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New Requirements for Vaccination Exemptions on the Horizon

California state Senator and pediatrician Dr. Richard Pan (D-Sacramento) has introduced multiple vaccination-related legislation during his tenure as Chair of the Senate Health Committee. Starting in 2015, SB 277, was passed to eliminate all non-medical (i.e., religious and personal belief) exemptions for immunizations required for school entry. According to the California Department of Public Health (CDPH), while SB 277 was successful in raising immunization rates across the state, there has also been an increase in the number of medical exemptions issued. The CDHP notes the percentage of kindergarteners with medical exemptions rose from 0.2 percent of students in the 2014-2015 school year to 0.9 percent of students in 2018-19.

At a time when there has been both a rise of medical exemptions in the state and in a year that has seen the worst measles epidemic in 27 years, vaccination-related legislation was back front and center at the state Capitol in 2019, making it one of the year’s most contentious issues. 

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According to the Centers for Disease Control website, from January 1 to September 12, 2019, 1,241 individual cases of measles have been confirmed in 31 states, including California. 

Back in February, Dr. Pan introduced SB 276 to address what he considered the dramatic increase in medical exemptions from vaccinations required for school entry. The bill went through several iterations, as discussions prompted multiple amendments throughout the committee hearing process and discussions with the Governor’s Office, which was closely following the developments.

In its final version signed by Governor Newsom, SB 276 will require:

  • By January 1, 2021, the CDPH shall develop and make available for use by licensed physicians and surgeons an electronic, standardized, statewide medical exemption certification form that shall be transmitted directly to the department’s California Immunization Registry (CAIR). The form shall be printed, signed, and submitted directly to the school or institution at which the child will attend, submitted directly to the governing authority of the school or institution, or submitted to that governing authority through the CAIR, where applicable.
  • CDPH will annually review exemption forms that meet any of the following criteria: 1) submitted to schools with overall immunizations rates less than 95 percent; 2) submitted by physicians who have granted more than five medical exemptions in one year; or 3) submitted to schools that have failed to report their immunization records to CDPH.
  • The State Public Health Officer or a physician designee may deny or revoke medical exemptions that do not align with CDC/ACIP or AAP guidelines if the exemption is determined to be inconsistent with standard of care.
  • The Department will notify the Medical Board of California of any physician who submits an exemption that is denied or revoked, and of any physician from whom the Department is not accepting exemptions.
  • The Department will not accept medical exemptions from physicians who pose a risk to the public’s health, or from physicians with pending accusations with the Medical Board of California until the accusation is resolved in favor of the physician.
  • The bill would authorize a parent or guardian to appeal a medical exemption denial or revocation to the Secretary of California Health and Human Services. The appeal would be conducted by an independent expert review panel of licensed physicians and surgeons established by the secretary. The bill would require the independent expert review panel to evaluate appeals consistent with specified guidelines and to submit its decision to the secretary.

In signing SB 276, Governor Newsom also signed a companion bill, SB 714, which allows a child who has a medical exemption issued before January 1, 2020, to be allowed to continue enrollment until the child enrolls in the next grade span.  


Gabriela Villanueva is CAP’s Public Affairs Analyst. Questions or comments related to this article should be directed to