California vaccination rate drops as doctors grant more exemptions
California’s kindergarten vaccination rate dropped again in the most recent school year as more parents sought permission from doctors to not immunize their children, according to new state data.
The troubling trend comes amid a national measles outbreak as well as intense debate over whether California should strengthen its school immunization laws.
California already has one of the strictest vaccination laws in the country, preventing children from skipping their shots unless a doctor says they have a medical reason to be exempt. Some health advocates fear that parents are obtaining exemptions for their children without valid medical reasons. Those advocates are now pushing lawmakers to clamp down on fraudulent exemptions.
In the school year that ended last month, 4,812 kindergartners had obtained medical exemptions from vaccines, a 70 percent increase from two years ago, when the vaccination law first took effect, according to data from the California Department of Public Health. The data suggests that large concentrations of medical exemptions are being granted to school children in relatively affluent parts of the state, such as Santa Cruz and Sonoma counties.
“It’s alarming that you’re having increasing numbers of medical exemptions,” said Dr. James Campbell, a member of the American Academy of Pediatrics’ infectious disease committee. “You cannot imagine that that number of additional people now have new medical problems.”
The newly released data analyzed by the Los Angeles Times also shows:
The kindergarten vaccination rate in California dropped to 94.8 percent in 2018-19 from 95.1 percent in 2017-18 and 95.6 percent the previous year.
The school districts with the most medical exemptions were L.A. Unified, Capistrano Unified and San Diego Unified. The rate of medical exemptions in Capistrano Unified – a smaller district in Orange County – was 10 times higher than that of L.A. Unified’s.
About 1,500 schools in California had kindergarten vaccination rates below 95 percent.
At 117 schools, 10 percent or more of the kindergartners were not immunized because their doctors had excused them from vaccines. At 17 schools, 30 percent or more of the kindergarten class had medical exemptions on file.
Overall, .9 percent of kindergartners had medical exemptions in 2018-19, up from .7 percent in 201718 and .5 percent the previous year.
Following a major measles outbreak centered at Disneyland, California passed a law in 2015 barring parents from citing their personal beliefs to avoid vaccinating their kids. California, which had become a hotbed for antivaccine sentiment, joined just two other states with such a restriction.
Three years after the law took effect, some lawmakers suspect that parents and doctors are submitting exemptions for invalid reasons. A recent Voice of San Diego investigation found that doctors penned exemptions for reasons such as “eczema” and “food allergies.”
Under Senate Bill 276, the state’s health department would review and potentially reject any child’s medical exemption if they attend a school or day care with an immunization rate of less than 95 percent. Physicians say that 95 percent of children must be immunized to prevent the spread of the most contagious diseases, such as measles.
According to the new state data, health department officials would have to review more than 1,500 schools under the law, making up approximately a quarter of all schools statewide.
“Frankly, trying to refuse vaccines when your child needs it is an issue of privilege,” said state Sen. Richard Pan, D-sacramento, a pediatrician who wrote SB 276 as well as the original 2015 vaccination law. “What you are doing is relying on everyone else to vaccinate their child to protect yours.”
The new data is already sparking debate on whether the medical exemption spike is contributing to the state’s reduced vaccination rate. The data shows that 5.2 percent of kindergartners were not vaccinated in 2018-19, which includes the nearly 1 percent of kindergarten students statewide who obtained medical exemptions.
The decrease in the overall vaccination rate is also attributable to an increase in students being homeschooled, which allows them to skip their shots, according to state data. The remaining unvaccinated children either didn’t have their required vaccines at the beginning of the school year but were expected to by the end of the year or were marked as overdue and may have been excluded from school.
Rebecca Estepp, a San Diego mother who opposes SB 276, said she thinks the focus on medical exemptions is misguided.
Estepp said that before California banned the personal belief exemption, there were more than 14,000 kindergartners with either medical or personal belief exemptions. Now, just 4,800 kindergartners have an exemption, a major drop, she said.
“There’s only a third of the exemptions there used to be, so I don’t understand this overreaching bill,” she said.
Leigh Dundas, an attorney who works with the opposition group Advocates for Physicians’ Rights, agreed that the public health department’s data shows medical exemptions aren’t the driving factor in low vaccination rates.
Half of the 1,500 schools that would come under state scrutiny if SB 276 was signed into law have no medical exemptions. Instead, those schools have large rates of undervaccinated children who enrolled in private homes schools or in off-campus independent study programs. Those students would not be affected by the bill.
“What is the problem this legislation is trying to solve?” Dundas said. “When you are playing with less than 1 percent, anyone who has taken a junior high math class knows that is statistically insignificant.”