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california legislation > AB 2109

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Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair

AB 2109 (Pan) - Communicable diseases: immunization exemption.

Amended: June 20, 2012Policy Vote: Health 7-1
Urgency: No Mandate: Yes
Hearing Date: August 6, 2012
Consultant: Brendan McCarthy

This bill does not meet the criteria for referral to the
Suspense File.

Bill Summary: AB 2109 requires a separate form indicating that a
health care provider has provided information on the benefits
and risks of vaccination to accompany a personal belief
exemption letter or affidavit when a parent or guardian elects
not to have a child vaccinated before school admission.

Fiscal Impact:
The Department of Public Health will incur one-time costs
of about $80,000 (federal funds) to develop and distribute
the required forms and related materials to schools and
health practitioners.

Costs to the Department of Education and the Department of
Social Services for staff training are expected to be minor
and absorbable (General Fund).

Minor potential reimbursable mandate costs to schools to
collect the new form with currently required documentation
of personal belief exemptions (General Fund). Under current
law, parents who elect not to have their child vaccinated
before enrolling in school must provide information to the
school regarding their personal belief exemption. Under the
bill, parents would also be required to provide the required
form signed by a health professional. Any marginal costs to
collect and store the additional form are likely to be

Background: Under current law, children admitted to schools or
child care facilities, must be vaccinated against certain,
specified diseases. Current law provides an exemption from the
vaccination requirement, if the parent or guardian attests that

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he or she has a religious or philosophical objection to
vaccination (collectively referred to as personal belief
exemptions). In either case, the parent or guardian must provide
either a vaccination record or an attestation to the personal
belief exemption before the child is admitted to school.

Proposed Law: AB 2109 would require, beginning on January 1,
2014, any parent or guardian claiming a personal belief
exemption to vaccination requirements to provide an additional
form signed by a health practitioner alongside the parent's
attestation to the school.

The Department of Public Health would be required to develop the
form. The form must indicate that the health practitioner has
discussed the benefits and risks of vaccination with the parent
or guardian.

In order to be accepted by the school, both the practitioner and
the parent or guardian must have signed the form not more than
six months prior to enrollment.

The bill specifies that physicians and surgeons, nurse
practitioners, physician assistants, osteopathic physicians and
surgeons, and naturopathic doctors are eligible practitioners
who can sign the form.

Staff Comments: According to the Department of Public Health,
the percentage of kindergarteners who have not received required
immunizations increased from 0.5 percent in 1978 to 2.5 percent
in 2010, due to parents using personal belief exemptions.

It is important to note that not all children can be immunized
against common childhood illnesses. Children under six months of
age and children with compromised immune systems cannot always
be vaccinated. In order to protect those children, a high level
of community immunization levels are needed to provide the "herd
immunity" that will protect those children from exposure. To the
extent that increasing numbers of children are unvaccinated,
herd immunity is lessened and children who cannot be vaccinated
are put at risk.

The Centers for Disease Control and Prevention indicates that
there are rare instances of adverse reactions to immunization
(for example 1 in 1,000,000 people who receive the

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measles-mumps-rubella vaccination will experience encephalitis
or a severe allergic reaction). On the other hand, the mortality
risk for someone contracting the measles is 1 in 500. Further, a
single published study indicating that there is a connection
between the measles-mumps-rubella vaccine and the incidence of
autism has been discredited.