Some Doctors Charging for Medical Vaccination Exemptions

California eliminated nonmedical exemptions, and now some doctors are charging steep fees to parents who oppose vaccinations and want medical exemptions for their children, according to a study in Pediatrics.

Researchers interviewed health officers and immunization staff throughout the state of California to learn more about the impact of Senate Bill 277, which eliminated nonmedical exemptions for immunizations needed for entrance into school in 2015.

In the initial year of implementation, investigators had expected to see slight increase in the rate of medical exemptions, but the rates actually jumped 150% from 0.2% to 0.5%. In the second year, the rate continued to grow, lead researcher Salini Mohanty, DrPH, tells Drug Topics.

"A slight increase was expected because families with children who legitimately qualified for medical exemptions before SB277 might have just gotten personal belief exemptions because they were easier and more convenient to get. However, by the second year of implementation it had increased to 0.7%, which was a 250% increase from before the law was put into effect," said Mohanty, a postdoctoral research fellow at the University of Pennsylvania School of Nursing.

Physicians must write the medical exemptions, which are then submitted to directly to the student's school. But, according to the research, some physicians are charging parents to obtain a medical exemption.

"It was hypothesized among health officers and immunizations staff that vaccine-hesitant parents were finding doctors who were willing to grant their request for a medical exemption," Mohanty said. "Through these interviews, we heard reports of physicians charging fees in exchange for granting medical exemption requests."

The study also found that medical exemptions were being granted for contraindications like family history of allergies or autoimmune disease. Some health officers and immunization staff disagreed with some of the contraindications that were listed for a medical exemption, but said under California law, they have no authority to question the scientific validity of the exemptions, the study said.

Mohanty said the results of the study provide important information about specific ways in which SB277 could be reworked to address issues found in the study, including what types of contraindications can be accepted and to prevent the practice of granting medical exemptions for a fee.

"One way to make sure that some of these medical exemptions that are outside the intention of the law don't get accepted is to require some sort of standard review of medical exemptions either by the local health department or by the state health department," she said. "Giving the local health officers and health departments more of a role in implementing and enforcing the law could also help."

Mohanty said the study could also provide important lessons to other states that are considering implementing similar laws.