California Forum

Doctors who sell vaccination exemptions endanger our kids. It’s time to crack down

California leads the nation on vaccination policy. Following a measles outbreak at Disneyland in 2014, thousands of parents across the state united to call for legislative action to tighten vaccination requirements for school children – and California took action.

Senate Bill 277, authored by state Senator Dr. Richard Pan (D-Sacramento), took effect in July 2016. It eliminated all non-medical exemptions to the required vaccines for school. Many of us breathed a sigh of relief when SB 277 passed, hoping that it would ensure our children’s safety from vaccine-preventable disease at school.

The law significantly increased state vaccination rates. Overall vaccination rates for kindergarten students rose from 92.8 percent the year before the bill took effect to a near-record high of 95.1 percent for the 2017-2018 school year. This is above the threshold for “herd immunity,” which provides protection from outbreaks to all members of the community.

But a dangerous new trend has emerged that demands additional legislative action to protect the health of California’s children.

A few unscrupulous doctors are preying on unjustified fears about vaccines and selling medical exemptions to parents. Since SB 277 went into effect, the rate of medical exemptions has more than tripled, from 0.2 percent in 2015-2016 to 0.7 percent in 2017-2018, according to California Department of Public Health data. Private schools experienced an even steeper increase in medical exemptions – from 0.3 percent to 2.1 percent.


Some California kindergartens reported medical exemption rates greater than 50 percent. Parents across the state who fought to secure SB 277 are again worried that the significant pockets of “personal belief” exemptions have now transformed into significant pockets of unjustified medical exemptions. Our children remain at risk.

Finding the few doctors willing to write unjustified medical exemptions is not difficult. Many openly advertise their medical exemption sales online. Some are active participants in anti-vaccine Facebook groups. Others exploit Facebook’s dangerous ad targeting to reach people skeptical of vaccine science. Still others rely on word of mouth, which spreads all too easily among parents. Anti-vaccine websites list doctors willing to provide medical exemptions and even coach parents on what to say to obtain the exemption.

Leah Russin Photo.jpg
Leah Russin

A 2018 study in the journal Pediatrics found that California public health officials are alarmed by the rise in medical exemptions and frustrated by their inability to do anything about it. Although California was the third state to do away with all non-medical exemptions, there is currently no process in place for California officials to review the exemptions.

Health officials lack the authority to challenge and overturn questionable medical exemptions. It’s troubling that California health officials must review and approve exemption requests for the dog rabies vaccine, but they do not have the same authority when it comes to protecting our children.

In 2019, parents are once again calling for action. We believe that science, not fear, must govern public policy. We believe everyone who can get vaccinated should get vaccinated in order to protect those who cannot.

We believe that medical exemptions should only be given to those who truly need them: the infant on the arm of a new mother in San Francisco; the young boy in Santa Cruz who was born needing surgery and must delay his vaccines due to his illnesses; the middle school student recovering from cancer in Los Angeles who wants to get back to school and visit with friends; or the twin girls in San Diego who are among the 1 percent for whom some vaccines don’t work.

All these children, every newborn and many adults rely on herd immunity for their survival. Every baseless and unjustifiable medical exemption jeopardizes their health and safety.

Vaccines are one of the most effective public health tools ever invented, but community immunity is fragile. The 2018 California measles outbreak – which began with an unvaccinated teen and spread to other unvaccinated youth, including two with suspect medical exemptions – is a grave reminder that vaccine-preventable illnesses remain a present threat to public health.

It’s once again time for parents, physicians, health officials and concerned Californians to speak up about the abuse of medical exemptions. It’s also time for the California State Legislature to act to end these abuses. The rest of the country is watching.

Leah Russin is the co-founder and executive director of Vaccinate California, a parent advocacy group working to improve public health in California by raising vaccination rates.
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