According to the Centers for Disease Control and Prevention, vaccination dose orders declined from mid-March, the beginning of the emergency declaration due to the COVID-19 pandemic, to mid-April by 2.5 million compared to previous years. In a report issued May 18, the agency wrote, “The identified declines in routine pediatric vaccine ordering and doses administered might indicate that U.S. children and their communities face increased risks for outbreaks of vaccine-preventable diseases.”
In California, data from the Department of Public Health shows that the number of vaccinations given to children from birth to 18 years old declined by 40 percent from April 2019 to April 2020. While this troublesome trend is perhaps unsurprising with the COVID-19 pandemic running rampant through much of the U.S., it does add further safety concerns regarding reopening schools across much of the nation. In California, however, some of the fears are allayed by legislation — which was strengthened just last year — requiring immunizations in order to begin school and at certain checkpoints throughout a student’s academic trajectory.
California’s vaccination laws
In 2015, California passed one of the nation’s strictest immunization laws, Senate Bill 277 (Pan, D-Sacramento), which eliminated personal belief and religious exemptions. In the 2016–17 school year, the first year the law was enacted, the CDPH reported a 95.6 percent kindergarten immunization rate. That meets the 95 percent threshold for herd immunity required for the most contagious disease, measles. However, in the two years since, vaccinations were on the decline — the kindergarten vaccination rate in California dropped to 94.8 percent in 2018–19 from 95.1 percent in 2017–18. According to a Los Angeles Times analysis, medical exemptions from vaccines has increased 70 percent since the enactment of SB 277.
Alarmed by this trend, lawmakers again stepped in last year to shore up the law. Senate Bill 276 (Pan), enacted Jan. 1, 2020, allows the state some oversight of medical exemptions written after Jan. 1, 2020, for students attending public and private schools and day care centers. The law requires a clinically trained physician, surgeon or registered nurse from the CDPH to annually review immunization reports from schools and institutions to identify those with an overall immunization rate of less than 95 percent; doctors who submitted five or more medical exemption forms in a calendar year; and schools and institutions that do not report immunization rates to the department. The law also prohibits doctors from charging any fees for vaccination-related exams or forms related to such dispensation.
If a CDPH staff member finds that a medical exemption is inappropriate or otherwise invalid, it will be reviewed by the State Public Health Officer or a physician and surgeon designated by the State Public Health Officer, and revoked by the State Public Health Officer or physician and surgeon designee, under prescribed circumstances. Medical exemptions written before Jan. 1, 2020, are not under state review, but new medical exemptions are required when a child enters kindergarten, seventh grade or changes schools.
By January 2021, the state will create a standardized form and new submission process so that immunization records will go directly to the CDPH; for the 2020–21 school year, parents will still submit medical exemption letters from their child’s doctor to their school.
Vaccination checkpoints and other details
Districts should have a process in place to check vaccination records at the designated checkpoints: when children newly enroll in the district, enroll in transitional kindergarten/kindergarten and when students advance to seventh grade. Schools are required to document each student’s vaccination history. The vaccination record of each student enrolled conditionally must be reviewed regularly to ensure they receive their immunizations by the required time. Those who fail to receive their immunizations by the designated date will be prohibited from attending school.It is important to note that medical exemptions will still be accepted unless CDPH staff determine otherwise. In addition, the CDPH directs that, “students who have an individualized education program (IEP) may continue to receive all necessary services identified in their IEP regardless of their immunization status.”
The National Public Health Information Coalition offers a toolkit containing key messages, vaccine information and helpful links to web resources from the CDC and other organizations at www.nphic.org/niam.