Exploiting fear

Too many doctors are giving exemptions from life-saving vaccinations

Suzanne Stewart is a pediatric resident in Sacramento.

Suzanne Stewart is a pediatric resident in Sacramento.

Bright-eyed, 2-year-old Anna was hospitalized three months ago for the chicken pox and was successfully treated with intravenous fluids for dehydration.

She was unvaccinated due to her mother’s choice. Thankfully, Anna had no long-term complications, yet without vaccines, she is still vulnerable to infections such as the current potentially deadly measles outbreak.

Over the past two years, health care providers have spent hours with Anna’s mother discussing the benefits of immunizations, but even after the chicken pox, the mother wasn’t convinced. Instead, the mother said she has seen another doctor and received a medical exemption for Anna to remain unvaccinated.

This is surprising since there are no medical reasons for her daughter not to get vaccines, so I asked how it works. She explained that the other doctor sees Anna multiple times and does a very thorough physical exam and blood tests before writing the vaccine exemption. Every visit was paid out of pocket.

These exemptions are intended for the relatively few with medical conditions that prevent individuals from receiving the vaccines. The reasons are clearly outlined by the federal Centers for Disease Control and Prevention. But a recent investigation by Voice of San Diego, a nonprofit news organization, found that just one doctor wrote one-third of all 486 medical exemptions for the San Diego Unified School District since 2015.

Since Senate Bill 277 became law in 2015, removing the “personal belief” exemption to required vaccinations for children to attend schools, the rate of medical exemptions has more than tripled (from 0.2% in 2015-16 to 0.7% in 2017-18).

To create immunity and prevent outbreaks of measles and other diseases, there needs to be at least a 95 percent vaccination rate. While a 0.7 percent exemption rate may not seem high, they cluster within communities so many schools in California have vaccination rates closer to 70 percent. Sadly, it only takes one child to get infected and expose the entire school.

The problem isn’t limited to elementary-age children. Last month, hundreds of students and employees at UCLA and Cal State Los Angeles were quarantined after being exposed to measles and unable to prove they were immunized.

In 2019, 40 people in California, including three in Sacramento and 10 children, have been infected with measles as of May 2, compared to 21 in all of 2018, according to state health officials. Nationwide, 704 cases have been reported this year, the most since 2000.

Given the startling rate of measles and its grave consequences, the state Department of Public Health is urging Californians to be fully vaccinated before traveling internationally.

Currently, there is no clear way to penalize doctors who are exploiting the fears of parents by giving immunization exemptions that are not medically necessary while charging thousands of dollars for multiple visits and blood tests.

SB 276—authored by Sen. Richard Pan of Sacramento and now before the Legislature—would create a partnership between doctors, state public health officials and schools to reserve medical exemptions for individuals who actually need them. If the bill becomes law, otherwise healthy children will get life-saving vaccines if they attend public school without threatening vulnerable children who truly have impaired or weakened immune systems.