Suggestions for How to Improve Oversight of Vaccine Medical Exemptions

A Viewpoint published today in JAMA Pediatrics discusses concerns about exploitable loopholes in state vaccination exemption policies. In it, Y. Tony Yang, ScD, LLM, MPH of the George Washington University’s Milken Institute School of Public Health and School of Nursing describes a recent high profile case in California. He and his coauthor, Ross D. Silverman, JD, MPH of the Indiana University Fairbanks School of Public Health outline more prevention-focused options for structuring and regulating medical and nonmedical vaccination exemption requests.

The California case involves Robert “Dr Bob” Sears, MD, an American Academy of Pediatrics fellow and leading vaccine skeptic. In June 2018, the Medical Board of California placed him on 35 months probation for substandard care for writing a medical report exempting a boy from all childhood vaccinations.

“The medical board’s action represents a novel and important development in how states protect the public’s health from vaccine-preventable illnesses,” Yang and Silverman write. “It also reveals concerns about exploitable loopholes in many states’ vaccination exemption policies.”

In addition to providing details about the Sears case and California’s action, the Viewpoint explains why Yang and Silverman feel that reliance on state medical boards to regulate medical exemption practices is not an ideal oversight or public health approach.

The prevention-focused options available to states discussed in the Viewpoint include permitting review of exemption requests on both technical and substantive grounds. “A law that does not grant the state authority to review and reject an exemption’s substance is at increased risk both for relatively high exemption rates and exemptions permitted on specious grounds,” they say, citing California and Washington state’s law as examples.

The Viewpoint lauds West Virginia as a state that only permits medically indicated exemptions to school vaccination requirements. The state employs a licensed physician as its State Immunization Officer to review medical exemption requests for both completeness and substance. The authors recommend that states adopt preventive, substantive review processes similar to that of West Virginia.

“Lessons from California’s Discipline of a Popular Physician for Vaccination Exemptions Without Medical Cause” can be accessed here.