THE ISSUE: The Assembly Appropriations Committee will soon consider a bill by Assemblyman Richard Pan, D-Sacramento, that would require parents to obtain a signed waiver from a doctor before seeking personal-belief exemptions from required immunizations.

Should we make it harder for parents to opt their kids out of vaccinations?

Ben Boychuk: Yes

Some legislation shouldn't be controversial, and some things in life should not be optional. But for a variety of reasons, mass inoculation against disease – one of the greatest advances in public health in all of human history – causes some otherwise intelligent people to take leave of their senses.

Pan's bill wouldn't compel foolish parents to vaccinate their children. The bill would merely require parents to obtain a piece of paper signed by a doctor, acknowledging their foolishness (in so many words). Not all doctors will sign the paper, which will make obtaining exemptions difficult for some parents.

Perhaps that's as it should be.

Widespread vaccinations wiped out polio and smallpox – diseases that until the middle of the 20th century killed or crippled millions of people. That's simply a fact.

It's also a fact that measles, whooping cough and other communicable diseases, several of which had been all but eradicated, have made remarkable and terrifying comebacks over the past few years.

Some of that resurgence – as with tuberculosis, for example – may be blamed on illegal immigration. Even so, the U.S. Centers for Disease Control and Prevention also points to a decline in adult vaccination among native-born and Western European visitors as reason for the upsurge in measles and whooping cough.

Nothing is ever without risk. The CDC reports as many as 30,000 adverse reactions to vaccinations each year, of which anywhere from 3,000 to 5,000 would be considered "severe." A few thousand adverse results out of millions of safe doses is no reason to reject sound practice.

Even where research identifies some children with rare disorders who may be harmed by certain vaccines, adjusting public policy to accommodate those exceptional cases shouldn't require endangering the public at large.

Conservatives and libertarians rightly worry about government overreach disguised as "public health" necessity. Certainly the opposition to Obamacare and some of California's more outlandish health and safety regulations are rooted in the belief that a free, self-governing people do not need a nanny state.

But on this question, a purely libertarian stance is inadequate. Some of the Republicans who oppose AB 2109 on the grounds of "parental choice" have also supported common-sense legislation requiring information and parental consent for abortions. The principle is the same: informed choice.

Critics of Pan's bill say it "poses a threat to freedom." Other threats to freedom include epidemics, quarantines and public hysteria.

It pains me that the response to Pan's bill serves only to reinforce ignorance and fear. (The smart alecks should feel free to spare me their jibes.) Guard your liberties jealously, by all means. But don't be snookered by knee-jerk libertarianism on this one.

Ben Boychuk is associate editor of the Manhattan Institute's City Journal (www.city-journal.org/california).

Pia Lopez: Double yes!

Ben and I agree! Vaccination is essential to control infectious diseases. The Centers for Disease Control and Prevention puts vaccination atop the list of the 10 greatest public health achievements of the 20th century. Smallpox: eradicated. Polio: eliminated in the Americas. Measles, rubella, tetanus, diphtheria: under control.

But vaccination works only if a critical mass of people are covered. That's why all states, including California, require children to be vaccinated before entering school and child-care centers.

Unfortunately, California has a very loose "personal belief exemption" – not based on medical necessity or religion – that allows parents to opt out. It has made California the "epicenter of vaccine refusal" in the United States.

Assemblyman Richard Pan, a pediatrician, would tighten the exemption just a bit. Modeled on Washington state's law, his bill would require parents seeking to opt out to have a doctor sign a form saying they were provided information about immunization.

Look, vaccine refusal places the the entire community at risk, including babies (who don't get their first vaccination against measles until 12 months) and individuals who have compromised immune systems (such as people with cancer who are undergoing chemotherapy).

We've seen how this works. In 2008, one intentionally unvaccinated 7-year-old San Diego boy contracted measles on a vacation in Switzerland. Between his school, swimming class and doctor visits, he exposed 839 people to measles. A study on the outbreak published April 2010 in Pediatrics journal found that vaccine-refusing parents "tended to be white, college-educated and of upper- and middle-income levels." This is not about ethnic minorities or families living in poverty or people with less education, the usual stereotypes.

Worse, the study found that a majority of the refusers believe vaccines cause harm, especially autism. This is just nonsense. The one study that linked the measles-mumps-rubella vaccine to autism, by British doctor Andrew Wakefield in 1998, has been discredited. Reports in the British Medical Journal found it was an "elaborate fraud." Wakefield's medical license was revoked for "serious professional misconduct."

Public health officials get worried when more than 10 percent of students in a school are intentionally unvaccinated – as "sites of concentrated vaccine-preventable disease risk." Unfortunately, the opt-out trend is growing. In 2000, 148 kindergartens statewide were over the 10 percent mark. In 2009, it was 452. Pan's bill aims to reverse that.

In our region, Waldorf schools, public and private, stand out for high levels of unvaccinated kids: Live Oak Waldorf (94 percent unvaccinated in 2010), Camellia Waldorf (58 percent), Alice Birney Waldorf (57 percent), Sacramento Waldorf (57 percent), Davis Waldorf (53 percent).

These kids aren't just free-riders on community immunity. They can expose vulnerable populations to serious illness. In the end, this is an ethical issue, not just a health issue. Tightening California's law is the responsible thing to do.

Pia Lopez is an editorial writer at The Bee.

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