A growing number of patients are requesting exemptions from vaccinations, posing a public health concern across the country and challenging states to form a response.

One state was tested on this issue in June 2018. The Medical Board of California put pediatrician Robert Sears, MD, on probation for writing a report exempting a 2-year-old patient from receiving vaccines after his mother complained that he became ill after a vaccination. The state accused Dr Sears of negligence based on concerns with his assessment of the patient’s eligibility for exemption. Dr Sears ultimately agreed with all charges brought against him and was placed on 35 months’ probation.

“The medical board’s action represents a novel and important development in how states protect the public’s health from vaccine-preventable illnesses,” wrote Ross D. Silverman, JD, MPH, in a recent article published in JAMA Pediatrics. “It also reveals concerns about exploitable loopholes in many states’ vaccination exemption policies whether the state permits religious and philosophical exemptions.”

A lack of strong oversight for medical exemption review can lead to public health concerns, but relying on state medical boards to regulate the exemption process is not the best solution, according to Mr Silverman.

For example, medical boards have no authority to reverse exemptions and they take a long time to act. In Dr Sears’ case, it took 4 years from the time he wrote the exemption until the case was settled. The other difficulty for medical boards is that the patient must be willing to cooperate by providing medical records, which is unlikely to happen in cases where the patient does not agree with what the board is investigating.

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“To improve oversight of medical exemptions (as well as non-medical exemptions), health care professionals and professional associations should encourage states to strengthen their vaccine exemption laws by adopting a preventive, substantive review processes,” Mr Silverman wrote, “empowering state public health authorities to not merely ensure that medical exemption forms are submitted appropriately but also to assess application content and reject those that fail to state valid, evidence-based exemption grounds.”

Reference

Silverman RD, Yang YT. Lessons from California’s discipline of a popular physician for vaccination exemptions without medical cause [published online December 10, 2018]. JAMA Pediatr. doi:10.1001/jamapediatrics.2018.3835