Senate Standing Committee on Health

Is Cortese coming?

Good morning, and thank you to everyone joining us here in San Diego for the Senate Health Committee's informational hearing on medical exemption for state immunization requirements. I first want to welcome everyone to San Diego who is not a resident here, and thank you all so much for coming down. I also wanna thank the County of San Diego and the county board of supervisors for allowing us to use their chambers for today's hearing.

This is a very important public health issue, and it deserves a thoughtful, fact based discussion, especially as we continue to see vaccine preventable diseases outbreaks across this country and across this state. In fact, this week, the Pan American Health Organization is reviewing the United States measles elimination status, which we are at risk of losing for the first time since achieving it in 2000.

We have a responsibility to protect children from vaccine preventable disease, including children who cannot be vaccinated and must rely on community immunity. We also have a responsibility to ensure that the systems we establish are working as intended. Earlier this year, during our committee's hearing on SB 1377, questions were raised about the number of medical exemptions being revoked and whether physicians are experiencing difficulties with the level of oversight in the current medical exemption process.

At that hearing, I talked about the importance of understanding how the medical exemption process is working and whether it is accomplishing what it was designed to do before considering changes in existing law. I had some concern that some of the information presented at the hearing did not appear to align with the data being reported by the entities responsible for implementing the law.

We wanna move with facts and not fiction. To understand what is working and where challenges exist, it is important that we are working with the accurate information. So today's hearing is an opportunity to take a closer look at the data and hear directly from physicians and the implementing agencies to understand how the process is working, what the data show, and whether there is a legitimate gap or unintended consequences that warrant further attention.

I also want to acknowledge the fact that, since this is a Senate Health Committee hearing, we did invite all of the Members of the Senate Health Committee in addition to a couple of the Senators who were concerned specifically about vaccines, including Senator Allen, Senator Cortese, and Senator Jones, who I thank you so much for coming. Really appreciate you being here. I appreciate all our witnesses being here today, and I look forward to very substantial discussion. And we will begin with our first speaker.

Would it be okay if I said some welcoming remarks?

Right after Senator Jones says welcoming remarks.

Thank you very much, chairwoman. I appreciate the opportunity to be here this morning, and thank you very much for following through with this very important committee hearing. It is encouraging to me that we've had some very robust conversations in the capitol building over the last year, and particularly in regards to the bill that I proposed earlier in the year, 1377. The, you know, the discussion... And I agree with all of your comments in the opening.

You know, one of the things that has concerned me about the vaccination conversation, as the media digs into it and pays attention to it, they have a tendency to portray sides and try to make it into a partisan issue. I do not believe that this is a partisan issue at all, and that's why I'm very thankful that we had a coalition, bicameral coalition and bipartisan coalition discussion earlier in the year on this. I have three kids, two, a daughter-in-law, a son-in-law.

I have two grandchildren, a third grandchild on the way. I'm vaccinated. My wife is vaccinated. All of my kids are vaccinated. My grandkids are vaccinated. And the... So what I'm hoping that we'll gain out of this conversation is, you know, to your point of what you said, is there a gap? Is there a challenge that needs to be solved? You know, some people are gonna say that there isn't.

Some people are gonna say that there isn't, but that's the reason that we're here today. You know, my concern is in the state of California, are parents gonna have the authority over their children to make medical decisions that are important to their family? And so I'm hoping that... I don't, I don't know that, I don't know that we'll draw any conclusions today.

But what I am hopeful is that we're on the road to having a more and continuous robust conversation on this and that California can lead the way for the rest of the country on a common sense answer to these very important questions. And, again, thank you very much for doing this.

This is one of the issues that makes me disappointed that I'm termed out because it is one of the things I would like to continue working on, but I know that I'm leaving it in good hands with you at the helm of the Health Committee. And I'll still be living in California, and I'll still be a constituent. So I will have lots to say about it. So thank you all very much.

Thank you, Senator Jones. You will definitely be missed, but you won't be too far away from me. So that's the good part. We will now start with our first presenter, who will be presenting on immunization requirements as a public health policy, Dr. Elena Conis.

Thank you, Madam Chair and Senator, for the opportunity to speak before you today. My name is Dr. Elena Conis. I am professor and North Gate Chair in the School of Journalism and the Department of History at the University of California, Berkeley. I am a historian of medicine and public health, and my scholarship examines the history of infectious disease, vaccination, vaccine preventable disease, and public trust in medicine and health.

