Pediatric Academy Says Vaccine Exemptions May Need Government Oversight

Due to the recent measles outbreaks, legal battles are underway in many states to eliminate non-medical exemptions to vaccination, says Dr. Sean T. O’Leary, M.D., in an editorial published by the American Academy of Pediatrics (AAP). 

The AAP’s current policy states that vaccine exemptions from vaccinations for school entry should be reserved only for true medical contraindications and is clearly opposed to non-medical exemptions. 

While the adoption of such laws is good for public health, states must put processes in place to ensure medical exemptions are legitimate. 

In Mississippi and West Virginia, approval for medical exemptions to vaccination must go through a central- or state-level review after submission by a physician. 

In California, however, medical exemptions may be approved solely by a licensed physician. 

New evidence is emerging that some physicians in California are writing bogus medical exemptions for children who do not have a true contraindication to vaccination. 

These unscrupulous exemption-writing practices by a few medical providers have placed herd immunity at risk and have not gone unnoticed by the Medical Board of California. 

That California agency has placed one individual on probation and continues to review additional cases of physicians who may be inappropriately writing medical exemptions for vaccines. 

In addition, California Sen. Richard J. Pan, M.D., M.P.H., FAAP, recently introduced a bill that would require physicians to submit medical exemptions to the public health department for approval. 

As states consider eliminating non-medical exemptions, they may need to consider oversight of the process for obtaining medical exemptions in order to prevent illegal exemptions by the small proportion of health care providers, who may seek to undermine policies banning non-medical exemptions. 

These invalid medical exemptions may leave children and those around them, unnecessarily at risk for vaccine-preventable diseases. 

Dr. O’Leary is a member of the AAP Committee on Infectious Diseases.