Call to Action: Contact Senate Appropriations Committee Before August 6, 2012

If you want to take action to protect California's public health, take action!  AB 2109 is a very simple bill. If a parent wishes to  send her child to school without the required vaccines the parent must document having had a face-to-face conversation about vaccine risks and benefits with a licensed health care provider.

That's it.  That's all.  AB 2109 doesn't take away "parent choice" or "attack legal vaccine exemptions" or "force parents into a relationship" or any of the other specious objections the anti-vaccine forces, lead by the National Vaccine (mis)Information Center (NVIC) VIC and the Canary Party, have ginned up.

The action you need to take is to fax and email  the members of the Senate Appropriations Committee, tell them why you support AB 2109, and ask them to join you.  A draft letter is at the bottom of this post.  It is also available as a Word document on the Facebook page, 


Members (links lead to web page with contact form; email addresses where available. Fax numbers below.) 

• Senator Christine Kehoe (Chair)  senator.kehoe@sen.ca.gov
• Senator Mimi Walters (Vice Chair)
• Senator Elaine Alquist
• Senator Bob Dutton
• Senator Ted W. Lieu
• Senator Curren Price  senator.price@senate.ca.gov
• Senator Darrell Steinberg

Addresses & Staff

• Staff Director: Bob Franzoia
• Consultants: Marie Liu, Brendan McCarthy, Mark McKenzie, Jolie Onodera, Maureen Ortiz and Jacqueline Wong-Hernandez
• Assistants: Jennifer Douglas and Lydia McKim
• Phone: (916) 651-4101
• Room: 2206

So far, this is what we know:

Silent or not stating position:

Senator Christine Kehoe (Dem) (Chair) Fax: 916-327-2188
Senator Elaine Alquist (Dem) Fax: 916-324-0283

Position unknown

Senator Ted W. Lieu (Dem) Fax: 916-323-6056
Senator Curren Price (Dem) Fax: (916) 445-8899
Senator Darrell Steinberg (Dem) Fax: 916-323-2263


Leaning toward opposition
Senator Bob Dutton (Rep) Fax: 916-327-2272


In opposition 
Senator Mimi Walters (Rep) (Vice Chair) Fax: 916-445-9754

If any of these senators represent you, you may also wish to contact the Senator via phone, to express why you support AB 2109.

Draft letter for your use.  Feel free to copy and paste, or you can download a Word doc version from the Facebook page, http://www.facebook.com/groups/385230668174221/450955078268446/

[insert your letterhead here]

July 30, 2012

Senator Christine Kehoe, Chair Fax: 916-327-2188
Senator Mimi Walters, Vice Chair Fax: 916-445-9754
Senator Elaine Alquist Fax: 916-324-0283
Senator Bob Dutton Fax: 916-327-2272
Senator Ted W. Lieu Fax: 916-323-6056
Senator Curren Price Fax: (916) 445-8899
Senator Darrell Steinberg, Senate President pro tem Fax: 916-323-2263

re: Support for AB 2109

Dear Senator [name]

I am writing to ask you to vote in favor of AB 2109 when it comes before the Senate Appropriations Committee on August 5, 2012.

The current law is extremely lax. It merely requires that the parent sign the statement below:



AB 2109 is very simple. It merely requires that if a parent wishes to send her child to school without the required vaccines the parent must document having had a face-to-face conversation about vaccine risks and benefits with a licensed health care provider.

I support this bill for several reasons. There are wide variations in rates of Personal Belief Exemptions (PBE). Some public schools have rates as high as 81%. Children who are unvaccinated against measles are 22 to 224 times more likely to contract disease. This represents a cost to government and to individuals: the 2008 San Diego measles outbreak was caused by an unvaccinated child with a PBE; eight of the nine measles-infected children old enough to be vaccinated had PBEs. It cost about $177,000 to contain; the figure does not include the hospitalization costs for several of the children or parents’ lost wages.

