In California, some doctors sell "medical exemptions" for vaccination of children

In 2015, California passed legislation eliminating exemptions from personal beliefs about immunization that children must receive before they can attend public school.

The researchers found that since then, the number of medical exemptions granted by doctors for these mandatory vaccinations has increased dramatically.

"After the first year, the number of children has gone from 0.2% to 0.5%," said Salini Mohanty, Principal Investigator, Postdoctoral Researcher at the School of Nursing at the University of Pennsylvania . "Then, the second year, it was 0.7%, an increase of 250%, which is alarming."

At least some of these medical exemptions are written by doctors who charge high fees to fearful parents, according to public health officials interviewed for the study.

"I receive a very large number of medical exemptions from a provider, and as far as I understand it, for all intents and purposes, she is selling these exemptions for medical care," said one official quoted as saying. in the study. "She was in the habit of giving permanent medical exemptions, and now she is giving for a temporary 3 months." Families now have to come back every 3 months and pay $ 300 for their temporary medical exemption to be updated. . "

These doctors are fighting decades of work to develop and improve vaccines that "combat the infectious diseases that have plagued humanity since the species has evolved," said Dr. Amesh Adalja, an academic at the Security Center. Johns Hopkins sanitary facility in Baltimore. .

"Hearing about doctors who advertise medical exemptions, most of them unjustified, is like spitting on the face of these pioneers who have given us vaccines and making these doctors defenders of the primitive darkness when Vaccine-preventable diseases have bloomed, "Adalja said.

The 2015 law made California the first state for nearly 35 years to eliminate exemptions from personal beliefs for mandatory vaccinations, the study's authors said in briefing notes. The law was motivated in part by a 2014 measles outbreak at Disneyland.

The researchers reported that the law had a positive effect on vaccination rates throughout California.

Following the implementation of the law, the proportion of parents of children who received all the required vaccines increased to 92.1% in 2017-2018, compared to 92.8% in 2015-2016.

The results were published online on October 29 in the journal pediatrics.

To get a ground assessment of law enforcement, the researchers interviewed 40 health workers representing about half of California's local health jurisdictions.

Public health officials have expressed concern that parents opposed to the vaccine will be denied personal belief exemptions for their children and are currently seeking doctors willing to issue medical exemptions for a fee, Mohanty said.

Many of these medical exemptions cite conditions that are not generally considered barriers to immunization by US Centers for Disease Control and Prevention, such as a family history of allergies or autoimmune disorders. said Mohanty.

However, these conditions are based on the statutory wording of the law, she said.

The number of medical exemptions issued has not yet reached the level of exemptions from personal beliefs claimed before the adoption of the law, which for the 2015-2016 school year was about 2.4%, said Mohanty.

But if nothing has been done, the rapid increase in medical exemptions could weaken vaccine protection for schoolchildren, said Democratic Senator Richard Pan, pediatrician and author of California law.

"They threaten the immunity of the community and threaten the health of all children," said Pan about the exemptions.

The anti-vaccine parent groups seem to share lists of doctors willing to issue medical exemptions for a fee, Pan said.

"It's a very small number, but it's all it takes, right?" said Pan, who wrote an editorial accompanying the new study. "They are asking for $ 500 or more for these exemptions, so they really get what they pay for."

The study reported that some of these doctors have been brought before the California Medical Board for charges of ethics.

But Pan suggested a simpler solution. He would like to change the California law so that public health officials have the power to revoke the power of doctors to issue medical exemptions.

Pan argued that the power to issue medical exemptions is a public health function at the state level that has been delegated to physicians. It could therefore be canceled if we discover that they take advantage of the patients.

For example, pediatricians in West Virginia are not able to issue medical waivers. Instead, they must seek waivers from the health department of their state, on behalf of patients, Pan said.

"When a person abuses the authority that has been delegated to him, then the state should be able to take back that authority," Pan said. "And not only to revoke this authority, but also to invalidate all improperly written medical exemptions posing a threat to public health."

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More information:
Salini Mohanty, Dr.P.H., M.P.H., Postdoctoral Researcher, School of Nursing, University of Pennsylvania, Philadelphia; Amesh Adalja, M.D., Principal Investigator, Johns Hopkins Center for Health Security, Baltimore; State of California, Senator Richard Pan (Dem.), M.D., M.P.H .; October 29, 2018, pediatrics

US Centers for Disease Control and Prevention have more to do with state immunization requirements.