The 2014-’15 measles outbreak linked to Disneyland in California stoked the debate
over whether religious and personal exemptions from school vaccine requirements should
More than 100 people around the country and in Canada contracted measles in the outbreak
believed to be caused by a visitor who caught the disease overseas and then visited
the amusement park while infectious. Among those who fell ill were infants too young
to be vaccinated and some who were not vaccinated due to personal beliefs, according
to the California Department of Public Health.
The outbreak prompted some states, including California, to consider whether nonmedical
exemptions from school vaccine requirements should be allowed.
The issue will be debated by Richard Pan, MD, MPH, FAAP, a member of the AAP Council
on School Health, and Aviva Katz, MD, MA, FAAP, immediate past chair of the AAP Committee
on Bioethics, during a point-counterpoint session titled “Vaccine Exemptions for School:
Personal, Religious, All, or None? (D2044).” The session will be held from 8:30-9:30
am Sunday, Sept. 17.
Dr. Pan is a California state senator who authored a law (SB 277) that eliminated
personal belief exemptions from school vaccine requirements in his state. The law
took effect on July 1, 2016. Dr. Katz is associate professor of surgery at the University
of Pittsburgh School of Medicine and director of the Consortium Ethics Program at
University of Pittsburgh.
After the Disneyland outbreak, Dr. Pan said he spoke with many parents concerned about
their children contracting vaccine-preventable diseases, especially youngsters who
could not be vaccinated due to medical conditions or receipt of immunosuppressive
“Every child has the right to be safe and healthy, and every child needs to be safe
in their school and their community,” Dr. Pan said. “That was a reason I authored
SB 277, which has raised vaccination rates to levels not seen since 2001 in California.”
Dr. Katz maintains there is a place for personal exemptions from state vaccine requirements.
“I will be taking the position that decisions about proceeding with childhood vaccination
fall within the spectrum of medical decision-making that we allow families,” she said.
“While we strongly disagree as pediatric care professionals with either deferring
vaccination or delaying or altering the vaccination schedule, outside of the occurrence
of an epidemic, the risk associated with this act does not rise to the level of mandating
vaccination without an opportunity for exemptions.”
Dr. Pan pointed out that the California law does not force parents to get their children
vaccinated but rather restricts unvaccinated children from attending public schools.
These children still can get an education through homeschooling, independent study
from the public school system or at a private school.
“If someone makes a choice to put other people’s children at risk because they have
beliefs that are not supported by science about vaccines, then there’s a consequence
to protect those children,” Dr. Pan said.
Dr. Katz said she favors less restrictive methods to increase vaccination rates.
“Altering access to exemptions, making exemptions more difficult to obtain and linking
exemptions to receiving education can potentially decrease the use of personal exemptions
and could be instituted rather than a blanket removal of all nonmedical exemptions,”