According to figures published by the California Department of Education, there were 12,256 incoming kindergarteners with PBEs in the 2011-2012 school year. (see http://www.cdph.ca.gov/programs/immunize/Pages/ImmunizationLevels.aspx)

I was on a conference call with Dr. Pan on Tuesday, July 24, 2012. In that call, Dr. Pan explained that his sense is that many parents choose the PBE option out of convenience or fear, rather than conviction. The student may have fallen behind in one or more of the required vaccines due to lack of time, access to medical care, or financial issues. The parent then takes the option of signing the PBE at the time of school entry out of convenience. In other cases, parents may be unsure of the value of one or more vaccines, and rather than discuss these concerns with a trained health care provider, will sign the PBE. AB 2109 will address both these issues.

The question for your committee is, what will it cost the state if AB 2109 becomes law? An AB 2109 opponent claimed that it would cost “millions”. If “millions” means $2 million, that means that each PBE at 2011-2012 rates would cost the state around $163.00, which is a ridiculously high figure.

It is my sense that the cost to California will be modest, and would be somewhat offset by savings in public health expenditures. Without examining each of the 7,327 schools in the data table cited above, schools with a high percentage of low-SES students tend to have a higher rate of fully-vaccinated students, compared to schools in high-SES areas. The data on private schools are equivocal; those influenced by anthroposophical notions or Waldorf philosophy tend to have high PBE rates while more main-stream private schools tend to have high rates of fully-vaccinated students.

I hope you will agree with me that this bill is a benefit to California’s health.

Sincerely,

Listening to those opposed to AB 2109: Dawn Winkler

These were the instructions from the Chair:

The "Dawn" is Dawn Winkler, a long-time anti-vaccination activist, who is determined to defeat AB 2109

Dawn's "83 of 105" figure was from "research" was evidently done by Amy Templeton Helstrup. Evidently she called pediatric practices in a 30-mile radius of her zip code.  I'm not sure what she asked; I can imagine that you could phrase the question in such a way to get the scheduler to refuse.  So pediatric practices are refusing to take new families who are vaccine-refusers.

Yes, evidently Dawn lost a daughter to SIDS, which she insists is vaccine-induced.

HAPI is Health Advocacy in the Public Interest.  In 2004 they sent 4 vaccine syringes for testing to Doctor's Data, a notorious lab.  It's not clear to me that Doctor's Data is even competent to test vaccines.

I'm not sure what the next tweet is about.  Evidently the anti-vaccine forces proposed a number of amendments to the bill, but I can't find texts for them.

This was the end of Winkler's testimony.  Up next is the D-list actor, Rob Schneider

Listening to those opposed to AB 2109: Julian Whittaker, MD

Julian Whittaker, MD testified before the committee.

 Dr. Whitaker's facebook page and his page opposing AB2109.

Oh the "more vaccines makes the infant mortality go up" canard AND the "vaccines didn't save us canard".  Straight out of the vaccine rejectionists' playbook.  For the former, see Science Based Medicine.  For the latter, see Respectful Insolence.

Whitaker wants the vaccine consult to mis-state the evidence.  Unvaccinated children not health risks?  Tell that to all the infants who contracted measles from unvaccinated children.

How is a simple conversation "harassment"?  

The government mandates behavior all the time.  Think of seat belts.

Here come some more canards and FUD.

Whitaker probably doesn't know that the awards amount to about 1.3 awards per million doses of vaccines.  No, he's using the "the amount  awarded is so large, vaccines must be dangerous".  Nope. I have no idea what the 40 million children are.

Will parents be told the truth about the risks?  I hope so.  Again and again, the risks of all diseases we vaccinate against are much higher than the risks form the vaccination.

The Merck suit is the new stick to convince people that all pharma is corrupt.

I shouldn't be surprised.  This is how Whitaker describes himself on his facebook page:

 A pioneer of alternative medicine, Dr. Whitaker is an expert on nutritional supplementation and has been offering guidance on natural therapies for over 30 years.

Description
Julian Whitaker, MD - For more than 30 years, I've been practicing alternative medicine and giving my patients drug-free and surgery-free options for heart disease, diabetes, and other common conditions.

