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found doctors willing to write medical exemptions so that their children would not get vaccinations and still be in school,” she says. “We know this because they shared information on the internet, Facebook and other social media sites about where parents could find a vaccine exemption-friendly doctor.”

      California State Sen. Dr. Richard Pan, a Democrat and a pediatrician, introduced a bill to require that a doctor’s waiver be approved by state health officials.³¹ Both measures have been strongly opposed by anti-vaccine advocates, including Kennedy, and groups such as the Informed Consent Action Network and Parents United 4 Kids. Actress Biel traveled to the state Capitol in Sacramento to lobby against the new legislation. Opponents say these provisions violate patient-doctor relationships and infringe on medical freedom.

      Dorit Reiss, a UC Hastings law professor, has written extensively about the vaccine requirements and testified before the California State Senate judiciary committee in support of the current law and the proposed change. “No court, state or federal, has ever struck down an immunization law, because parental rights have never been absolute,” says Reiss. “They have always been limited. Vaccine mandates are especially natural because they protect the welfare of the child and the safety of others.”

      At Issue

       Should nonmedical vaccine exemptions be eliminated?

       Yes

       Sandra Fryhofer, M.D.

       Board Member, American Medical Association; Liaison to the Advisory Committee on Immunization Practices

      Written for CQ Researcher, September 2019

      Immunization programs are credited with having controlled or eliminated the spread of epidemic diseases, including measles, smallpox, mumps, rubella, diphtheria and polio. That public health success is in jeopardy today as a growing number of parents are refusing to vaccinate their children based on long-debunked claims about vaccine safety, efficacy or necessity.

      According to the Centers for Disease Control and Prevention (CDC), the United States has the highest number of measles cases since the disease was considered eradicated nearly 20 years ago. This recent outbreak is the result of declining vaccination rates.

      The scientific evidence is overwhelming that vaccines are among the safest and most effective medical interventions. Vaccines prevent death and illness from preventable diseases, such as measles, and safeguard public health by helping to prevent the disease from spreading to others in close contact. When individuals opt out as a matter of convenience, personal preference or misinformation, they put themselves and others at risk—particularly children too young to be vaccinated, cancer patients and other immunosuppressed patients who cannot be vaccinated.

      To protect communities, it is vitally important that policymakers eliminate nonmedical exemptions from required childhood immunizations and physicians grant exemption requests only when patients cannot receive vaccines for medical reasons. And, given the declining child vaccination rates, the American Medical Association supports legislation, regulations, programs and policies that encourage states to eliminate all nonmedical exemptions from mandated pediatric immunizations.

      Nonmedical vaccine exemptions have doubled in the past 20 years. The process for obtaining personal-belief exemptions varies by state, with some requiring education about the risks and benefits of vaccines before an exemption can be granted and others allowing a parent to simply check a box on a school form. Allowing personal-belief exemptions lends credence to the disproven claim that vaccines are unsafe or cause health problems.

      Broad vaccine exemption policies take us down a dangerous path to compromising public health. People who cannot be vaccinated due to medical reasons rely on community or “herd” immunity to prevent disease. At least 93 percent of the population needs to receive the measles vaccine to guard against the spread of the disease.

      Some parents say they should be free to make medical decisions on behalf of their children, but they also have a responsibility to do what’s in the best interest of their child and the community at large. We cannot allow misinformation and persistent rumors about vaccines to take us backward in this fight to eradicate disease.

       NO

       Michael Sussman

       Civil Rights Lawyer for Vaccine Opponents

      Written for CQ Researcher, September 2019

      The difficulty with eliminating nonmedical vaccine waivers is vividly illustrated by a pending vaccine exemption case in New York state.

      In early fall 2018, a measles outbreak developed in several New York counties. Public health authorities failed to utilize the measures and means permitted by state law to quell such outbreaks. They did not quarantine or isolate those infected with measles. The outbreak spread, and in early December a county health commissioner barred all unvaccinated children from all public and private schools, even though there was no evidence that these children had contributed to the spread of the disease. In addition, state law allows that if a case of measles occurs in any school, unvaccinated children could be barred from that school for several weeks.

      In March 2019, Rockland County Executive Ed Day declared a public health emergency, ordered all unvaccinated children with religious exemptions to remain indoors and barred them from any public place. Apart from the obvious enforcement issues, this ban was both troublingly overbroad and under-inclusive at the same time. Unvaccinated adults were not included because it would be too expensive and disruptive, Day’s lawyer told a state Supreme Court justice. And more than 1,000 healthy children were stigmatized and isolated by Day’s order. The Supreme Court enjoined Day’s ban, so Day began vociferously lobbying state legislators to repeal the religious exemption to vaccinations. His message—and that of bill sponsors—was quite blunt: People claiming religious exemptions were frauds; no religion prohibits vaccinations, and those claiming the contrary were pretenders.

      This direct assault on sincerely held religious beliefs continued in the legislature, where lawmakers repealed the 55-year-old religious exemption, without any legislative hearings, tossing 26,000 children out of their schools without a strategy for educating them. This includes special-needs children whose educations are protected by federal law.

      I am challenging the repeal of the religious exemption, because the legislative debate makes it clear that the discussion was dominated by an animosity toward religion—indeed, the outright denigration of people of religious faith, invalidating the state’s action. Motive matters, and those who spoke made clear that their very belated response to the ebbing outbreak was intended to signal that people who hold religious views contrary to those of the majority should be damned. That is not what a constitutional democracy looks like. It is more like the establishment of a state religion, which is prohibited, quite strictly, by the First Amendment.

      Not all such legislative efforts have been successful. Democrats in the Oregon Legislature abandoned a bill to end nonmedical exemptions after Republicans walked out of the Capitol to block its passage. In Alabama the Senate failed to pass a bill introduced in May that would have removed religious exemptions. And in Florida, after religious exemptions increased nearly fourfold last year, from about 6,500 in 2011 to 25,000, efforts to disallow such exemptions have stalled.³²

      Connecticut lawmakers dropped proposed legislation that would have prohibited unvaccinated students from enrolling in the state’s public schools. The legislators could not agree on how to address unvaccinated children who were already in school.³³ “They let the perfect become the enemy of the good,” says the American College of Physicians’ McLean.

      Public health officials acknowledge that countering online misinformation is an uphill battle. “It’s impossible to respond to everything on social media and the internet,” says Fauci of the National Institute of Allergy and Infectious Diseases. “Instead of responding tit-for-tat, we tend to give statements regarding the

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