultimately failed) have occurred. Because parents can no longer claim religion or personal beliefs as a reason not to vaccinate their children in California, some have decided to homeschool while others have decided to move out of the state altogether. Several lawsuits challenging the validity of SB277 have been filed in court. Some pro-vaccine-choice physicians in California have even been selling medical exemptions to try to circumnavigate the law for anti-vax families. Yikes!
When parents withhold vaccines from their children, they are directly or indirectly putting their children and everyone else (especially the very young or elderly and those who cannot be vaccinated due to a medical condition) at risk. It is not merely a parental freedom. The California legislature seemed to view this matter as a regulation of safe behavior, not necessarily of parental rights. Withholding vaccines is a decision that can affect everyone — at a minimum, it is inconsequential, but at a maximum, it may cause someone to contract a life-threatening and preventable disease. Besides, in no way is purposely not vaccinating actually protecting the child. The state is actually enacting these laws to protect all children, not just a few.
No, California’s vaccine mandate is not a perfect resolution to the debate, but it’s a good start. I would expect other states to consider adopting similar laws, especially if California’s model continues to improve vaccination rates and there is a significant reduction in preventable disease outbreaks.
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