California Immunization Exemption Legislation

**Note: this post was updated on 10/1/2012. California Assemblyman Richard Pan, MD (D - Sacramento), introduced Assembly Bill 2109 (AB 2109) on February 23, 2012. In California, parents who object to vaccinating their children may sign a “letter or affidavit stating that the immunization is contrary to his or her beliefs” to use California’s personal belief exemption to vaccinations required for school attendance. AB 2109 expands on that requirement by mandating that parents consult with a licensed healthcare provider in order to receive the exemption. Under AB 2109, the provider would sign a form attesting that he or she informed that parent about the risks and benefits of vaccination and the risks of vaccine-preventable diseases. The parent would sign the form as well. The bill was approved by the California Assembly on May 11, 2012, by a vote of 44 to 19, and it has moved to the California State Senate. [Ed. note: The California Senate approved the bill on August 22, 2012. Governor Jerry Brown signed the bill into law September 29, 2012, and made this note: "I will direct the [California Health D]epartment to allow for a separate religious exemption on the form. In this way, people whose religious beliefs preclude vaccinations will not be required to seek a health care practitioner’s signature."]

Assemblyman Pan, a pediatrician, has stated that the aim of the bill is to make sure that parents who opt out of vaccination are informed about the risks and benefits of such a decision, and that medical professionals are the best qualified people to inform parents. In 2010, about 2.5% of California school children had personal belief exemptions to some or all required vaccinations, and that rate appears to be rising.[1]

The bill has been controversial and the subject of many critical opinions from different individuals and groups. For example, Bob Sears, MD, a practicing California pediatrician, wrote that he is concerned “that some doctors will refuse to sign this form.”[2] Alan Phillips, an attorney, states that “(r)eligious objections (to vaccination) concern a higher power not subject to medical opinion.”[3] The Canary Party, a political action group, requested that Assemblyman Pan withdraw the legislation: it views the bill as “an unnecessary intrusion into the rights of parents.”[4] Finally, the National Vaccine Information Center (NVIC), an organization “dedicated to the prevention of vaccine injuries and deaths through public education and to defending the informed consent ethic in medicine,” has stated that this bill would make parents “pay for an expensive appointment at a medical doctor’s office to be given vaccine risk and benefit information that is already available online for free.”[5] This is only a sampling of those who are against this legislation.

Supporting the bill are other individuals and groups. Vincent Iannelli, MD, a practicing pediatrician, wrote that “(m)aking sure that parents are fully informed before thinking about choosing a vaccine exemption, especially since the decision impacts everyone else in the community, seems like the least we can do if these types of vaccine exemptions aren't eliminated all together.”[6] Erin Digitale, PhD, a nutritionist and science writer for the Stanford School of Medicine, wrote that the “law would ensure that parents will learn about their role in building ‘herd immunity’ – the importance of vaccinating to protect not just their own kids but also others – before they choose to forgo vaccines.”[7] The Modesto Bee published an opinion piece stating that the bill “is intended to provide accurate information, and ensure that parents realize that they place their child and other parents' children at risk by failing to get their children immunized.”[8] This also is only a sampling of opinions supporting the bill.

While nothing in the bill states that healthcare providers will have a say in whether or not the children of parents who oppose vaccination will be vaccinated, some fear that this bill will intrude on that choice. On the other hand, those who support the bill point out that parents will be receiving reliable and professional information on the risks and benefits of vaccines and the risks of the diseases they are designed and proven to prevent--some of those risks being very serious. Yet to be determined, however, is whether requiring that parents be exposed to accurate medical information on the risks and benefits of vaccination--and the risks of vaccine-preventable diseases--will translate into reduced rates of vaccine refusal.


[1] "FAQ on AB2109” Immunize.org, available at http://www.immunizeca.org/wp-content/uploads/2012/02/FAQ-AB2109.pdf

[2] “California Bill AB2109 Threatens Vaccine Freedom of Choice,” The Huffington Post, available at http://www.huffingtonpost.com/dr-bob-sears/california-vaccination-bill_b_1355370.html

[3] "ALERT: California's AB 2109 Would Make Doctors Gatekeepers for Non-Medical Vaccine Exemptions!” NaturalNews.com, available at http://www.naturalnews.com/035212_AB_2109_vaccine_exemptions_California.html

[4] “Request that Assemblyman Pan Withdraw AB 2109,” The Canary Party, available at http://www.canaryparty.org/index.php/the-news/84-request-that-assemblyman-pan-withdraw-ab2109