He blames vaccines for autism and other disorders.

And he's actually proud of being recognized by a predatory quack:
•30th Anniversary Award of Excellence, Burzynski Clinic, 2008

And by other quacks.
•American Physician Award, Reflexology of America, 2006

Listening to those Opposed to AB 2109: Intro

I have been keeping an eye on what the opposition has been saying.  A twitter user named CaliVaxChoice live-tweeted last week's Health Committee Hearing.  Here they are in order, with my comments interspersed.

I imagine the strictness had to do with the conduct of the anti-AB2109 contingent at previous hearings on this bill, not following the instructions, going overtime, and so forth.

Say CaliVaxChoice, herd immunity not just a claim; measles outbreaks not a fiction.

 I'm not sure what "claims internet is misguided" is about, unless referring to outright misinformation, distortions, and fear-mongering at sites such as NVIC, VaxChoice etc.

I have to come up with a name for the "It's Always About the Money".  The elided claim here is that pediatricians are supporting AB 2109 because they will all make much, much more money if this bill passes.

 Well that is an ugly little comment.  I need to look up the death rate from pneumococcal disease before the advent of the vaccine.  

It's not a "claim" it's a fact that children unvaccinated against pneumococcal disease are X times more likely to catch the disease.  Golly, how hard is that to understand?

History of Vaccines on AB 2109

The excellent and informative website, History of Vaccines, also has a blog, where  a fair and balanced article on AB 2109 was published. The conclusion:

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.

Handy Infographic: CDC Recommended Vaccines and California Required Vaccines

This is the first draft, as it has not been checked for accuracy by a health care provider or immunization professional.  Personally I think that this would have been helpful to the Health Committee.

On to the Senate Appropriations Committee

The next step is the Senate Appropriations Committee.  As of this writing, the bill hasn't been calendared.

 Members
Senator Christine Kehoe (Chair)
Senator Mimi Walters (Vice Chair)
Senator Elaine Alquist
Senator Bob Dutton
Senator Ted W. Lieu
Senator Curren Price
Senator Darrell Steinberg

Addresses & Staff
Staff Director: Bob Franzoia
Consultants: Marie Liu, Brendan McCarthy, Mark McKenzie, Jolie Onodera, Maureen Ortiz and Jacqueline Wong-Hernandez
Assistants: Jennifer Douglas and Lydia McKim
Phone: (916) 651-4101
Room: 2206

Huzzah! AB 2109 Passed Senate Health Committee, 7-1

Vote June 27, 2012
Ayes:

Elaine Alquist (D-13)
Sam Blakeslee (R-15)
Mark DeSaulnier (D-7)
Tom Harman (R-35) (Chair of the Senate Republican Caucus and Vice Chair of Health)
Ed Hernandez (D-24) (Chair of the Health Committee and an optometrist)
Michael J. Rubio (D-16)
Lois Wolk (D-05)

Noes
Joel Anderson (R-36)


No Vote Recorded
Kevin deLeón (D-22)

Here is the amended bill (as of June 20, 2012)
http://www.leginfo.ca.gov/pub/11-12/bill/asm/ab_2101-2150/ab_2109_bill_20120620_amended_sen_v97.pdf

History, As of June 27

BILL NUMBER  : A.B. No. 2109
AUTHOR : Pan
TOPIC : Communicable disease: immunization exemption.

TYPE OF BILL :
                Active
                Non-Urgency
                Non-Appropriations
                Majority Vote Required
                State-Mandated Local Program
                Fiscal
                Non-Tax Levy