I'm here today in my capacity as a historian and subject matter expert exclusively, and the views I offer reflect my own professional expertise. They are not to be taken as an official position of either UC Berkeley or the University of California system. As a historian, I study the forces that have both supported and constrained a widely vaccinated US public over the last 200 years. This wide array of factors includes everything from scientific developments coming from labs and clinics to the political, economic, social, and cultural trends that define moments in time.

My work has shown, for example, the influence of post-war social movements on vaccination acceptance in the 20th century, the role of vaccination policy within the broader health policy landscape, and the, what I call, framing effect that begins when a new vaccine is developed, which reconfigures how we conceptualize and attempt to manage its target infection, whether that's smallpox, polio, measles, or HPV.

The history of vaccination in the US is also the history of resistance to vaccination and anti vaccination, which has challenged government vaccination requirements, also called mandates, as long as these have existed. Mandates were first introduced in earnest in the middle of the 19th century. Anti vaccination became an organized social movement a few decades later, with local chapters and societies forming in US cities from the 1870s through the 1900s.

At the turn of the 20th century, these groups lobbied for and generally succeeded in achieving modifications to state and local vaccination laws and regulations, which we now refer to as vaccine or vaccination exemptions. Today, we talk of three kinds of exemptions, medical, religious, and philosophical.

These exemptions were not included in our earliest mandates. They were largely lobbied for over time. Though the topic of today's hearing is medical exemptions, this exemption's origins are entwined with those of nonmedical exemptions and the history of mandates generally.

So I'll provide a brief overview of the origins, the policy origins of vaccine mandates in the US states, followed by a description of the four phases of exemptions. I'll highlight aspects of California's specific policy experience and conclude with some brief comments on the political meaning of exemptions. Although vaccination was introduced to the US in the 1790s, mandates followed much later around the 1850s. These early immunization requirements were very local.

They focused on cities, they targeted only smallpox, and they were generally invoked only in the face of active epidemics. In most cases, these immunization requirements were one of several police powers, as they are called, assumed by local governments as they formed their first boards of health in their growing cities and towns. Because enforcement was intermittent, uneven, and highly local, opposition was limited and highly contained.

But under the laws of that time, again, this is the mid to late 19th century, vaccine refusers could be barred from school or work. They could be isolated or quarantined. They could also be fined or jailed. There were no mandates with exemptions as we now know them. The first organized anti vaccination groups formed in the 1870s, and they gained momentum in the face of stepped up immunization enforcement in the 1880s.

Their formation actually set the conditions for the first era of vaccination exemptions, the first of four, which I refer to as the smallpox era of exemptions. In the smallpox era, state governments began enacting statewide smallpox immunization requirements, authorizing local authorities to enforce them. The laws were widely contested all across the country.

They faced opposition from school boards when school enrollment was involved. They faced opposition in communities that felt unfairly targeted with enforcement, and organized anti vaccine groups decried the laws as affronts to personal freedoms and individual liberty. California's experience at this time shows how this early period of the exemption history helped configure the immunization exemption. California enacted a law requiring smallpox vaccination for school admission, public school admission in 1889.

Anti vaccination groups organized up and down the state over the next ten years. And from 1901 to 1911, the legislature considered roughly a dozen bills to repeal or limit that mandate. The legislature actually passed a ban on school mandates in 1905. This was the same year that the US Supreme Court upheld state vaccination mandates, albeit recognizing the need for medical exemption.

But the governor vetoed that bill at the time. In 1911, another bill passed, this one successfully signed by Governor Hiram Johnson, and it allowed anyone who was conscientiously opposed to mandatory vaccination to be exempt from it. This nonmedical exemption was one of several approaches to nullifying the vaccination mandate in the smallpox era. Some states repealed their mandates entirely. Others passed laws prohibiting mandates.

Some added clauses to mandates allowing individuals to exercise their own will or their consent. Other states, like Massachusetts, had medical exemptions that were so loosely worded they could be used by anyone. The smallpox era was followed by decades of a turn away from immunization requirements in favor of persuasion, but this changed in the 50s following the rollout of the first polio vaccine. Used on an entirely voluntary basis, the vaccine quickly drove down polio rates across the country.

But after a few years, persistent small outbreaks prompted a few states to consider new mandates, this time focused exclusively on children. This time around, exemption clauses were written into these immunization requirements from the outset. Michigan, for example, tempered its mandate with a religious or other objection clause.

