(USA TODAY) - As children return to their classrooms, California lawmakers are debating a bill that aims to boost the number of kids who go to school with all of their shots.
The move comes as health officials across the USA grapple with the resurgence of once-forgotten infectious diseases, including what could be the biggest epidemic of whooping cough in 50 years.
Although all states require children be vaccinated before attending school, each has different policies about exemptions, with some granting waivers only for medical reasons, while others allow kids to opt out based on religious or personal beliefs. A bill proposed by Sacramento pediatrician Richard Pan, a member of the California State Assembly, would require that parents meet with a health care provider before getting a waiver based on personal beliefs. The state senate is expected to take up the bill this week.
"You don't have to agree with your doctor, and we're not taking away a parent's right to an exemption," Pan says. "But we do want parents to be informed."
A similar bill in the Arizona Legislature this year never made it out of committee. In Washington state, a law requiring that parents meet with health care providers before getting vaccine waivers took effect in July 2011.
The number of kids getting their shots in Washington is already rising. The percentage of kindergartners with vaccine exemptions dropped from 6% in the 2010-11 school year to 4.5% in 2011-12, according to Every Child By Two, an immunization advocacy group.
Debate over vaccines has been heated in state legislatures across the USA.
Earlier this year, Vermont lawmakers considered, but voted against, a measure to eliminate the state's philosophical exemption. Instead, lawmakers voted to require parents receive educational materials about vaccines before getting waivers.
On the other side, eight states this year considered but failed to pass proposals to make it easier to opt out of shots. Those states were South Dakota, New York, New Jersey, West Virginia, Kansas, Minnesota, Massachusettes and Mississippi.
South Dakota state Sen. Tim Begalka, who sponsored one of the bills in his state, says he's disappointed his state failed to pass a measure allowing parents to refuse vaccines based on personal beliefs. "I don't think the government should be able to force people to take any immunization," says Begalka, a Republican, from Clear Lake, S.D., who says he has concerns about vaccine safety.
Like many states, South Dakota allows parents to opt out of vaccines because of religious beliefs or for medical reasons. But Begalka says the religious exemption is very narrow. "There are a lot of people who don't want their kids immunized, but they don't belong to a church that believes that," Begalka says. "What are they supposed to do - lie?"
Michael Smith, president of the Virginia-based Home School Legal Defense Association, follows vaccine waiver legislation across the USA. He opposes the California bill. "They are saying to parents, 'We can't trust you to make these decisions for your children,' " Smith says. " 'We are going to require you to meet with a doctor and a doctor will tell you the risks and benefits, and then you will be smart enough to make the decision."
Although few parents deny their children all vaccines, studies show that a growing number in recent years have begun selectively skipping or spacing out shots, motivated by now-debunked claims about vaccines and autism or other chronic diseases. Dozens of studies show that vaccines are safe, and they're credited with saving millions of lives, says William Schaffner, an infectious disease expert at the Vanderbilt University School of Medicine. Yet many parents continue to get inaccurate information from friends, neighbors and the Internet, Pan says.
Vaccinating children is not a simple individual choice, such as choosing whether or not to smoke or eat meat, says James Cherry, a pediatrician at Mattel Children's Hospital at UCLA. That's because vaccines can only eliminate disease if almost everyone in a community gets them. People who can't be vaccinated - such as those with cancer or HIV, or newborns too young to be fully immunized - depend on the "herd immunity" provided by their communities, Cherry says. Because people who oppose vaccines often live in the same community, their "herds" may be particularly porous, allowing infections to take hold.
More than 18,000 Americans were sickened by whooping cough, or pertussis, from January to July - twice the number as in the time period last year, according to the Centers for Disease Control and Prevention. Health officials say part of the rise is due to people refusing vaccines, while part of the increase is due to a newer, less powerful vaccine, which came into use after parents voiced concerns about the safety of a an older vaccine.
Research shows that strict school vaccine laws can help control epidemics. About 50% more people develop whooping cough in states that allow people to opt out of vaccinations for personal beliefs, compared with states that grant waivers only for religious beliefs, according to a 2006 study in Pediatrics.
Washington state has declared a whooping cough epidemic, with more than 3,000 cases.
Two years ago, California also declared an epidemic when it was hit with 10,000 cases, including the deaths of 10 infants too young to be fully immunized.
"Parents need to understand that this is not just about their own child," Pan says. "It's about the impact of their decision on the community. ... No one wants a child to cough himself to death."