BILL HISTORY
2012
June 27 From committee: Do pass and re-refer to Com. on  APPR. (Ayes  7.
Noes  1.) (June  27). Re-referred to Com. on  APPR.
June 20 From committee chair, with author's amendments:  Amend, and re-refer
to committee.  Read second time, amended, and re-referred to Com. on
HEALTH.
May 31 Referred to Com. on  HEALTH.
May 10 In Senate.  Read first time.  To Com. on RLS. for assignment.
May 10 Read third time. Passed. Ordered to the Senate. (Ayes 47. Noes 26.
Page 4770.)
May 3 Read second time. Ordered to third reading.
May 2 From committee:  Do pass. (Ayes 12. Noes  5.) (May  2).
Apr. 24 Re-referred to Com. on  APPR.
Apr. 23 Read second time and amended.
Apr. 19 From committee: Do pass as amended and re-refer to Com. on  APPR.
(Ayes 13. Noes  5.) (April  17).
Mar. 12 Referred to Com. on  HEALTH.
Feb. 24 From printer.  May be heard in committee  March  25.
Feb. 23 Read first time.  To print.


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Legislative Analysis of AB 2109

Link is http://www.leginfo.ca.gov/pub/11-12/bill/asm/ab_2101-2150/ab_2109_cfa_20120501_150815_asm_comm.html

Here is a short exerpt:
)Rationale  . According to the author, this bill preserves a
            parent's option to exempt their child from immunization
            requirements and ensures that a decision to do so is an
            informed one, based on accurate and up-to-date information
            regarding individual and public health risks of not immunizing
            their child.  According to the author, the number of vaccine
            exemptions has increased dramatically in the last decade,
            leading to real concern about the loss of "herd immunity" and
            potential for serious disease outbreaks, particularly in
            school classrooms and communities whose exemption rates can
            exceed 40%. He indicates that misinformation widely available
            on the internet and sensationalist media reports have made it
            more difficult for parents to receive accurate, fact-based
            information about vaccines and to ascertain what information
            is reliable.  In addition, he indicates the bill will preserve
            the right to exemption for those with deeply held beliefs,
            while deterring parents who may request an exemption out of
            convenience.  Under current law, exemption only requires a
            parent's signature and is simpler than submitting proof of
            vaccination.  

            This bill is supported by a wide range of public health
            agencies and medical associations, and is co-sponsored by the
            California Medical Association, California Immunization
            Coalition, American Academy of Pediatrics, and the Health
            Officers Association of California.

Letters to Appropriations Committee

Individually-addressed letters to members of the Appropriations Committee


Clicking on the links below will take you to Google Docs, which will allow you to download and edit each letter.  Each letter has further instructions.

You may also send several letters to each Assemblymember, emphasizing different elements in each letter.

• Letter to Fuentes
• Letter to Harkey
• Letter to Blumenfield
• Letter to Bradford
• Letter to Calderon
• Letter to Campos
• Letter to Davis
• Letter to Donnelly
• Letter to Gatto
• Letter to Hall
• Letter to Hill
• Letter to Lara
• Letter to Mitchell
• Letter to Nielsen
• Letter to Norby
• Letter to Solorio
• Letter to Wagner

Additional Paragraphs for Your Use (in process)

You can download these paragraphs or copy-paste from the links and add them to your letter, if you wish.

• Safety and efficacy of vaccines 
• Sources of vaccine misinformation and accurate information
• Alternative ways of meeting need for health care worker's signature
• Opposition to naturopaths (per Orac Knows at Respectful Insolence)

California's AB 2109: Will Vaccine-Refusing Families Have A Hard Time Finding Health Care?

Here's Dr. Bob Sears on the issue:

However, what gravely concerns me is that some doctors will refuse to sign this form. I know how doctors think. Many doctors strongly believe that vaccines should be mandatory, and that parents should not have the right to decline vaccines. Some doctors are willing to provide care to unvaccinated kids, despite this difference in philosophy. But now the power over this decision will be put directly into doctors' hands. He or she can simply refuse to sign the form. Doctors who oppose vaccine freedom of choice have been frustrated for years over this issue. Finally, they will have the power to impose their beliefs on their patients. Patients will be forced to find another doctor to sign the form, submit to vaccines, or get kicked out of public school.

Several things to notice: he's sure that only doctors can sign the form (wrong: Physician Assistants and Nurse Practioners with appropriate qualifications can sign); and notice that he doesn't quantify anything, or use any facts.  It's just "I know how doctors think" and the threat of "being kicked out of public school".