Ohio allowed parents to object on any grounds, and California's proposed bill, which was introduced in 1961, was written to allow medical and religious belief exemptions, but opponents convinced its sponsors to strike the word religious. The opponents this time around were not anti vaccination groups. They were medical libertarian groups focused on limiting government regulation of health care and the medical marketplace.

Two of the groups were based in San Francisco but national in scope, helping citizens fight against vaccination, fluoridation, drug regulation, and other issues across the US. California's earlier smallpox mandate had not actually lasted past the 1920s, so this new mandate, replete with its own broad exemption clause, ended up being applied to each vaccine added to the state code for the next fifty years.

The third of the four stages of exemptions came with a wave of laws passed from the mid 60s to the late 70s focused on requiring measles vaccination for school enrollment. In contrast to smallpox, measles at the time was not considered a public health emergency. In contrast to polio, measles vaccination at the time was not quickly or widely used.

Measles mandates were introduced in the 60s for a distinctly modern set of reasons, to limit disease complications, to reduce climbing health care spending, to ensure equitable access to new biomedical technologies, and to not just control local outbreaks, but nationally eradicate the disease, a federal goal that had been declared in 1967. Federal support from Washington and from Atlanta encouraged state measles mandates.

And, again, from the outset, the state bills that were introduced in this period were characterized by very broad exemption clauses that referenced medical, religious, and personal or philosophical convictions or beliefs or the right to refuse. Some of these exemptions, like California's, were carried over from preexisting laws.

Others were drafted anew. They reflected the rights movements and legal battles of the 60s and 70s, which advocated for informed consent, civil rights, and secular rights. They also, importantly, reflected thinking about the new targets of vaccines in the 60s and 70s. Measles and soon after mumps and rubella were considered mild diseases relative to smallpox, diphtheria, and polio, which had been the earlier targets of immunization requirements.

So these broad nonmedical exemptions were readily embraced in an era that expanded mandates to what were then called the mild diseases. The final era of exemptions is one marked by a strong shift toward and then away from nonmedical exemptions. Or put another way, from, away from and then toward strictly medical exemptions.

As multiple new vaccines were added to the childhood immunization schedule in the 90s and 2000s, the exemption modified mandate became a de facto policy approach to encouraging widespread childhood immunization. Some states, like California again, continued the trend of carrying over preexisting exemptions. Other states expanded earlier medical or religious exemptions to include broad belief exemptions.

Others adopted such exemptions for the first time and sometimes only for new vaccines like HPV. This pattern lasted until the 2010s when first California and then a handful of other states removed or restricted the nonmedical exemptions in their school or childhood vaccination mandates, a trend that slowed with the start of the COVID pandemic. So to conclude, exemptions have characterized vaccination mandates since they began to be enacted and enforced at the state level at the end of the 19th century.

Historically, they've been most energetically sought in the context of heightened immunization requirements. When they first emerged in the smallpox era, they reflected the religious rights based and risk based objections to vaccination that are as old as vaccination itself. In that era, they specifically sought to nullify vaccination as a compulsory act.

In the polio era, they sought to constrain government medical regulation generally. And in the measles era, they sought to recognize and preserve a broad spectrum of individual rights. Today, their presence in immunization policies testifies to their utility in maintaining political support for immunization mandates or diffusing opposition to them across a long history of contestation over required vaccinations. Thank you.

Thank you so much for that historical background. Don't know if there are any questions. Thank you so much for your presentation. We will now have a presentation on vaccine preventable disease outbreaks from Dr. Shah, who's here at the County of San Diego. Thank you.

Great. Thank you, Chair Dr. Weber Pierson, Members of the Senate Health Committee, members of the public, for the opportunity to comment today on the behalf of the County of San Diego Health and Human Services Agency. My name is Seema Shah. I'm the medical director for epidemiology and immunization services.

As both a pediatric emergency medicine physician and public health official, I have cared for children and families affected by vaccine preventable diseases and have responded to outbreaks in our community. These experiences have reinforced a fundamental public health truth. Vaccines work best when they work not only for individuals but for communities.

Recently, San Diego County Public Health responded to a mumps outbreak associated with San Diego State University that resulted in 27 cases. While many people think of mumps as a mild childhood illness, it can cause serious complications, such as extensive brain inflammation, hearing loss, inflammation of the ovaries and testicles that can have long term fertility consequences.

