Sacramento Bee

Editorial: Anti-vax doctors are granting bogus vaccine exemptions. How to make them think twice.

August 14, 2018

By the Sacramento Bee Editorial Board

Few pieces of legislation have made more of a difference to more Californians more quickly than the bill two years ago to tighten school vaccination laws.

Pushed by Sens. Richard Pan and Ben Allen and signed by Gov. Jerry Brown in the face of fierce anti-vax blowback, Senate Bill 277 ended the so-called “personal belief” exemption that let misinformed parents send their children to school without vaccinations against lethal diseases such as whooping cough, polio, rubella and measles. Now an unimmunized child must either be home-schooled or get a medical exemption signed by a licensed physician in order to enroll.

The new law has worked like a champ, raising dangerously low levels of immunity in California back up to the public health minimum, 95 percent of the population. But that’s a statewide number, and outbreaks, when they happen, do so locally.

In holdout communities such as Nevada City and Sebastopol, there are still pockets of willfully low vaccination rates. A Los Angeles Times report earlier this month found that in nearly 800 of California’s 6,500 elementary schools, 10 percent or more of kindergartners were walking around without all their required shots, inviting an outbreak and risking the health of infants, the elderly and children with compromised immune systems.

At 20 schools, most of them in Northern California, the rate of medical exemptions among kindergartners was a stunning one in four.

That’s a lot of unvaccinated kids concentrated in a relatively few places, and to call it fishy would be an understatement. All signs point to a minority of ethically challenged pediatricians selling medical exemptions, which have quadrupled since SB 277 passed in 2015.

This month, the Medical Board of California sanctioned Bob Sears, an Orange County pediatrician with a high profile among vaccine skeptics, putting him on probation for 35 months for giving a toddler an unjustified medical exemption. But Sears, who has built a practice enabling the irrational fear of vaccines, and who published a book advocating “alternative” vaccine schedules, is hardly the only Dr. Feelgood catering to the anti-vax crowd.

Lists of sympathetic pediatricians circulate online, along with the discredited science and New Age conspiracy theories that started this misinformed movement. State licensing authorities know who the soft touches are, but can do little unless the children they treat, or their parents, complain to the medical board and cooperate with an investigation. Since the parents seek out these doctors, that isn’t likely.

Nor are school officials in a position to judge the legitimacy of medical exemptions, even though every unvaccinated child lowers a classroom’s immunity and heightens the risk of an outbreak. In California, they just have to take the doctor’s word.

These loopholes need to be closed. If California were like, say, West Virginia, state health officials would have to sign off on any medical exemption. But California has left that kind of oversight out of the equation, and inserting it would invite another massive, emotional political fight.

Perhaps, however, doctors could be administratively required to simply file exemptions with state or local health officials in addition to schools, so that authorities could at least see who is exempting suspicious numbers of children. Such filings would also offer a better picture of where gaps in immunity are concentrated. Pan and state health officials should explore such administrative options this summer, before the start of the next school year.

Legislation may yet be required to shield California kids from childhood diseases, which are still dangerous and still out there; just this month, public health officials announced that an infant died of whooping cough in San Bernardino County.

But short-term, sunshine can be excellent medicine, and might make anti-vax Dr. Feelgoods think twice.