It's important to know how many vaccine providers there are (pediatricians, family practice MDs, and the county health departments' low-cost or free vaccine clinics) and how many of those would "fire" or discharge vaccine-refusing families.

The survey of physicians reported at the 2011 meeting of Infectious Diseases Society of America showed enormous regional variation in practice responses to vaccine refusal.  The survey didn't cover California or the West at all.

Let's look at some real doctors.

Heidi Roman MD is a mother and a pediatrician who practices in California.  She recently wrote Why I Won't Fire Vaccine-Hesitant Families, giving three sound reasons

....the particular issue of families who are hesitant about vaccinating their children is something all child health providers have come across. I won’t dismiss patients/families for this reason.

Wendy Sue Swanson MD practices in Washington state, but has written (and made videos) about vaccine issues.  In Pediatricians Who Refuse Families Who Don't Immunize, she wrote

I will always keep my practice open to vaccine-hesitant families. However, the waiting room risk (unimmunized kids & risk to vulnerable populations–ie infants, those too young for vaccines, and immunocompromised children) is a good one and the only compelling reason to close to patients who refuse immunizations in my opinion.
But it’s not a good enough reason for me to send families away who have questions and hesitations about the AAP/CDC schedule. All children deserve a pediatrician versed in immunization benefit/risk & deserve an expert in conversation w their parents to foster insight & understanding. Frankly, if waiting room risk is the concern, there are ways to create separate waiting rooms for kids “up to date” and kids who are not.

Roy Benaroch, MD at The Pediatric Insider develops a typology of vaccine-refusing parents, and  concludes:

...my own philosophy that it’s not the kids fault they’re not vaccinated; and with patience and continuous discussions, I can usually get even the most stubbornly misinformed parents to vaccinate. So finally, with a lot of extra work, the kids get protected. That’s my goal.

Linda Shaw MD practices in a low-income area, and has very, very few vaccine-hesitant or vaccine-refusing families.  Given the constraints of her practice,

Our practice group has decided that caring for vaccine-refusing patients is too much of a liability risk. We will alter vaccine schedules if the parents request it, but they are informed that they may have additional out-of-pocket costs. Patients who adamantly refuse to consider immunization for their children are asked to find another provider to see them. (We will also discharge from the practice patients who chronically "no show" for appointments.)

I think that even if AB 2109 passes, the California Medical Association or the two Public Health Associations (North and South) should sponsor research into the facts on vaccine refusal and hesitancy in California.

Dr. Bob Sears: What Was His Role in the 2009 San Diego Measles Outbreak?

I am keeping a list of reactions (pro and con) to the California Assembly Bill 2109 (AB 2109), which would make Personal Belief Exemptions (PBE) to required school entry vaccinations  slightly -- very slightly-- more difficult to obtain.

But there's a side issue.  One of the opponents to the legislation, Dr. Bob Sears, has been caught in ... a fib?  a misunderstanding?

I decided not to add those posts to the list, because the Dr. Bob question isn't really about AB 2109, but about the veracity of a physician who has done more to raise false fears of vaccines.  (If you think that's an exaggeration, why don't you read The Problem With Dr. Bob's Alternative Vaccine Schedule (full text at Pediatrics or  Download Offit_Problems_Dr_Bob_Alterna_Schedule (PDF))
What Dr. Bob claimed:




"I was not involved in that [the San Diego measles outbreak] at all."
But he was.
December 29, 2008, in the Orange County Register:

As it turns out, the boy who spread measles is a patient of Dr. Bob Sears, pictured at left, a member of the famous San Clemente pediatrician family and author of “The Vaccine Book.” 

"NOR have I ever spoken with Seth [Mnookin]"
But he has.
A number of people stepped up to confront Dr. Bob, both in commentsat the Huffington Post and later on other blogs.