[5] “CA: OPPOSE AB2109 Restricting Personal Beleif Exemptions to Mandatory Vaccination,” NVIC, available at http://nvicadvocacy.org/members/Resources/CAOPPOSEAB2109RestrictingVaccineExemptions.aspx

[6] “Pass the New California Vaccine Bill,” About.com Pediatrics, available at http://pediatrics.about.com/b/2012/03/21/pass-the-new-california-vaccine-bill.htm

[7] “Pending vaccine bill would protect vulnerable Californians,” SCOPE, Stanford School of Medicine, available at  http://scopeblog.stanford.edu/2012/03/pending-vaccine-bill-would-protect-vulnerable-californians/

[8] “We all have a stake in vaccination,” Modesto Bee, opinion-editorial, available at http://www.modbee.com/2012/03/22/2125227/we-all-have-stake-in-vaccination.html

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A perfect example of why no parent should have thier child vaccinated -

Big Pharma giant GlaxoSmithKline (GSK) admitted the company’s whooping cough vaccine had never been tested for long-term efficacy, and that the shot does not provide long-term protection against the illness. It should be noted that a single injection of GSK’s Boostrix vaccine for diphtheria, tetanus, and pertussis (whooping cough) would dose the average 11-year-old with 100 micro-grams of formaldehyde and 400 micro-grams of the heavy metal aluminum according to the National Vaccine Information Center.
Research released earlier this year also showed strong evidence that whooping cough outbreaks among vaccinated children were actually higher than in unvaccinated children.

Pertussis is an interesting case, isn't it? Even natural infection with pertussis doesn't provide reliable long-term protection. And the vaccine isn't perfect, but it still decreases risk of infection and severity of disease. Diphtheria, pertussis, tetanus antigens have been used singly since the 1920s and in combination since the 1940s and have been widely studied.

Re formaldehyde, from the Vaccine Education Center: "This quantity of formaldehyde [in Boostrix, less than .1mg/dose] is considered to be safe for two reasons:

First, formaldehyde is essential in human metabolism and is required for the synthesis of DNA and amino acids (the building blocks of protein). Therefore, all humans have detectable quantities of natural formaldehyde in their circulation (about 2.5 ug of formaldehyde per ml of blood). Assuming an average weight of a 2-month-old of 5 kg and an average blood volume of 85 ml per kg, the total quantity of formaldehyde found in an infant's circulation would be about 1.1 mg, a value at least five-fold greater than that to which an infant would be exposed in vaccines.
Second, quantities of formaldehyde at least 600 fold greater than that contained in vaccines have been given safely to animals." http://www.chop.edu/service/vaccine-education-center/hot-topics/formaldehyde.html

Re aluminum, also from the VEC: "The aluminum contained in vaccines is similar to that found in a liter (about 1 quart or 32 fluid ounces) of infant formula. While infants receive about 4.4 milligrams of aluminum in the first six months of life from vaccines, they receive more than that in their diet. Breast-fed infants ingest about 7 milligrams, formula-fed infants ingest about 38 milligrams, and infants who are fed soy formula ingest almost 117 milligrams of aluminum during the same period." Also "Given the quantities of aluminum we are exposed to on a daily basis, the quantity of aluminum in vaccines is miniscule. Aluminum-containing vaccines have been used for decades and have been given to over one billion people without problem. In spring 2000, the National Vaccine Program Office (NVPO) reviewed aluminum exposure through vaccines and determined that no changes to vaccine recommendations were needed based on aluminum content. The Global Advisory Committee on Vaccine Safety, part of the World Health Organization (WHO), has also reviewed studies and found no evidence of health risks that would require changes to vaccine policy." http://www.chop.edu/service/vaccine-education-center/hot-topics/aluminum.html

And perhaps you'd like to cite a source for your claim that "whooping cough outbreaks among vaccinated children were actually higher than in unvaccinated children"? The studies I know of all indicate that risk for pertussis is reduced with vaccination (eight-fold, for example, in this study: Misegades LK, Winter K, Harriman K, Talarico J, Clark T, Martin SW. DTaP effectiveness: results from the California pertussis vaccine effectiveness assessment. In: Proceedings of the 49th Infectious Diseases Society of America; October 20–23, 2011; Boston, MA. Arlington, VA: Infectious Diseases Society of America; 2011.) And, a recent MMWR on pertussis in Washington states clearly, "Although vaccinated children can develop pertussis, they are less infectious, have milder symptoms and shorter illness duration, and are at reduced risk for severe outcomes, including hospitalization." http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6128a1.htm

I would suggest you read Dr. Cherry's recent article in NEJM for a well-informed perspective on the challenges of pertussis. http://www.nejm.org/doi/full/10.1056/NEJMp1209051

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