By now, all Cali. Vaccine Concerned (“VC”) know that earlier this week, Senator Richard Pan dropped the bill he’s been hinting about for some time. His SB 276 will eliminate the power of physicians to issue vaccine medical exemptions. Instead, doctors will submit form applications/requests for exemptions which will be reviewed and approved or denied by unspecified state health officials.

Even more significant, but unsurprising is SB 276’s stated standard for which medical exemption applications will be reviewed: CDC contraindications, period, but GULP!

Before I continue, let’s have alittle perspective: This is just the first cut/draft of the bill. Like with SB 277, the legislative process may result in changes which could make the bill less – let’s just say – terminal to the hopes of the VC. Of course, the elimination of the contraindication exemption from SB 277 directly resulted in what Senator Pan believes are all these unjustified/fraudulent exemptions. So, expect him to be more recalcitrant this go around. But perhaps the same pressures which forced the elimination of the contraindications standard in SB 277 will surface again. Early signs are good. Senator Ben Allen (SB 277 co-sponsor) has stated he’s going to honor his SB 277 commitment to maintain a robust exemption option, and so for now (under the current version) he’s not with Senator Pan.

Still the situation for the Cali VC and especially the families with current complete medical exemptions is dire and alarming.

That’s because of the retroactive effect that SB 276’s contraindication standard will have on already issued permanent medical exemptions.

The retroactive effect is effectuated by the bill’s requiring all current vaccine exemptees to submit their exemptions to the DOH by July 1, 2020 and those exemptions will be reviewed a state or local public health official.

Here is the operative language of this part of the bill:

“2) If a medical exemption has been authorized pursuant to Section 120370 prior to the adoption of the statewide standardized form, the parent or guardian shall submit, by July 1, 2020, a copy of that medical exemption to the department for inclusion in the database in order for the medical exemption to remain valid.
(d) If the State Public Health Officer or a local public health officer determines that a medical exemption submitted to the department is fraudulent or inconsistent with applicable CDC guidelines, the State Public Health Officer or local public health officer may revoke the medical exemption.”

Ok, so it all comes down to whether a current medical exemption is inconsistent with applicable CDC guidelines.

Here is my bottom-line opinion on this:

There are no (or virtually no) currently issued medical vaccine exemptions for all vaccines throughout the duration of children which are consistent with CDC vaccine contraindications.

In fact, if the standard is CDC contraindications, I think the Department of Health could take the position that all of the permanent, all-inclusive vaccine exemptions are defective of their face for two reasons.

First, contraindications are vaccine or multi-vaccine shot specific and the contraindications differ (I’ll show you the contraindications in three of the basic vaccines in a bit). I suspect the state-approved form is going to list each vaccine/shot separately and ask the physician to note the contraindication to each vaccine. If a current exemption doesn’t do that, then without more, I’d say the exemption is not consistent with the CDC standards.

Second, for reasons I don’t want to publically explain, I’ve seen what I expect to be the academic infectious disease pediatrician view on this, and I believe these academics will take the position that there is no medical condition or family history which would justify an exemption from all vaccines throughout childhood. I don’t even think that’s surprising since even mega activist Barbara Loe Fisher has said about the same thing.

So, for all practical purposes, if you have a healthy child and you have a permanent all-inclusive vaccine exemption from a VC physician (and frankly, only VC physicians write permanent all-inclusive exemptions, because the concept/practice doesn’t exist with the majority of pediatrians), once the health officials review it, it will most likely be revoked.

What happens if that happens?

It’s unclear from the bill. For new exemption requests which are rejected, the physician has 30 days to submit additional information supporting the exemption request. But I don’t see a similar provision for review of existing exemptions, at least under the current bill. My guess is that they’ll go with the most administratively efficient solution which is that in the revocation notice, the parents will be informed of their right to reapply with the current form and show why each of the vaccines from which they wanted to be exempted is justified under each vaccine’s contraindications.

If I’m right, none (or almost none) of the prior permanent exemptions for all vaccines will be approved by the officials (unless your child is so immunocompromised that he/she lives in a bubble, and of course I’m not talking about temporarily immunocompromised kids, like say kids undergoing cancer chemotherapy).

Let’s look at a couple of specifics, and we’ll start with MMR because of the recent hullabaloo.