• March 26, 2012 Seth Mnookin at the Panic Virus: Bob Sears: Bald-faced Liar, Devious Dissembler, or Both (includes Mnookin's taped interview with Sears)
• March 27, 2012 Orac at Respectful Insolence Dr. Bob Sears vs. Seth Mnookin: Measles Outbreaks, AB 2109, and Lacking the Courage of One's Convictions
• March 27, 2012 Sullivan at Leftbrain/Rightbrain Who Decides Which Facts Are True?  Perhaps Not Dr. Bob

And here is Dr. Bob's rather ranty response to Lilady's repeated questioning.



Updated 3/28/2012 There is some confusion.  From news reports in 2008:
The measles-in-the-doctor's-waiting-room transmission:

Eight of the measles cases originated from the Cooperative Charter School, while another four stemmed from the Children's Clinic in La Jolla, according to county health officials.

And this news report from February 16 2008 at SignOn San Diego

The measles outbreak is San Diego County's first since 1991. It began when a 7-year-old patient returned from Switzerland on Jan. 15 with what would later be confirmed as measles. He or she infected two siblings and at least four classmates. The 8-year-old patient identified yesterday is a classmate of the 7-year-old.

On Jan. 25, the 7-year-old's parents took the youngster to the Children's Clinic of La Jolla. The child may have coughed and sneezed in the office, thus infecting four other children.

<\

California: Immunizations Required for Daycare and School Entry AB 2109

Currently in California, it is cheaper and easier to get an exemption from vaccine requirements for school entry than it is to actually comply with the requirements.
Now Assemblymember Richard Pan (D 5th District), a pediatrician, is planning to change that.  He has introduced AB 2109. (As of March 24, the bill is still in the Assembly Health Committee.) The change in the law is pretty mild: parents wishing an exemption have to talk to a licensed health care provider and have a form signed (just as they do if they are vaccine-compliant).
But I've heard read wild talk of what is required, so I thought I'd post a handy guide:
Immunizations Required for Daycare Attendance :


Immunizations Required for k-12 Attendance 


Read why the US vaccinates against Hepatitis B in childhood.  I live in a part of the United States where Asians and Pacific Islanders (API) make up a significant portion of the population.  The Stanford Asian Liver Center writes:

Why should Asian and Pacific Islanders care about Hepatitis B?
Despite the fact that only 0.2-0.5% of the U.S. population has chronic hepatitis B infection, this is still 1.25 million people, over half of whom are Asian and Pacific Islander (API) Americans. Depending on their country of origin, 5-15% of API immigrants have chronic hepatitis B. In some Pacific Rim countries, as many as 10-20% of the population are chronically infected.

Vaccine Exemptions in California: How Many Exemptions, and How Much Will They Cost? re AB 2109

Bob Sears is a vaccine-rejecting physician.  In a post claiming California Bill AB2109 Threatens Vaccine Freedom of Choice, Sears claimed:

At a time when we are trying to decrease health care spending, this bill will add millions of dollars of extra health care visits for families every year.

I haven't seen anyone quantify the numbers of exemptions and the costs yet.  The bill would become effective as of the beginning of the 2013-2014 school year.  As of the 2010-2011 school year (the last year rates were published) over the whole state, an average of 2.28% of incoming kindergarteners' parents had a Personal Belief Exemption

There are at least two times that families have to provide proof of immunization or an approved exemption, at the beginning of kindergarten (required vaccines) and at the beginning of 7th grade (TdaP-- whooping cough booster)

According to California state records: at http://www.cdph.ca.gov/data/statistics/Documents/VSC-2007-0201.pdf
566,137 live births in 2007 (estimate for incoming kindergarteners in fall of 2013)
529,245 live births in 2002 (estimate for incoming 7th graders in fall 2013)
566,137* 0.0228 = 12,680 (with rounding)
529,245** 0.0228 =12,067 (with rounding)
Let's say AB 2109 passes, and let's just round up to 25,000 students whose parents are refusing vaccines who require a signed form from an MD, DO, Physician's Assistant or Nurse Practioner (yes, the latter two can provide the education and sign the form.   "Millions of dollars" -- well, that would be at least $2 million.  Therefore:
25,000 * X = 2,000,000
X= $80.00
I'm trying to find out what the largest HMO in California, Kaiser Permanente, charges for a drop-in vaccine clinic visit, without success so far.

