Pushback against immunization laws leaves some California schools vulnerable to outbreaks

Dr. Bob Sears examines 2-month-old twins Andrew and William Sandoval in his office in 2014 as their mother, Karissa Sandoval, looks on. Among his many books on pediatrics, Sears has written "The Vaccine Book," in which he discusses his concerns about vaccines.

July 13, 2018 5 AM PT

Two years after California adopted one of the toughest child vaccination laws in the nation, the state’s immunization rates are near record high levels.

Approved after a measles outbreak that originated at Disneyland, the law makes California one of only three states that bar parents from citing their personal beliefs to avoid having their children vaccinated.

Yet, even with the strict new law, there remain schools and neighborhoods with dangerously low vaccination rates, experts say, largely because a growing number of parents are obtaining doctors’ notes exempting their kids from the required shots.

At least 95% of the population needs to be vaccinated to prevent an outbreak of a highly contagious disease such as measles, experts say.

But at 105 schools in the state, 10% or more of kindergartners had a medical exemption in the school year that ended last month, according to a Los Angeles Times analysis of state data. That was nearly double the number of such schools in the first year the law was in effect.

State Sen. Richard Pan (D-Sacramento), who sponsored the immunization law, said he is contemplating legislation that would tighten the state’s vaccination laws even further. Some physicians have advertised online that they will consider medical exemptions for children with asthma or skin conditions such as psoriasis.

“People are getting fraudulent exemptions,” Pan said in an interview. “If we continue to see abuses, then I think there should be some thought as to how to address it.… People need to realize this is about the safety of their kids.”

But parents resistant to vaccines seem to be digging their heels in. Many were angered last month when Dr. Bob Sears, an Orange County pediatrician, was punished by the state medical board for improperly exempting a young boy from all childhood vaccinations. The penalty — 35 months’ probation — inspired many to rally around Sears, who appeared to be gearing up for a battle with the state.

“Is this fight over? No it is not,” Sears wrote on Facebook. “I will fight against mandatory vaccination laws until they are no more.”

The debate over how to enforce the immunization law is shaping up to be the next chapter in the vaccine fight in California, a state that has become somewhat of a test case for regulating anti-vaccine attitudes.

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California lawmakers took action after a measles outbreak that began in Disneyland in 2014 was linked to children whose parents had refused vaccines.

Despite parents’ fears, vaccines are largely safe, experts say. The most common side effects are soreness at the injection site or developing a fever or rash, according to the U.S. Centers for Disease Control and Prevention.

“Everything else people are worried about doesn’t happen, like autism or developmental delays,” said Dr. Paul Offit, an infectious diseases expert at Children’s Hospital of Philadelphia.

With the personal belief exemption banned in California, the only way to skip the required shots is by homeschooling kids or having a doctor state that a child can’t tolerate vaccines because of a health reason.

The law, known as SB 277, has largely been effective. The vaccination rate among kindergartners is up to 95%, from 93% before the law took effect in 2016.

But doctors say that preventing outbreaks requires high vaccination rates not just statewide, but also in each neighborhood or school. Otherwise, diseases can spread in pockets with low immunity.

But at 785 of the roughly 6,500 elementary schools in the state, 90% or fewer kindergartners had all of their required shots. Some of those students were planning to get their shots later in the school year and they hadn’t come due yet. But many had notes from their doctors saying they shouldn’t be vaccinated for the rest of their childhood.

Doctors say that at most, 3% of people could have a medical reason for not tolerating vaccines, such as a gelatin allergy or because they’re undergoing chemotherapy. But at 20 schools, more than a quarter of students had a medical exemption, according to state data.

“One can only conclude that children are getting bogus medical exemptions and the doctors are willing to give them,” Offit said. “It’s unconscionable — suddenly, 25% of children can’t get vaccines? Really? It doesn’t make any sense.”

Many public health advocates said they worried that medical exemptions were becoming easier to obtain without a valid reason.

Indeed, the number of kindergartners in California with a vaccine exemption from a doctor has quadrupled since the law took effect.

“We’re disappointed to see it, but not shocked,” said Leah Russin, a member of Vaccinate California, a group that sponsored the 2015 vaccine law. “We know there are some communities where people really do resist vaccines in large numbers, and parents get together and share information about doctors who are sympathetic.”

Currently, no regulatory body in California is charged with vetting the validity of the medical exemptions. Schools merely collect the forms from parents and turn them in to the state.

Pan said he thinks that California could benefit from a system like the one in West Virginia, one of the two other states that have banned personal belief exemptions. There, the state requires that each exemption be vetted by the public health department. Their medical exemption rate is half of California’s.

“Obviously that would require some change in the law,” he said.

But that feels like a slap in the face for many parents.

Rebecca Estepp, who was part of a group that opposed SB 277, pointed out that the law allows doctors to use their professional judgment to decide whether a child qualifies for an exemption. There is no list of criteria that a patient must meet to get an exemption.

She said she felt that medical exemptions were facing undue scrutiny, as were doctors, such as Sears, who write them. Though some schools have higher medical exemption rates, only 0.7% of kindergartners have a medical exemption statewide.

“I guess I would understand if we had a very high rate of medical exemptions in the state of California, but we’re talking less than 1%,” she said. “I don’t see where this sort of witch hunt is warranted.”

Last month, the Medical Board of California ordered 35 months’ probation for Sears for wrongly writing an exemption for a 2-year-old boy. Sears later wrote on Facebook that the medical board was investigating four more cases against him for improper vaccine exemptions.

“It seems there is an attempt to keep me on probation for the rest of my medical career,” Sears wrote.

In addition to the complaint that launched the Sears investigation, more than 50 others have been filed against physicians who are accused of improperly writing exemptions in the last three years, according to the medical board. Roughly half have been investigated and closed without any disciplinary action, while the others are still pending.

Russin said she was relieved the board came out against Sears and hoped it would pursue other doctors.

“As far as I’m concerned, that’s their job,” Russin said. “If the medical board doesn’t do enough, doesn’t start investigating these, we may need to revisit the law.”

Schools with low vaccination rates are located across the state, but many are clustered in Sonoma, Humboldt, Mendocino, Santa Cruz and San Diego counties, The Times’ analysis found.

Many school administrators declined to comment on their vaccination rates or could not be reached because their offices were closed for summer break.

Of the more than 6,500 elementary schools in the state, Sebastopol Independent Charter had the highest rate of kindergartners with medical exemptions in the school year that began last fall. Twenty-six of 45 kindergartners at the Sonoma County school had a doctor’s note excusing them from their vaccinations, according to state data.

Chris Topham, the school’s executive director, said the law puts him in an awkward position. Though his staff must make sure all students’ immunization forms are turned in, he has no control over how many parents submit exemptions. He also worries about taking a strong stance on either side, given how passionately people feel about vaccines.

“We stay on top if it, but we definitely stay very neutral,” he said.

Topham said that he calls the county health department for advice whenever there’s illness at school. He was in constant contact with them during a whooping cough outbreak last year, he said.

“But it’s not like we have a special plan because we have a certain kind of vaccination rate,” he said.

California kindergartens with the highest medical exemption rates