As a matter of fact, before the introduction of the MMR vaccine, mumps was the leading, one of the leading causes of viral meningitis in the US. And even with mumps vaccination, we must also contend with waning immunity. Unfortunately, this isn't something that is easily measured, which is why maintaining high levels of collective community vaccination is critical. At UCS... Sorry. SDSU, we experienced firsthand the reality of a mumps outbreak.

Responding to an outbreak requires an enormous commitment of time, resources, and coordination. It was heartbreaking to have asked students to miss classes, athletic competitions, performances, and other important milestones because of illness or exclusion requirements. We provided extensive education and health promotion to school leadership, students, families, staff. We coordinated closely with the Centers for Disease Control and our partners at California Department of Public Health.

Communications were sent to more than 42,000 members of the student body as well as the public. Athletes were screening daily for symptoms. More than 200 diagnostic tests were performed, and genomic testing continues even through today. To boost immunity, nearly 600 vaccine doses were administered to help stop transmission and to protect the campus community.

And mumps is just one example of the disruption that these nearly once defeated diseases are now causing. Across the country, we have seen this year thousands of measles cases and multiple deaths from a disease that was once declared eliminated in the US. For every family whose child becomes seriously ill, statistics become personal. The human toll of vaccine preventable diseases extends far beyond those infected. Families experience uncertainty, stress, fear.

Students and children can be excluded from school for days or even weeks. Parents may lose wages while caring for sick children or even when complying with quarantine recommendations. Entire communities experience anxiety, particularly when outbreaks involve diseases that many people have never encountered because these vaccines have been so successful. Now vaccination rates are declining, and our collective protection is weakening. The consequences are many.

Outbreaks require intensive public health responses, including case investigations, contact tracing, exposure notifications, quarantine recommendations, and emergency vaccination clinics. Schools, universities, health care systems, employers, and local governments all bear the burden of this response.

And these responses are costly and resource intensive, and they're entirely preventable. Recently, the Johns Hopkins University School of Public Health performed a systematic review to examine the cost of measles outbreaks in the United States between 2000 and 2025. The study found that the average cost per case was approximately 43,000, ranging from just under 7,000 to more than 243,000.

Our own analysis in San Diego showed that each case estimated here at approximately a 150,000. And that's just the public health side. A 2016 Health Affairs analysis estimated costs from doctors' visits, hospitalizations, and lost income attributed to these vaccine preventable diseases among adults to be nearly 9 billion in a single year with unvaccinated individuals accounting for almost 80% of that burden.

In many ways, vaccines are the victims of their own success. Many Americans have never witnessed the devastating effects of widespread polio, diphtheria, measles, congenital rubella syndrome that previous generations had endured. But these diseases became rare. It can be easy to forget the suffering that they caused.

Yet these pathogens have not disappeared. And in our interconnected world, they remain only a plain ride away. The lesson from every outbreak is clear. Prevention through vaccination is easier, safer, and far less costly than the response. Thank you for the opportunity to testify today.

Thank you so much. We do have some questions. Senator Jones?

Yeah. Just a quick question. You said in part of your testimony that the vaccination rates are declining. Can you quantify that for me? Does that mean globally, nationally, California, San Diego County? What, where are they declining?

So that's a great question. So, yes, throughout the United States, especially in states when we look at those that have implemented exemptions, and I think that a lot of that will be covered later, but especially in states. And that's been added throughout. So conscious and medical exemptions, those numbers have been have been declining rapidly.

Obviously, even for, and globally, that is also the case. You know, we've seen that in, especially in countries, that, where, you know, Canada, you know, the UK, we've seen those numbers decline as well. And those are very general. If you want specifics statistics for San Diego County, for example, our numbers for...

You know, the best number to look at is MMR coverage for entering kindergartners. Our number here is at 92.3% for our last year of coverage, so that was 25-26. And that is showing a decline. And, again, this is where, why those, and in order to maintain strong community thresholds for things like measles, you need greater than 95% community vaccination rates.

Can you speak to if, with current California law and the vaccine requirements, you know, they're pretty robust in California. I've got, you know, my grandkids are gonna be checking into school here in the next couple of years. How's the vaccine rate dropping if California has such a strong requirement?

That is a great question because there are various loopholes that, unfortunately, that can speak to that. So, again, I think that they're... And we continue to work with schools and make, ensure that those vaccination rates improve. But, again, this is not just our county. This is throughout California that we've seen those numbers continue to decline despite the lack of...

