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It's not often that California, West Virginia, and Mississippi are politically aligned, but that unlikely trio formed on June 25, 2015, when California Governor Jerry Brown signed into law Senate Bill (SB) 277, substantially narrowing exceptions to school-entry vaccination mandates. With that law, California becomes the third state to disallow exemptions based on both religious and philosophical beliefs; only medical exemptions remain. The move represents a stunning victory for public health that affects not only California schoolchildren but also the prospects for strengthening vaccination requirements nationwide.
In 2014, California tightened its personal-belief exemption by requiring parents seeking such exemptions to obtain a physician's attestation that they had received information about vaccine-preventable illnesses and the benefits and risks of immunization. Just 18 months later, the legislature decided that that wasn't sufficient. The new law applies to elementary and secondary schools and day-care centers both public and private, exempting only home-schooled students. It prohibits these institutions from unconditionally admitting children who are not up to date on vaccinations against a prescribed list of diseases (see Vaccines Required for Unconditional Entry into Schools, Child-Care Centers, Day Nurseries, Nursery Schools, Family Day-Care Homes, and Development Centers in California) unless they have a medical exemption. The law also allows the state Department of Public Health (DPH) to add diseases to the list but, anomalously, permits personal-belief exemptions for any such additions.
The passage of SB 277 was anything but a foregone conclusion. Although California's predominantly liberal populace generally tolerates assertive public health policies, a vocal libertarian minority ardently opposes vaccination mandates. The bill's opponents mobilized fiercely against it, attending hearings with toddlers in tow and organizing strident protests. The pediatrician-senator who sponsored the bill received death threats.
Nevertheless, four factors converged to enable its passage. First, legislative supporters showed extraordinary backbone in resisting pressure to abandon the measure. Second, the DPH publicized data showing that rates of personal-belief exemptions in California have doubled since 2007,1 and analysts noted that vaccination coverage is low enough to jeopardize herd immunity in a quarter of schools.2 Third, the widely publicized Disneyland measles outbreak brought home the risks posed by lost herd immunity. Researchers swiftly concluded...