PD Editorial: Doctors fail kids by abusing vaccination exemption

California's landmark childhood vaccination law is being undermined from a surprising source - doctors. We'd like to think that doctors would know better than to help parents exploit a loophole in the law to avoid vaccinating their children, but apparently some cross that line. We hope lawmakers find a fix, but in the meantime, health jurisdictions should better track medical exemptions, and the state Medical Board ought to review whether those health care providers are living up to the Hippocratic Oath.

In 2015, lawmakers ended the personal belief and religious exemptions. Now, if parents choose not to vaccinate their kids, they need to home-school them. California no longer allows parents who have bought into the bad science that fuels the anti-vaccination movement to compromise the “herd immunity” of an entire school population.

A few narrow exemptions to vaccination requirements are necessary. For a small percentage of children, vaccines are dangerous. For example, children with autoimmune disorders or certain allergies cannot be vaccinated safely. A medical exemption therefore remains in the law. But that medical exemption has become a loophole.

Academic researchers reported in the November issue of the medical journal Pediatrics that the medical exemptions have become much more common since 2015. The researchers spoke with dozens of health officers around the state who shared frustration with its abuse.

One health official described doctors who basically sell exemptions. Another told of a nurse practitioner who gave exemptions, even though the law only allows doctors to do so. And one doctor was based in a medical marijuana dispensary and therefore not likely a primary care physician for kids.

The cited basis for exemptions often were speculative or unrelated. For example, a reported family history of autoimmune disease or allergies might be enough for some doctors even if there was no evidence the child actually had inherited the health problem.

If doctors are playing fast and loose with the rules to serve a passionate clientele to the detriment of public health, the California Medical Board should hold them accountable. The board investigates ethics violations all the time, and one might make the case that a vaccine exemption not supported by the health record of the patient might even rise to the level of malpractice.

In some ways, this feels like the sort of thing that happened back when medical marijuana was legal but recreational marijuana was not. People who wanted a prescription simply asked around to find the right doctor to visit for vague back pain.

The researchers also found that comprehensive data about medical exemptions is lacking. Only five health jurisdictions of the 35 contacted by researchers actively tracked medical exemptions, and one of them was facing a lawsuit filed by parents as a result. Officials from that jurisdiction reported receiving “hate mail and death threats across all social media” because they started tracking the exemptions.

The majority of jurisdictions that do not track told researchers that state law does not require them to do so. That's true, and lawmakers should fix that. In the meantime, state law doesn't prohibit them from doing it. The more data the state has, the better it can work to improve health.

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