San Luis Obispo pediatrician talks about childhood vaccinations
The number of kindergartners who began school with all their vaccines remained high in San Luis Obispo County last year — a relief to public health officers who for years worried about potential outbreaks of previously eradicated diseases such as measles and whooping cough.
Yet, local children continue to receive doctor’s notes exempting them from one or more vaccines twice as often as the state average.
The countywide rate of fully-vaccinated children entering school in the 2018-19 school year was just shy of the 95 percent guideline or “herd immunity” believed to protect the community, the most recent data from the California Department of Public Health show.
At its lowest point in 2013, only 85.55 percent of children entering school in the county had all their vaccines. And, some schools continue to report relatively low vaccination rates for students.
Most children without full immunization are those with personal medical exemptions — and local officials say tighter regulations are needed to identify cases in which the exemption is not medically legitimate.
In other words, they want to stop doctors from potentially selling medical exemptions to children who they say don’t really need them. That, officials say, would prevent vaccination rates from plummeting again.
Vaccination rates slip as medical exemptions rise
San Luis Obispo County parents claim exemptions far more often than parents in other parts of the state.
In fact, 2.3 percent of kindergartners attending private and public schools in the county in the 2018-2019 school year were exempted from at least one vaccine. That’s more than twice the rate of the state average of 0.9 percent.
Parents who don’t want their kids vaccinated are turning to doctors to get documentation for personal medical exemptions, whether they’re medically justified or not.
That’s borne out in the data.
A Tribune analysis found the rate of medical exemptions increased since state legislators eliminated the ability of parents to claim a personal belief exemption, and some speculate that a few doctors are simply selling exemptions to those who want them.
“A small number of doctors (in San Luis Obispo County) are issuing a fair number of medical exemptions,” said Rick Rosen, the county’s deputy public health officer.
It doesn’t help, he said, that “the reasoning for providing a medical exemption can be very vague. You can say, ‘family history,’ without any testing and that can work.”
Legislation proposed by state Sen. Richard Pan, D-Sacramento, would tighten medical exemptions to a narrow list of criteria defined by the Centers for Disease Control and Prevention, and give the state health department authority to review and decline them.
Some parents worry that giving the state so much control undermines parental rights and puts their children’s health in harm’s way — and they’re considering leaving California if the bill passes.
Meanwhile, more than 1,100 cases of measles have been confirmed in 30 states since the beginning of January as outbreaks sweep across the nation, according to the Centers for Disease Control and Prevention.
That’s up from last year, when 372 cases of measles were confirmed. The disease was declared eliminated from the United States in 2000.
A market for doctors’ notes
“The increase of people asking for exemptions is baffling,” said Dr. Rene Bravo, a pediatrician who practices in San Luis Obispo.
He’s experienced more dynamic conversations around vaccines, their risks and their value. Parents are asking about herd immunity and the safety of the shots. He said that’s a good thing.
“Vaccinations are probably one of the greatest health interventions in the last century,” Bravo said.
Even though he a strong proponent of vaccinations, he is also a “strong supporter of parents’ rights.”
He will treat patients who are not fully vaccinated, Bravo said, something that some doctors in the area refuse to do. But he won’t go so far as to issue a medical exemption when he has determined it’s not medically justified.
Bravo has been asked to do so, he said, by “some that don’t have a good reason.”
“It’s hard to ethically participate in that,” Bravo said.
As of 2019, the Medical Board of California has disciplined one doctor for wrongly writing a medical exemption.
Bob Sears, an Orange County pediatrician, was ordered to take medical education and ethics courses after he issued the exemption without reviewing the child’s medical history.
If the bill to tighten exemptions passes, the medical board may be reviewing a lot more cases.