Public Health Law

California Passes SB 277: No more personal or religious exemptions for vaccines

After many weeks of debate from legislators and stakeholders on both sides of the vaccine issue, Gov. Jerry Brown (D) signs California State Bill 277 into law on Tuesday June 30th. This bill co-authored by state Senators Richard Pan (D-Sacramento) and Ben Allen (D-Santa Ana) requires that all children in the state are to be vaccinated prior to entering public or private school with no exemptions granted for religious or personal reasons. California now becomes the third state to allow only for medical exemptions to vaccination.  The law will go into effect on July 1, 2016, but until that time what will happen among those who opposed the bill? Could this possibly be an opportunity for reflection on the outcome of this bill by those who oppose it? The data is clear, vaccines work.

The legislature, hearing the will of the people who first hand saw the effects (directly and indirectly) of a measles outbreak sought and achieved a solution that will protect children in the long run and promote a healthier state of California. But for those who continue to hold on to the gross misinformation that vaccines are harmful, cause autism or are ineffective, that “naturally acquiring” the disease is the “way it was intended” are more of a danger to a society that has become more mobile and has increased exposure to many more populations that may or may not have been properly vaccinated from preventable disease. At this point in civilization, we have access to levels of knowledge not seen in eras past. The problem is that many either do not know how to synthesize what sources are proper or in most cases don’t care to hear nor accept that vaccines are an unprecedented success and that in order to live together in a society, disease is a fact of life. Many diseases we have not yet controlled, we only have the means to cure, others we have neither control nor cure. What is so difficult about being proactive not just for oneself but to be a member of a society who is vaccinated and vaccinates their children? That is responsibility. Plain and simple.

As ruled in Jacobson v. Massachusetts (197 US 11 1905), the defendant Mr. Jacobson felt that his 14th Amendment rights were violated when the city of Cambridge, MA required that he be vaccinated for smallpox. The Supreme Court ruled that under the police powers of states in times of medical emergency (in this case a high prevalence of smallpox in the city of Cambridge) that the city was well within their right to implement compulsory vaccination. The opponents of this legislation are planning their next move and I think that this matter could be taken up by the Supreme Court at some point in the future. Jacobson v. Massachusetts provides a seminal example in case law that will be a major influence and reference if this law is challenged in the courts. Groups such as A Voice for Choice is planning to ask for a public referendum that will put a hold on the law. It will be interesting to see if this will be a successful effort and if not will the courts be the next step. Resisting the law is unfortunate, more time and effort could be spent engaged in dialogue among the stakeholders. If we understood the resistance a bit better, the education and outreach could be better. Instead, Senator Pan has been receiving threats for his efforts and a new fight is brewing due to this new law. California is the new testing ground for laws such as these that only grant medical exceptions and if (and potentially when) it reaches the courts, this will provide a new case law precedent that will serve as the guideline for future efforts to solidify vaccination efforts nationally.

Background information for this blog was obtained via the San Jose Mercury News

The Power of Herd Immunity

The state of California is currently debating legislation that will require all children to be vaccinated. Senate bill 277 will ensure that 10 childhood diseases will be prevented as the law will direct that vaccines for these diseases must be administered prior to admission to kindergarten or any daycare setting. Under this proposed law, only medical exemptions will be allowed to circumvent mandatory vaccination.

Vaccine exemptions exist in many forms and vary from state to state as to which are legal and how they are granted. One major type is that of a personal exemption. These exemptions are based on the belief that vaccines do more harm that good or that calling for mandatory vaccination is an infringement on personal liberty, that no government entity has the right to mandate vaccination. Personal exemptions however greatly undermine the power of medical exemptions which are important for those who cannot be vaccinated due to documented medical conditions. Religious exemptions are granted when vaccination policies are at odds with a person’s religious beliefs. Of the exemptions I have just briefly described, religious and medical exemptions appear to be the most reasonable to grant as the practice of one’s religion is a right granted by the constitution while medical as I mentioned is stating that the vaccine could be harmful to an individual’s health due to a preexisting medical condition.

No matter which of the three exemptions are granted, vaccination is still very important. Establishment of herd immunity and maintaining a high percentage of vaccinated individuals within a population reduces the incidence of disease within a population. How? I will use a very simplistic example with ten people (we know that this is an inappropriate sample size, but this is to illustrate the point).

Scenario 1: Of the ten people in this population, only 1 is vaccinated (10% vaccination rate), 1 person is infected (10% infection rate) and the remaining eight people are not vaccinated. Thus, we have 80% of this example population that is susceptible to disease and with a low vaccination rate, infection is rapid among the non-vaccinated.

Scenario 2: Vaccination rate increases to 50% (5 vaccinated individuals), only one infected individual and four non-vaccinated. Here, susceptibility has been halved from scenario 1 (40%) but it is still not enough to keep infection from passing readily through this population.

Maximum protection of the population (vaccinated as well as the non-vaccinated), we need the vaccination rate to be at 90% or higher and only 10% of the population is susceptible to infection. Looking at that, 10% may still be too high of a susceptibility rate but what this number really means is that the chances of infection are greatly lowered and can really be better defined as sporadic. This is due to the high percentage of the population that acts essentially to buffer the effects of the infection among the population.

In a perfect world, 100% of the population would be vaccinated, thus no one would suffer from disease. A rate of 90% is acceptable, although with the current state of vaccination in the U.S., this number has dwindled, placing us in a very dire state. If not for yourself. vaccinate for the good of all. Our fortunes against infectious disease rise and fall with every action we take or every opportunity we squander.