HERE IS THE GOSPEL ACCORDING TO THE CDC:

“Some people should not get MMR vaccine or should wait.
Tell your vaccine provider if the person getting the vaccine:
• Has any severe, life-threatening allergies. A person who has ever had a life-threatening allergic reaction after a dose of MMR vaccine, or has a severe allergy to any part of this vaccine, may be advised not to be vaccinated. Ask your health care provider if you want information about vaccine components.
• Is pregnant, or thinks she might be pregnant. Pregnant women should wait to get MMR vaccine until after they are no longer pregnant. Women should avoid getting pregnant for at least 1 month after getting MMR vaccine.
• Has a weakened immune system due to disease (such as cancer or HIV/AIDS) or medical treatments (such as radiation, immunotherapy, steroids, or chemotherapy).
• Has a parent, brother, or sister with a history of immune system problems.
• Has ever had a condition that makes them bruise or bleed easily.
• Has recently had a blood transfusion or received other blood products. You might be advised to postpone MMR vaccination for 3 months or more.
• Has tuberculosis.
• Has gotten any other vaccines in the past 4 weeks. Live vaccines given too close together might not work as well.
• Is not feeling well. A mild illness, such as a cold, is usually not a reason to postpone a vaccination. Someone who is moderately or severely ill should probably wait. Your doctor can advise you.
This information was taken directly from the MMR VIS”
https://www.cdc.gov/vaccines/vpd/should-not-vacc.html”

That seems pretty straightforward, but there’s some wiggle room in terms of what kind of first degree relative autoimmune issue might qualify.

Here are the Lord’s words on DPTa:

“Some children should not get DTaP vaccine or should wait.
DTaP is only for children younger than 7 years old. DTaP vaccine is not appropriate for everyone – a small number of children should receive a different vaccine that contains only diphtheria and tetanus instead of DTaP.
Tell your health care provider if your child:
• Has had an allergic reaction after a previous dose of DTaP, or has any severe, life-threatening allergies.
• Has had a coma or long repeated seizures within 7 days after a dose of DTaP.
• Has seizures or another nervous system problem.
• Has had a condition called Guillain-Barré Syndrome (GBS).
• Has had severe pain or swelling after a previous dose of DTaP or DT vaccine.
In some cases, your health care provider may decide to postpone your child’s DTaP vaccination to a future visit.
Children with minor illnesses, such as a cold, may be vaccinated. Children who are moderately or severely ill should usually wait until they recover before getting DTaP vaccine.
Your health care provider can give you more information.
This information was taken directly from the DTaP VIS”

And Jesus/Moses/Mohammed spoke onto the flock about HIB contraindications as follows: (and some of this nonsense seems about as current)

“Some people should not get this vaccine.
Hib vaccine should not be given to infants younger than 6 weeks of age.
A person who has ever had a life-threatening allergic reaction after a previous dose of Hib vaccine, OR has a severe allergy to any part of this vaccine, should not get Hib vaccine. Tell the person giving the vaccine about any severe allergies.
People who are mildly ill can get Hib vaccine. People who are moderately or severely ill should probably wait until they recover. Talk to your healthcare provider if the person getting the vaccine isn’t feeling well on the day the shot is scheduled.
This information was taken directly from the Hib VIS”

OK, so do you want to know for sure if you child’s current complete medical exemption will be continued by the state or local health officials?

Then go through all the childhood vaccines and see whether he/she fits a contraindication for every single vaccine. Per previous, I think that no otherwise healthy child is going to get there.

What about a complicated medical history? Easy, if it’s in the contraindication for a specific vaccine, you get it (for that vaccine). If not, you don’t.

And that’s the same basic response to any question you might have about your child’s particular medical issue or family history. (See my comment later on about dirt.)

Here is the CDC URL.
https://www.cdc.gov/vaccines/vpd/should-not-vacc.html

But let’s circle back to the beginning

Right now, SB 276 is just a first iteration of a bill. Bills get changed in the law making process, and bills get killed, even vaccine bills, as we’ve seen recently in Washington. And it’s much easier to kill a bill than pass one.

There are many reasons this bill should die, not the least of which is because it takes medical decision making out of the hands of physicians, which seems like not only a bad thing, but something which even the Medical Board of California and the California Medical Association shouldn’t be happy about.

It also reduces a critical decision about a child’s future health and safety to contraindication statements which in many cases are several decades old, and frozen in time without any consideration of what has been learned in the last decade or two, and without consideration of new emerging technologies.

The notion that an army of state or local health officials are going to make these vital and potentially life altering medical decision, seems stupid as dirt, but maybe that’s an insult to dirt.

Still, we live in a democracy, and the way it works is that you mount an effective legislative campaign, enlist as many allies as you can, work as hard as you can, and hope for the best.

Rick Jaffe, Esq.
Rickjaffeesquire@gmail.com