The California legislature advanced SB276, sending it to Governor Gavin Newsom for his signature. SB276 would crackdown on unethical medical exemptions for vaccines, which the anti-vaccine religion has abused in response to SB277, a 2015 law that eliminated personal belief exemptions to vaccination for children entering school.
On 3 September 2019, the bill passed by an overwhelming 47-17 vote in the strongly Democratic-controlled Assembly. It was sent to the California Senate, which previously passed the bill but the Assembly added amendments that required a revote. On 4 September, the California Senate approved the bill by another overwhelming 28-11 vote.
Like with SB277, Senator Dr. Richard Pan, MD led the effort to get the California legislature to pass SB276.
In response to the vote, the anti-vaccine nutjobs utilized their predictable litany pseudoscientific and illogical rhetoric making all kinds of laughable claims. Along with a few hate-filled violent metaphors, of course.
Let's take a look at the bill and some other updates to the political machinations surrounding it.
What is SB276?
As I mentioned above, SB276 simply adds some restrictions to medical exemptions to vaccinations which some doctors were abusing. It created a "market" for these medical exemptions which became a loophole for anti-vaccine parents. The California Medical Board started to bring complaints against physicians that were caught doing this.
The amended SB276 adds very strong provisions in response to any physician writing a medical exemption. Some of these provisions are:
- The physician writing the exemption needs to actually see the child in person. They can no longer do this online or by phone, which made it easy for anti-vaccine parents to find someone to write the exemption, usually for a large fee (see Note 1).
- Physicians writing these exemptions who are not the child's treating physician need to notify the primary care physician for the child.
- The physician writing the exemption must clearly address each contraindication applicable to each vaccine for the child. Currently, physicians would make blanket exemptions to all vaccines, despite the guidelines for contraindications are quite detailed for each vaccine.
- These physicians must certify, under pain of perjury, that the information in the exemption form is accurate.
- The bill provides that parents must agree in advance to release medical records of their children for whom a medical exemption is requested. This makes it easier for the California Medical Board to investigate fake exemptions.
- Physicians can no longer charge for filing a medical exemption, although they can charge for the examination of the child
- Finally, the bill gives the California Department of Health powers to stop accepting exemptions from a physician who poses a risk to public health or who has a pending accusation before the California Medical board related to immunizations.
Professor Dorit Rubinstein Reiss, a frequent contributor to this blog, wrote in detail about some changes to SB276 which were requested by Governor Newsom in June. Here are a couple of excerpts from her commentary:
I will say now that while SB276 makes concessions, I think overall it is a better, and stronger system, which preserves legitimate medical exemptions and correctly focuses on the doctors writing fake exemptions as the source of the problem, and creates tools to deal with them. And at any rate, the Governor expressed willingness to sign the amended bill – and a signed bill is better than a vetoed one.
In terms of concessions, the main concession of the bill was to remove the ex-ante general review process. In the original version, every medical exemption would have to be reviewed before it is approved. In the new version, a physician would have to submit a copy of the exemption to the department, and the department would create a system to review medical exemptions from schools with less than 95% immunization rates or doctors who submitted more than 5 exemptions.
So a medical exemption for a child in a school with high rates, whose physician only grants a very rare exemption, will not be reviewed.
I think this is a reasonable compromise for SB276. It creates criteria to identify problem spots – problem schools and problem doctors – but saves concerns and efforts for those in non-trouble spots. Yes, it may mean that some children will not face oversight, but there are other measures to oversee problem doctors, and limiting oversight to problem spots would probably already happen in practice, because of scarce resources.
In both cases, if an exemption was found invalid the amended bill creates an appeal process. It also clarifies that the officer will be “clinically trained.”
It also broadens the grounds for exemptions: where previously only CDC contraindications and precautions could be valid, no other grounds could be allowed if they are “consistent with the relevant standard of care.”
California legislature advanced SB276 – Newsom responds
Unfortunately, Governor Newsom has signaled that he wants further amendments, although none of us are clear on what that may be. Melody Gutierrez, a reporter for the LA Times who has been following SB276 posted this tweet:
From a 10,000 meter view, I'm really concerned about only one item – "no penalty of perjury for doctors." The problem has been that fake medical exemptions are plainly fake. They were mostly written in bad faith (at a minimum) or to further the anti-vaccine beliefs of the parents.
However, we aren't 100% sure what Governor Newsom wants to be changed in SB276. And according to another LA Times reporter Taryn Luna, Senator Pan, and Governor Newsom are working out the details for a separate bill.
Apparently, Governor Newsom is not as positive about vaccines as most of the Democrats in the state. We'll see how this turns out, and either Professor Reiss or I will update you, once we have better information.
California legislature advanced SB276 – anti-vaxxers whine
As expected, the anti-vaccine crackpots did their crackpotting in person and online in response to the passing of SB276. Ms. Gutteriez commented about the response from the anti-vaxxers:
I guess these anti-vaxxers don't quite understand how Democracy works. You know, something about electing representatives who try to do the best that they can do for citizen's public health. Of course, most of the no votes came from Republicans who aren't especially concerned about the public health of Californians.
Thanks to my fellow blogger, Vincent Iannelli, MD, at Vaxopedia, has been tracking some of the more ridiculous posts, memes, and claims from the anti-vaxxers in response to the passing of SB276. Here are a choice few:
That comment is referring to Senator Pan and California State Assemblymember Lorena Gonzalez whose nephew is immunocompromised:
His doctor said no, he can’t have live vaccines, so no, he can’t be immunized against measles or chicken pox. Every time he is not in the hospital, he wants to be in school, but those diseases could kill him. Definitely put him back in the hospital. These are the children, the truly medically fragile children that we are trying to prevent from getting these diseases and why it’s so important.
So, the anti-vaxxers are claiming that Assemblymember Gonzalez has some secret loophole for a medical exemption. In fact, her nephew deserved this medical exemption, because it is completely legitimate. These are facts that are not within the realm of the delusions of anti-vaxxers.
Well, I'm guessing that most Democrats (and Republicans) are thoroughly vaccinated. No need to do it forcibly.
And now for that violent imagery that is the standard in the anti-vaccine world.
So there you go, revolution and the 2nd amendment from a bunch of anti-vaccine nutjobs. These people, denying the settled science of vaccine safety and effectiveness, think that they need a revolution employing the 2nd amendment to bring guns for violence.
Around 90% of children are vaccinated – this would be the lamest revolution ever. But that won't stop the hate-filled violent rhetoric of these buffoons.
Regardless of these crackpots, let's celebrate that the California legislature advanced SB276 to protect the children of the state. This is a positive moral choice, so rare in government these days.
Notes
- The ability to "buy" a medical exemption goes to a point that I make constantly about anti-vaxxers – it's almost exclusively about white privilege. Just look at photos of these protestors! Moreover, most anti-vaxxers believe that either their children are superior to the rest of us or that their amazing organic, gluten-free, alkaline-water lifestyle makes vaccines unnecessary. Unfortunately for these ignorant fools, viruses and bacteria aren't very selective – they don't care if you live in poverty or a wealthy liberal neighborhood in Marin County, they will harm everyone.