My own provider, Palo Alto Medical Foundation, offers a host of classes on various parenting topics.  The baby-safety basics class is two hours and costs $40.00. So I believe that the cost to vaccine-refusing parents of complying with the provisions in AB 2109 would be far less than $80.00.

The decision not to vaccinate has dollar costs also.  The 2008 San Diego measles outbreak (which originated with an intentionally unvaccinated child who was a patient of Bob Sears) was quantified:

The importation resulted in 839 exposed persons, 11 additional cases (all in unvaccinated children), and the hospitalization of an infant too young to be vaccinated. Two-dose vaccination coverage of 95%, absence of vaccine failure, and a vigorous outbreak response halted spread beyond the third generation, at a net public-sector cost of $10376 per case. Although 75% of the cases were of persons who were intentionally unvaccinated, 48 children too young to be vaccinated were quarantined, at an average family cost of $775 per child.

 That's a healthy chunk of change for a family, $775.

Roundup For And Against California's Immunization Exemption Bill, AB 2109

This list will be updated silently
 Currently in California, it is cheaper and easier to get an exemption from vaccine requirements for school entry than it is to actually comply with the immunization requirements. 
Now Assemblymember Richard Pan (D 5th District), also a physician, is planning to change that.  He has introduced AB 2109, which adds the requirement that parents speak with a licensed health professional.  The bill passed the Assembly Health Committee on April 17, 2012.
Blog posts and newspaper reports on AB 2109--In favor

• February 29, 2012: Press release from Richard Pan Dr. Pan Introduces Bill to Provide Parents Immunization Information to Prevent Outbreaks
• March 20, 2012 Kenny Goldberg, KPBS Bill Attempts To Reduce Number Of Unimmunized Children In California
• March 20, 2012 ToddW at Harpocrates Speaks California Assembly Working to Protect Public Health
• March 20, 2012 Liz Ditz at I Speak Of Dreams Californians, Protect The Health of All Children: Support AB 2109 (with links to the Assembly Health Committee)
• March 21, 2012 Vincent Iannelli at About Pediatrics Pass the New California Vaccine Bill
• March 22, 2012 Erin Digitale at Scope Stanford School of Medicine Blog Pending vaccine bill would protect vulnerable Californians
• March 22, 2012 Modesto and Sacramento Bee Editorial We all have stake in vaccination rate
• March 22, 2012 ToddW at Harpocrates Speaks The Anti-Vaccine Crowd Shows They Are Anti-Informed Consent
• March 22, 2012 Nurses Who Vaccinate at Nurses Who Vaccinate California's AB 2109
• March 23, 2012 Orac at Respectful Insolence California Bill AB 2109 Real Informed Consent vs. Anti-Vaccine Misinformed Consent
• March 24, 2012  Liz Ditz at I Speak of Dreams California's AB 2109, Strengthening School-Entry Vaccination Requirements, A Mild Change
• March 25, 2012 Liz Ditz at I Speak of Dreams Vaccine Exemptions in California: How Many Exemptions and How Much Will They Cost (re AB 2109) 
• March 26, 2012 David Gorski MD at Science-Based Medicine California Bill AB 2109 The Anti-Vaccine Movement Attacks School Vaccine Mandates Again
• March 29, 2012 Hannah Guzik, California Health Report  Number of vaccinated kids drops steadily in California