Okay. And then final question, and I meant to ask the previous speaker this too, and just kinda maybe an opinion. You know, the focus of this morning is current California law regarding exemptions. And, you know, where should we be on that? I guess I'll call it a scale of zero exemptions to, you know, open exemptions, which I don't think anybody's arguing for either one of those extremes. Do you feel like the current California law is working regarding exemptions for physicians, parents, and children? And the, I guess, I would add to the public into that as well.

Yes. And I can say that on both as a public health official and reviewing. And, again, we do see those numbers as well, but also as a practicing pediatric emergency medicine physician and what I see. And, actually, I also work in that pediatric clinic. So in all three of those realms, and I actually interface on a regular basis with our local chapter with the American Academy of Pediatrics.

And I'm not, you know, again, I feel that where there's appropriate levels of, you know, where exemptions need to be applied, they're being applied. And where there's situations where they shouldn't be applied, they're not. They are being correctly applied. So this has not been an issue for us.

Thank you.

Thank you so much for your presentations. I do have a couple questions. So, you know, I think one of the challenges that we as legislators have, Senator Jones talked about parental rights. As a parent, I completely understand that. I think when we deal with these preventable...

Does the good of the one, the one family, outweigh the good of the many, which is the community? Because we are interconnected. So what you decide to do for your family may ultimately impact your entire community. And that's kind of where we are. I am concerned about the fact...

With the San Diego University outbreak of their football team, I got a lot of, a lot of calls about that one, for a couple of reasons. One, it was around where our vaccine requirements for our colleges. And I know you... That's not, that's not your area, but Dr. Pan, I will be asking you that later on. But, also, the fact that many of those individuals had received a vaccine but were, at some point, potentially exposed to someone who was not vaccinated.

And therefore, they needed to get another one, a third shot. So I'm not... That's a little concerning to hear. The ninety two percent in San Diego is also a little concerning to hear if we need to be at ninety five. And I too am wondering why our numbers are not a little higher.

What is it that we're doing here? So you may not have that information today, but I, I would like someone to follow up with my office on that or the Health Committee staff on that. But I'm just wondering if you could comment a little bit more on the impact for people who may be vaccinated being in a society where the vaccination rate is low and what kind of risk that puts them at.

Yeah. I, I

I think... So had this been in a community of unvaccinated individuals, it would have taken off like wildfire because I think that we forget just how infectious these diseases like measles and mumps truly are. So, again, I think... And and all the mumps outbreaks that have occurred in the last... post-MMR implementation have really occurred in populations that have been in close quarters.

So for example, detention facilities, unfortunately, we've seen that in those situations. And the other key place is really schools and universities. And so this... Not a completely unusual occurrence for that to happen, but that's why I, I implied in my testimony that... That's why the entire community needs to be vaccinated because we wanna be able to prevent spillover of these events.

That's why we were able to limit to only twenty seven cases. That's why we were... We implemented these measures. We made sure that we brought people's immunity up. You know, unfortunately, with MMR, a lot of the things that come up around exemptions is that, you know, we...

People are like, well, I can check titers and all the various things, but you can't check for mumps titers. That's, I also implied that in my testimony, and that's the... That's kind of another difficult nuance. And mumps only confers about eighty six percent immunity after two doses of the vaccine. And so, again, for most of us, it's not an issue because we have really good immunity.

But if you're in close quarters, it certainly does put you at risk. And so that's why we see these outbreaks often happen, and that's why you have to make sure your community levels are adequate so you don't have spillover. You don't have to... Into, into the larger... Into the larger campus community as well.

So that's why we, we were very aggressive. We were able to... At, at this point, outbreak's not officially over yet. But at this point, we were able to limit to that that tie... To twenty seven cases.

Well, thank you so much for coming and answering our questions. We will now move to our next panel or our next presentation, our first panel, which will be on medical exemption. We have Dr. Sawyer from pediatric infectious disease specialist from UCSD, Dr. Ball, a primary care pediatrician and Chair of the American Academy of Pediatrics, and Dr. Graff, who is a clinical professor in pediatrics at UCSD. Thank you all so much for being here. You may begin.

Thanks very much for having us and allowing us to be participate in this conversation. I practice pediatric infectious disease here at UC San Diego for over thirty five years and have lived through some of that history that was laid out about the development of new vaccines. And I've seen the near disappearance of chickenpox, for example. And I've seen the ability to prevent cervical cancer with HPV vaccine. Not that that's a mandate issue, but I'm just bringing up some poignant examples.

