Oakland Unified, new state law creates tougher vaccine enforcement
on October 21, 2015
The clock is ticking for California schools. The January 1, 2016 deadline, is fast approaching for districts to comply with SB 277, the controversial new law eliminating personal belief exemptions for state-mandated vaccinations.
Signed by Governor Jerry Brown on June 30, SB 277 requires nearly all California families to immunize their children in accordance with state standards. It specifically forbids parents from using their religious or personal beliefs as grounds to refuse to vaccinate children against diseases such as measles or pertussis. Co-authors of the legislation, Senators Richard Pan (D-Sacramento) and Ben Allen (D-Santa Monica), and their supporters drew fierce criticism from opponents led by organizations such as A Voice for Choice.
With fall well underway, the Oakland Unified School District (OUSD) is already taking steps to ensure the administration will be in full compliance with SB 277 come the new year. “We’re going to be even more rigorous [about] not enrolling students who don’t have the proper vaccination records,” said Troy Flint, public information officer for the district. “While that’s always been the official practice, that hasn’t always played out that way.
According to the California Department of Public Health, as of October 2014, only 74 percent of kindergartners in the OUSD were up-to-date with state-mandated immunizations including those for diphtheria, tetanus and pertussis (DTP); polio, measles mumps and rubella (MMR); hepatitis B; and varicella or chickenpox. That rate falls far short of the state average of 90.4 percent. Among OUSD 7th graders last year, only 84 percent were current with compulsory adolescent version of the vaccine for diphtheria, tetanus and pertussis (Tdap), compared to 97.8 percent throughout the state, according to the CDPH statistics.
“We are stressing that it’s not going to be a laissez-faire approach anymore, and that we’re holding the line,” Flint said.
Alameda County public health officials view SB 277 as a potential boon to boost the district’s lagging immunization rates, although they don’t necessarily think the biggest gains will come from eliminating exemptions based on religious or philosophical grounds.
“Our issue is not the 15 personal belief exemptions [in OUSD], but that’s the issue that gets all the media attention because it’s sexier,” said Amy Pine, director of immunization at the Alameda County Public Health Department. “The real issue is the non-sexy stuff. It’s the training of staff. It’s the access to immunization at the doctor’s office. It’s the level of organization of the school district at the school level. It’s just all these checks and balances along the way.”
In the OUSD, personal belief exemptions account for less than 1 percent of total kindergarten students enrolled—much less than the 2.54 percent average in California, according to Pine. Instead, most of the district exemptions account for less than 1 percent are known as “conditional entrants,” students who do not fully meet all immunization requirements but are admitted provided they follow up to complete all inoculations.
“What has happened in the past in Alameda County in a lot of schools, not just in Oakland Unified—but in others, too—is that there has not been a proper understanding of what ‘conditional entrance’ means. Schools have, in the past, let students in who just simply weren’t up-to-date,” said Pine.
According to the publicly available figures on the CAPH’s website, in the 2014-2015 school year, over 25 percent of OUSD kindergartners were conditional entrants, far higher than the 6.9 percent average statewide. In Oakland, record-keeping and administrative follow-up have been less than adequate, leading to some students passing from grade to grade without a full immunization card, said Pine. “I think that staff just was not being really well-trained on how to screen for proper immunization and how to document proper immunization and they were calling a lot of students that might not have been up-to-date as ‘conditional entrants,’” said Pine.
“One of the problems that we’ve seen with monitoring the vaccination rates and compliance is whether all that documentation is recorded properly and entered properly using the right codes into the various student information system,” agreed Flint.
Public health historian Elena Conis, author of Vaccine Nation: America’s Changing Relationship with Immunization, predicts that after the law takes full effect, “compliance will go up because people who were able to be kind of—I don’t want to say careless—but lax in getting their kids’ vaccines on schedule now won’t have that luxury.”
Conis added that SB 277, while not likely to have a profound overall effect on Bay Area schools, was likely to have a significant one on busy families who now have to find time to get their children vaccinated, thanks to the stricter administrative policies.
For some parents of kids with special medical concerns, it’s important to ensure that other students at the school are vaccinated. Laurian Rhodes is the mother of a Peralta Elementary School student who was diagnosed with acute lymphoblastic leukemia. Her son, Blixa Cawley, underwent over three years of chemotherapy, but his immune system is still vulnerable due to the treatment. His doctors have recommended he wait six months to be re-vaccinated—leaving him potentially susceptible to a variety of maladies.
His mother is concerned about the high rates of PBEs and conditional entrants at Peralta, which according to CAPH figures are both 9 percent. “You send your kid to school assuming that there’s herd immunity. We can’t be comfortable with the high rates of people not vaccinating for what really seems to me as spurious reasons,” said Rhodes. “We don’t have that security anymore.”
Rhodes’ vocal pro-vaccination stance in her community has resulted in a number of “pretty intense conversations, mostly online” with staunch vaccination critics, she said. “There’s so much misinformation out there. People can find all sorts of doctors that validate people’s misguided concerns,” said Rhodes.
But not everyone agrees. Oakland resident Tina Kimmel, a former state public health official and local pro-vaccine choice activist, is strongly opposed to the new law. She is distrustful of government control over individual liberties, such as mandates that parents must vaccinate their children. “I’m very scared of the police state encroaching in on our children,” Kimmel said. A recent state-wide petition aiming to put SB 277 up for referendum on the November 2016 ballot fell short of the required 365,880 signatures.
At an informational meeting in September led by OUSD director Jumoke Hinton-Hodge (District 3), Christopher Muhammed, a social justice activist and a San Francisco Bay Area Minister of the Nation of Islam, said he was concerned about “extremely high rates of autism… particularly among black boys.” He added that district officials have “no idea about the details of SB 277 that they’re being called upon to implement.”
School district and public health officials have maintained their position. “Any child who’s not immunized is not protected. And when any child is not immunized, they’re also not protecting the children who can’t be immunized,” said Pine of Alameda County Public Health.
“We do think that this is just and right from a public health perspective. People can debate the science but the science is overwhelmingly in favor of the idea that vaccines are not linked to autism—that the risks that are posed by vaccines to the individual are worth the gains in public health for the greater number of people,” said Flint of OUSD. “I think that people recognize that [the policy has] been made at a state level and we’re required to comply.”
Correction: A previous version of this article incorrectly implied that there are state-mandated vaccinations for tuberculosis. There are, in fact, no required TB immunizations. However, for children entering first grade in Alameda County there are required health screenings which include risk assessments for TB infection and, for children determined to be at risk for infection, TB testing.
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