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|SENATE RULES COMMITTEE | AB 2109|
|Office of Senate Floor Analyses | |
|1020 N Street, Suite 524| |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
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THIRD READING


Bill No: AB 2109
Author: Pan (D), et al.
Amended: 6/20/12 in Senate
Vote: 21


SENATE HEALTH COMMITTEE : 7-1, 6/27/12
AYES: Hernandez, Harman, Alquist, Blakeslee, DeSaulnier,
Rubio, Wolk
NOES: Anderson
NO VOTE RECORDED: De León

SENATE APPROPRIATIONS COMMITTEE : 5-2, 8/6/12
AYES: Kehoe, Alquist, Lieu, Price, Steinberg
NOES: Walters, Dutton

ASSEMBLY FLOOR
: 47-26, 5/10/12 - See last page for vote


SUBJECT : Communicable disease: immunization exemption

SOURCE : American Academy of Pediatrics
California Medical Association
Health Officers Association of California


DIGEST : This bill requires, after July 1, 2014, a
separate form prescribed by the Department of Public Health
(DPH) to accompany a letter or affidavit to exempt a child
from immunization requirements under existing law on the
basis that immunization is contrary to beliefs of the
child's parent or guardian.

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AB 2109
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2

ANALYSIS :

Existing law:

1. Prohibits the governing authority of a school or other
institution from unconditionally admitting any person as
a pupil of any private or public elementary or secondary
school, child care center, day nursery, nursery school,
family day care home, or development center, unless,
prior to his/her first admission to that institution,
he/she has been fully immunized against diphtheria,
haemophilus influenzae type b (Hib), measles, mumps,
pertussis, poliomyelitis, rubella, tetanus, hepatitis b
(except after 7th grade), and chickenpox, as specified.

2. Permits DPH to add to this list any other disease deemed
appropriate, taking into consideration the
recommendations of the Centers for Disease Control and
Prevention (CDC) Advisory Committee on Immunization
Practices (ACIP) and the American Academy of Pediatrics
(AAP) Committee on Infectious Diseases.

3. Waives the above requirements if the parent or guardian
or adult who has assumed responsibility for the child's
care and custody, or the person seeking admission, if an
emancipated minor, files a letter or affidavit with the
governing authority stating that the immunization is
contrary to his/her beliefs.

4. Permits a child for whom the requirement has been
waived, whenever there is good cause to believe that he
or she has been exposed to one of the specified
communicable diseases, to be temporarily excluded from
the school or institution until the local health officer
is satisfied that the child is no longer at risk of
developing the disease.

This bill:

1. Requires, after July 1, 2014, a separate form prescribed
by DPH to accompany a letter or affidavit to exempt a
child from immunization requirements under existing law
on the basis that immunization is contrary to the
beliefs of the child's parent or guardian.

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2. Requires the form to include:

A. A signed attestation from a health care
practitioner that indicates that he/she provided the
parent or guardian of the person who is subject to
the immunization requirements in existing law, the
adult who has assumed responsibility for the care and
custody of the person, or to the person if he or she
is a emancipated minor, with information regarding
the benefits and risks of the immunization and the
health risks of specified communicable diseases to
the person and to the community.

B. A written statement signed by the parent or
guardian of the person who is subject to the
immunization requirements in existing law, the adult
who has assumed responsibility for the care and
custody of the person, or the person if he or she is
an emancipated minor, that indicates that the signer
has received the information provided by the health
care practitioner.

3. Requires the form to be signed not more than six months
prior to the date when the person first becomes subject
to the immunization requirement for which exemption is
being sought.

4. Permits a photocopy of the signed form or a letter
signed by a health care practitioner that includes all
information and attestations included on the form to be
accepted in lieu of the original form.

5. Defines, for the purposes of this bill, a "health care
practitioner" as a physician and surgeon, a nurse
practitioner, a physician assistant, an osteopathic
physician and surgeon, or a naturopathic doctor, as
specified.

6. Exempts issuance and revision of the form from
rulemaking requirements under the Administrative
Procedure Act.

Background

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Immunizations . According to the CDC, vaccines contain the
same antigens or parts of antigens that cause diseases, but
the antigens in vaccines are either killed or greatly
weakened. Vaccine antigens are not strong enough to cause
disease but, they are strong enough to make the immune
system produce antibodies against them. Memory cells
prevent re-infection when they encounter that disease again
in the future. Vaccines are responsible for the control of
many infectious diseases that were once common around the
world, including polio, measles, diphtheria, pertussis
(whooping cough), rubella (German measles), mumps, tetanus,
and Hib. Vaccine eradicated smallpox, one of the most
devastating diseases in history. Over the years, vaccines
have prevented countless cases of infectious diseases and
saved literally millions of lives. Vaccine-preventable
diseases have a costly impact, resulting in doctor's
visits, hospitalizations, and premature deaths. Sick
children can also cause parents to lose time from work.
CDC recommends routine vaccination to prevent 17
vaccine-preventable diseases that occur in infants,
children, adolescents, or adults. According to DPH,
implementation of statewide immunization requirements has
been effective in maintaining a 92% immunization coverage
rate among children in licensed child care facilities and
kindergartens.