Blog posts and newspaper reports on AB 2109--Oppposed

• March 2, 2012 Tim O'Shea DC End of Vaccine Exemptions in California?
• March 5, 2012 Sayer Ji various sources  Corporate Media Blackout On AB 2109 Threatening Vaccine Rights
• March 11, 2012 Alan Phillips JD at Natural News ALERT: California's AB 2109 Would Make Doctors Gatekeepers for Non-Medical Vaccine Exemptions!
• March 11, 2012 at Susanne Posel at Occupy Corporatism  AB 2109 Legislation To Take Away Our Right Not To Vaccinate
• March 14, 2012 Action Alert, Autism Action Coalition  Senator Wolk Receives $58K from Vaccine Manufacturers and Sponsors Restrictive Exemption Bill
• March 15, 2012 Sylvia Pimental of the Canary Party Request Assemblyman Pan Withdraw AB 2109
• March 22, 2012 Bob Sears ("Dr. Bob") at Huffington Post California Bill AB2109 Threatens Vaccine Freedom of Choice
• March 23, 2012 Dawn Richardson of NVIC, e-mail posted at another blog Let's Stop AB2109
• March 25 Emily at Laundry and Lullabies AB 2109 - no "personal belief" vaccine exemptions
• No date: Dawn Richardson  at the National Vaccine (mis)Information CenterCalifornia: Oppose AB 2109 Restricting Vaccine Exemptions

Evidence-Based Resources

• Shots for School (California Department of Health Website)
• Informed Consent for Vaccination from VaccineEthics.org
• Vaccination Requirements and Exemptions from VaccineEthics.org
• Vaccination Refusal: Ethics, Individual Rights, and the Common Good by Jason L. Schwartz, MBE, AM and Arthur L. Caplan, PhD

California's AB 2109, Strengthening School-Entry Vaccination Requirements, A Mild Change

Currently in California, it is cheaper and easier to get an exemption from vaccine requirements for school entry than it is to actually comply with the requirements. 
Now Assemblymember Richard Pan (D 5th District), also a physician, is planning to change that.  He has introduced AB 2109. (As of March 24, the bill is still in the Assembly Health Committee.) The change in the law is pretty mild.  Vincent Iannelli MD summarizes the change:

Instead of simply signing a personal belief vaccine exemption form on their own, parents will be required to have a written statement signed by a [licensed] health practitioner that says the parent was given information about the benefits and risks of immunizations and the risks of certain vaccine-preventable diseases.

The provisions of AB 2109 are much milder than the recommendations from the The Pediatric Infectious Diseases Society ( Download Pediatric_infectious_disease_soc_vaccine_exemptions).  I've excerpted part of the Position Statement below, and added emphasis
Position Statement Regarding Personal Belief Exemption from Immunization Mandates from The Pediatric Infectious Diseases Society March 2011

It is recognized that in some states, failure to pass personal belief exemption legislation or regulation could result in public backlash that will erode support for immunization mandates. If legislation or regulation is being considered in this situation, it should contain the following provisions, which are intended to minimize use of exemptions as the “path of least resistance” for children who are behind on immunizations (whereby it would be easier to obtain an exemption than to catch-up the child’s immunizations):

• The personal belief against immunization must be sincere and firmly held.
• Before a child is granted an exemption, the parents or guardians must receive state-approved counseling that delineates the personal and public health importance of immunization, the scientific basis for safety of vaccines, and the consequences of exemption for their child as well as other children in the community who are vulnerable to disease and cannot otherwise be protected.
• Before a child is granted an exemption, the parents or guardians must sign a statement that delineates the basis, strength, and duration of their belief; their understanding of the risks that refusal to immunize has on their child’s health and the health of others (including the potential for serious illness or death); and their acknowledgement that they are making the decision not to vaccinate on behalf of their child.
• Parents and guardians who claim exemptions should be required to revisit the decision annually with a state-approved counselor and should be required to sign a statement each year to renew the exemption.
• Children should be barred from school attendance and other group activities if there is an outbreak of a disease that is preventable by a vaccination from which they have been exempted. Parents and guardians who claim exemptions for their children should acknowledge in writing their understanding that this will occur.
• States that adopt provisions for personal belief exemptions should track exemption rates and periodically reassess the impact that exemptions may have on disease rates.

Despite the relative mildness of AB 2109, both in-state and out-of-state anti-vaccine activists are opposing the bill.

Current status of the bill:

• Passed the Health Committee 
• Next: Appropriations Committee (not yet scheduled)