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In California, Some Doctors Sell 'Medical Exemptions' for Kids' Vaccinations

HealthDay News
by By Dennis Thompson
HealthDay Reporter
Updated: Oct 29th 2018

new article illustration

MONDAY, Oct. 29, 2018 (HealthDay News) -- A handful of California doctors are making hay off anti-vaccine parents, charging hundreds of dollars to issue medical exemptions for required childhood vaccinations, a new study claims.

In 2015, California passed a law eliminating personal belief exemptions for vaccinations that kids must receive before they can attend public school.

In the years since, there's been a major increase in the number of medical exemptions issued by doctors for these required immunizations, researchers found.

"After the first year, it increased from 0.2 percent to 0.5 percent of children," said lead researcher Salini Mohanty, a postdoctoral research fellow with the University of Pennsylvania School of Nursing. "Then by the second year it had increased to 0.7 percent, which is a 250 percent increase, which is sort of alarming."

At least some of these medical exemptions are being written by doctors who charge big fees to fearful parents, according to public health officers interviewed for the study.

"I'm getting a very high volume of medical exemptions from one provider, and from what I understand, for all intents and purposes, she's selling these medical exemptions," said one official quoted in the study. "She used to just give permanent medical exemptions, and now she's giving temporary for 3 months. So now families have to go back every 3 months and pay $300 to get their temporary medical exemption updated."

These doctors are flying in the face of decades of work to develop and improve vaccines that "beat back infectious diseases that plagued humanity since the species evolved," said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security in Baltimore.

"To hear of physicians advertising to issue medical exemptions, which are mostly unwarranted, is to spit in the face of those pioneers who gave us vaccines, and has made those physicians advocates of the primitive Dark Ages when vaccine-preventable diseases flourished," Adalja said.

The 2015 law made California the first state in nearly 35 years to eliminate personal belief exemptions for mandatory vaccinations, the study authors said in background notes. The law was prompted in part by a 2014 measles outbreak at Disneyland.

The law has had a positive effect on immunization rates overall in California, the researchers reported.

Following the law's implementation, the proportion of kindergartners who received all required vaccines increased to 95.1 percent in 2017-2018, up from 92.8 percent in 2015-2016.

The findings were published online Oct. 29 in the journal Pediatrics.

To get a ground-level assessment of the law's rollout, researchers interviewed 40 health officers representing about half of the local health jurisdictions in California.

The public health officials said they are concerned anti-vaccine parents denied personal belief exemptions for their children now are seeking out doctors willing to issue medical exemptions for a fee, Mohanty said.

Many of these medical exemptions cite conditions typically not considered barriers to immunization by the U.S. Centers for Disease Control and Prevention, such as a family history of allergies or autoimmune disorders, Mohanty said.

However, these conditions squeak by based on the regulatory language of the law, she said.

The number of medical exemptions issued has not yet reached the level of personal belief exemptions claimed prior to the law's passage, which for the 2015-2016 school year was about 2.4 percent, Mohanty said.

But if left unchecked, the rapid increase of medical exemptions could weaken vaccine protection for school kids, said Democratic state Sen. Dr. Richard Pan, a pediatrician and author of the California law.

"They threaten community immunity and threaten the health of all children," Pan said of the exemptions.

Anti-vaccine parent groups appear to be sharing lists of doctors willing to issue medical exemptions for a fee, Pan said.

"It's a very small number, but that's all it takes, right?" said Pan, who wrote an editorial accompanying the new study. "They're charging $500 or more a pop for these exemptions, so they're definitely in it for the money."

Some of these doctors have been brought before the California Medical Board on ethics charges, the study reported.

But Pan suggested a more straightforward solution. He'd like to amend California law so public health officials would have the power to revoke doctors' authority to issue medical exemptions.

Pan argued the power to issue medical exemptions is a state-level public health function that has been delegated to doctors, and therefore could be rescinded if it's found they're taking advantage of patients.

For example, West Virginia pediatricians do not have the ability to issue medical exemptions -- instead, they must apply to their state health department for exemptions on patients' behalf, Pan noted.

"When someone abuses that authority that's been delegated to them, then the state should be able to take back that authority from that person," Pan said. "And not only revoke that authority but then invalidate all of the medical exemptions that have been inappropriately written, as a threat to public health."

More information

The U.S. Centers for Disease Control and Prevention have more about state vaccination requirements.