One gratuitous sentence and the public health
Imagine a California where polio becomes a threat to children’s health again, as it was before the 1950s, when first the Salk vaccine and later the even more effective Sabin formula threw this dreaded and crippling disease into dormancy.
Or a California where dozens of kids die every year from pertussis, better known as whooping cough for the gasping “whoop” afflicted children often make after coughing. And more.
There’s a possibility — slim, but still there — that a single sentence in one of Gov. Jerry Brown’s signing messages on an unpublicized 2012 law could open these kinds of Pandora’s boxes, at least for children of parents who want to avoid vaccinating them.
The law, passed as Assembly Bill 2109, was intended to do the reverse. It requires documentation when the value of vaccinations to children and the community at large is explained to parents or guardians not planning to vaccinate their kids. It reiterates previous rules requiring persons opting out due to religious belief to get a signed statement from a doctor, nurse or physician’s assistant saying they’ve been told the benefits of vaccination. And it says parents must file one written statement of their beliefs and another attesting to receipt of information about vaccination.
The idea was to improve vaccination rates and benefits by making doubly sure everyone is fully informed. But Brown stuck one wild-card sentence into his signing message, where no signing message was required.
“I will direct the Department (of Public Health) to allow for a separate religious exemption on the form,” he said, adding that “in this way, people whose religious beliefs preclude vaccinations will not be required to seek a health practitioner’s signature.”
Brown, thus, ordered a weaker approach than mandated by the law he had just signed. The Department of Public Health issued a new exemption form embodying this in October.
From now on, any parent or guardian who doesn’t feel like getting his or her child vaccinated for polio, diphtheria, measles, rubella, mumps or pertussis has an easy out. A box on the new form even lets parents claim their religion precludes seeking medical advice.
The vaccinations are normally required to register kids in various levels of public school with pertussis shots before seventh grade coming at the most advanced age on the list.
It’s a lot easier to check off a box than it would be to follow even the old rules, which the 2012 law aimed to beef up.
That box on the new form stunned some health advocates, since it is neither mentioned nor authorized by law or regulation. It led to speculation about why Brown ordered that “separate religious exemption” on the new form.
Diana Dooley, state Health and Human Services secretary, asserted the governor’s order “does not countermand the law.” She refused to explain how that can be, when the law provides for no easy out like Brown ordered.
Added another Brown spokesman, “The governor believes that vaccinations are profoundly important and a major public health benefit. This law is intended to strongly encourage people to take full advantage of vaccinations. We’ve also taken into account fundamental First Amendment religious freedoms through an extremely narrow exemption.”
It all spurs fear in public health advocates mindful of the fact that California has seen thousands of whooping cough cases over the last few years, more than 9,000 in 2010 alone. In that year, 10 children died from the disease, but strong vaccination drives in the next two years reduced later tolls. Who knows what could happen with the easy exemption Brown calls “narrow?”
What’s known is that a Johns Hopkins University study found the heaviest concentrations of 2010 pertussis cases came where the most religious exemptions were filed. (http://pediatrics.aappublications.org/content/early/2013/09/24/peds.2013-0878.abstract)
Which means that barriers to parents and guardians opting their charges out strictly for convenience really do aid public health.
It will be some time before anyone can assess the effects of the new form and its dicey box, but one thing is for sure: The state will now do less than it has for decades to suppress pernicious diseases that formerly caused huge health problems.
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