California moves to end personal belief exemptions for vaccination--at last

The solution: a single-dose vial of the measles-mumps-rubella, or MMR, vaccine.
(Damian Dovarganes / AP)

As we’ve been pointing out almost since the inception of the 2015 measles epidemic, outbreaks of such vaccine-preventable diseases are often associated with overly indulgent exemptions from mandatory childhood immunizations.

Two California legislators have taken aim at exactly that problem. My colleague Patrick McGreevy reports from Sacramento that state senators Richard Pan of Sacramento and Ben Allen of Santa Monica plan to introduce a bill repealing California’s personal belief exemption for children going to public or private schools. Closing the loophole would be a major step toward improving public health.

Every state in the union allows exemptions from immunizations for medical reasons, such as suppressed immune systems or specific susceptibility to side effects. All states but two (Mississippi and West Virginia) also grant exemptions for religious beliefs. But only 20 allow loose open-ended philosophical objections to keep children unvaccinated.

In California, personal belief exemptions have helped to build pockets of vaccine-denial that plainly have fueled the measles outbreak, which apparently began with unvaccinated visitors to Disneyland and Disney’s California Adventure theme parks before Christmas. Last year, about 13,500 exemptions were granted, including about 2,700 for religious reasons.

But a change in California law that went into effect on Jan. 1, 2014, may have begun to turn around the trend. The change, which Pan sponsored in 2012 as a state assemblyman, required parents seeking personal-belief waivers to receive counseling about the benefits and risks of childhood immunization from a medical professional first.


We’ve been skeptical that this requirement would achieve much, given the presence in California of medical charlatans promoting suspicions about vaccines, but the numbers imply a different story: Statewide, the rate of vaccine waivers for kindergartners entering school in the fall declined to 2.5% in 2014 from 3.1% in 2013. Bigger declines were seen in districts with high exemption rates--in the Santa Monica-Malibu Unified School District, the rate fell from 14.8% to 11.5%; Beverly Hills Unified declined from 11.9% to 5%; and Laguna Beach Unified declined from 15.1% to 2%, according to a Times analysis.

That suggests that for many parents, skepticism about vaccines is only lightly held, and placing even a mild obstacle in the path of waivers prompts them to get their kids immunized. It also implies that erecting an even higher barrier by outlawing personal belief exemptions will have a major effect. “A parent’s decision to ignore science and medical facts puts other children at risk,” says Assemblyman Lorena Gonzalez (D-San Diego), who is co-sponsoring the personal-belief repeal.

It’s possible that publicity about the current outbreak will drive the vaccine opt-out rate even lower. One factor in vaccine skepticism is complacency about the serious health perils that measles poses for its victims. As of now, few parents can be unaware of the possible consequences of failing to have their children immunized. The last brick in the wall is to remove the option of a waiver based on anything but a genuine, rather than imaginary, medical risk from a shot. Senators Pan and Allen are right to hammer that brick into place.

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