The following editorial appears on Bloomberg Opinion.
The threat from measles is severe and getting worse. According to the Centers for Disease Control and Prevention, the number of U.S. measles cases in the first five months of 2019 surpassed the annual total in each of the previous 25 years. The cause of this surge is no mystery. Too many parents are failing to vaccinate their children.
New approaches are required to help parents recognize the necessity of protecting their children from this dangerous and highly infectious disease. Officials understand the urgency of getting more children vaccinated, but anti-vaccine propaganda has convinced some parents to seek medical exemptions from vaccination, even where not warranted. Doctors who enable this behavior put entire communities at risk.
New York, which accounted for more measles cases this year than any other state, just eliminated religious exemptions for school vaccines. California eliminated non-medical vaccine exemptions for daycare, nursery school and K-12 in 2015. Yet, in a disturbing development, the state now finds it must take the fight one step further. Too many doctors are signing forms claiming a medical exemption without justification.
One study found numerous examples of California doctors citing “conditions that are not consistent with scientifically-justified medical contraindications for immunization (family history of allergies and autoimmune diseases) and of physicians charging steep fees ($150-$300) for medical exemptions.” Reported immunization rates for California kindergartners declined over the past two school years. Some exemptions were regionally concentrated, suggesting that unjustified medical exemptions were the cause, not legitimate (and rare) medical needs.
To weed out fraudulent exemptions, the state senate passed a bill in May directing the California Department of Public Health to develop a standardized medical exemption request form while also tightening criteria for exemptions. The bill’s sponsor, State Sen. Richard Pan, a Democrat from Sacramento, cited figures showing that the rate of kindergartners with medical exemptions quadrupled in the years since the state banned non-medical exemptions.
California Gov. Gavin Newsom created headwinds for the bill, however, voicing vague concerns about “bureaucratic relationships” supplanting doctor-patient relationships. In response, the bill has been amended so that only doctors who write five or more exemptions in a year will receive scrutiny from the state department of public health, along with schools where vaccination rates fall below 95 percent, which is the level necessary to achieve so-called herd immunity and protect infants and others. (The vaccination rate among last fall’s entering class of California kindergartners dipped below the 95 percent threshold.)
Musing about the doctor-patient relationship won’t protect nearly 40 million Californians — or millions more who travel to the state or encounter Californians outside state lines. Doctors who drive down the vaccination rate by indulging, or even spreading, conspiracy theories discredit their profession and put people at risk. Boards of medicine should require physicians to provide accurate information and recommendations about vaccination.
Ultimately, however, it’s the job of the legislature and the governor to safeguard the whole community. The amended bill in California shouldn’t be watered down further. The legislature should pass it, and the governor should sign it.