ACIP . ACIP consists of 16 experts in fields associated
with immunization who have been selected by the Secretary
of the U.S. Department of Health and Human Services to
provide advice and guidance to the Secretary, the Assistant
Secretary for Health, and the CDC on the most effective
means to prevent vaccine-preventable diseases. ACIP
develops written recommendations for the routine
administration of vaccines to pediatric and adult
populations, along with schedules regarding the appropriate
periodicity, dosage, and contraindications applicable to
the vaccines and is the only entity within the federal
government which makes such recommendations. The overall
goals of ACIP are to provide advice to assist in reducing
the incidence of vaccine-preventable diseases and to
increase the safe usage of vaccines and related biological
products.


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ACIP, along with AAP and the American Academy of Family
Physicians, approved the 2012 Recommended Immunization
Schedules for Persons Aged 0 Through 18 Years. Children
under six are recommended to receive vaccines for hepatitis
b; rotavirus; diphtheria, tetanus, and pertussis (DTaP);
Hib; pneumococcal; polio; influenza; measles, mumps,
rubella (MMR); varicella; hepatitis a; and meningococcal.

FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes

According to the Senate Appropriations Committee:

DPH 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 existing 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 minor.

SUPPORT : (Verified 6/27/12) (per Senate Health Committee
analysis - unable to reverify at time of writing)

American Academy of Pediatrics (co-source)
California Medical Association (co-source)
Health Officers Association of California (co-source)
Association of Northern California Oncologists
BayBio
California Black Health Network
California Hepatitis C Task Force
California Immunization Coalition
California Naturopathic Doctors Association

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California Pharmacists Association
California Primary Care Association
California School Health Centers Association
California State Association of Counties
County Health Executives Association of California
Los Angeles County Board of Supervisors
Los Angeles Unified School District
March of Dimes, California Chapter
San Francisco Immunization Coalition
Santa Clara County Board of Supervisors
Tracy Unified School District

OPPOSITION : (Verified 6/27/12) (per Senate Health
Committee analysis - unable to reverify at time of writing)

California Federation of Republican Women
California Right to Life Committee, Inc.
Canary Party
Child and Family Protection Association
CORE Sacramento
Health Advocacy in the Public Interest
Maher Insurance and Financial Services
National Vaccine Information Center
Pacific Justice Institute
ParentalRights.Org
Private School Advocacy Center

ARGUMENTS IN SUPPORT : The AAP, California Medical
Association, and the Health Officers Association of
California (HOAC), joint sponsors of this bill, state that
this bill increases protection for children and communities
from vaccine-preventable diseases, while still respecting
and preserving parent choice. They state that the
continued increase in PBEs and resultant decreases in
community immunization rates could have a significant
impact on public safety and because PBEs are relatively
easy to obtain, parents or schools may use them simply
because they find vaccination inconvenient, or because they
have been misinformed about the health effects of vaccines.

The California Maternal, Child and Adolescent Health
Directors, the California School Health Centers
Association, March of Dimes, and the California Black
Health Network state that this bill will make certain that

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all parents are aware of the individual and public health
risks of exempting a child from required immunizations.
They also state that this bill increases the protection of
children and communities from vaccine-preventable diseases
while still respecting and preserving parent choice.

ARGUMENTS IN OPPOSITION : The Pacific Justice Institute
states that existing law provides a reasonable process for
exemptions from mandated student vaccinations. This bill
changes the current approach and inserts more bureaucracy
into intimate medical decisions. Health Advocacy in the
Public Interest indicates that parents must have the
freedom to make their own decisions with respect to the
vaccination of their children. Numerous letters from
individuals, parents, and practitioners state that this
bill is an intrusion into the personal freedom of parents
to make health care decisions for their children. They
state that this bill causes an undue burden on parents,
discriminates against families utilizing complementary and
alternative medicine, and promotes more vaccine use and
profit from the pharmaceutical industry.


ASSEMBLY FLOOR : 47-26, 5/10/12
AYES: Alejo, Allen, Ammiano, Atkins, Beall, Block,
Blumenfield, Bonilla, Bradford, Brownley, Buchanan,
Butler, Charles Calderon, Campos, Carter, Cedillo,
Chesbro, Davis, Dickinson, Eng, Feuer, Fong, Fuentes,
Galgiani, Gordon, Hall, Hayashi, Roger Hernández, Hill,
Hueso, Huffman, Lara, Bonnie Lowenthal, Ma, Mendoza,
Mitchell, Monning, Pan, Perea, Portantino, Skinner,
Swanson, Torres, Wieckowski, Williams, Yamada, John A.
Pérez
NOES: Achadjian, Bill Berryhill, Cook, Donnelly, Beth
Gaines, Garrick, Gatto, Gorell, Grove, Hagman, Halderman,
Harkey, Huber, Jones, Knight, Logue, Mansoor, Miller,
Morrell, Nestande, Nielsen, Norby, Silva, Smyth, Valadao,
Wagner
NO VOTE RECORDED: Conway, Fletcher, Furutani, Jeffries,
Olsen, V. Manuel Pérez, Solorio


CTW:m 8/8/12 Senate Floor Analyses


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SUPPORT/OPPOSITION: SEE ABOVE

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