And the concept of community immunity is central to this discussion. At the end of my career, I was the pediatric program director for the residency here at UCSD, training over 60 pediatricians at, at one time... At a time. And I can say it during my tenure, most of my residents have never seen a case of measles or even chickenpox, whereas in my generation, those were universal things that we all knew... Could recognize by walking in the door.

So vaccines work. But as we're learning across the world right now, if you let your community immunity drop, the back... The illnesses will come back. Measles is, of course, the current dramatic example of that. So there's this concept of herd immunity that's talked about in vaccine...

In the vaccine policy world, and herd immunity works as long as you have a certain level. And it also depends on what herd you're in. These outbreaks tend to occur in communities that are like minded individuals who either do or don't immunize. The outbreaks tend to occur in the communities that don't immunize as well, and they just sort of the beginning of, of the erosion of the problem that we have are trying to address with this issue of exemption.

So I just I wanna illustrate the importance of community immunity.

I thought I'd spend a minute on what we're talking about here in terms of what constitutes a medical exemption. So there are contraindications and precautions to vaccines that are established. These are medical conditions that make your risk of getting vaccinated higher than the risk of the disease or the risk of getting some serious consequence from the vaccine or in the case of a precaution situation where some judgment might need to be made about whether a vaccine is indicated or not.

These contraindications and precautions are established by the FDA and the CDC in consultation with medical specialists of many different types. They are reviewed extensively.

By the time my vaccine recommendation comes from CDC. More than 100 experts in the field of vaccines, pediatrics, epidemiology have reviewed the contraindications and the precautions, and they are based very strongly on the evidence of what puts people at risk and what doesn't put people at risk from vaccines. Further guidance is provided by professional medical associations like the American Academy of Pediatrics and local health departments. These situations may be temporary or they may be permanent.

So you may have a condition that at the moment indicates you shouldn't get a vaccine, but a year from now, it may be okay to get a vaccine, and that's important to keep in mind. What conditions warrant medical exemptions?

So the things that are well established in the literature are if you're allergic to a vaccine, you shouldn't get another dose. If you have an immune compromising condition that might put you at risk from the vaccine because your immune system can't handle it, pregnancy is a contraindication to certain vaccines, but obviously is a temporary state.

If you have a history of a past serious reaction to a vaccine like Guillain-Barré syndrome, which is an immunologic phenomenon that leads to temporary paralysis or something that may prevent the person from responding to these vaccines. Altogether, these sorts of conditions affect about zero point two percent of the population. What isn't a contraindication or a precaution?

These are things that many people think should be or might be. It makes some sense if you haven't reviewed the literature or the evidence. So, for example, family history of a reaction to a vaccine. So just because your cousin or your uncle had a reaction to a vaccine is there's no evidence that that sort of genetic predisposition is, is there to indicate that you would be at the same risk as the person who had the reaction.

Behavioral and developmental disorders in general are not found to be worsened by getting vaccinations.

Allergy to the vaccine to unless... Allergies in general, unless it's to the vaccine. So for example, if you're allergic to eggs, that doesn't mean you can't get a vaccine. Even, in fact, it turns out vaccines that are made in eggs, but we won't go into that detail. An exemption to one vaccine or a reaction to one vaccine doesn't indicate you're gonna have a reaction to a different vaccine.

So if you put all those conditions together, that probably makes up ten percent of the population. So if we were to provide exemptions for all of those conditions, we would certainly lose our community immunity.

These guidelines and the contraindications and precautions are published on the website as part of the annual CDC and AAP immunization schedule, so they're readily available. And they're under constant review. Federal government has established a very robust vaccine safety monitoring system, which allows us to find new side effects from vaccines or study new vaccines very carefully to make sure we're aware of what the side effects are.

It is important to note that a physician can issue a medical exemption for any reason as long as it's medically justifiable and based on the evidence and documented in the medical record. So I would say overall, the system is quite robust and is working. And I hope we will continue to keep our community immunity so we don't go down the road that some other communities and countries have with regard to outbreaks of infectious disease. Thanks very much.

Thank you so much for the opportunity to attend this informational hearing and speak about my experiences with medical exemptions to immunizations. My name is Eric Ball. I'm a primary care pediatrician in Orange County, and I have the honor of serving as the Chair of the American Academy of Pediatrics of California, representing nearly 4,000 California pediatricians, pediatric medical subspecialists, and pediatric surgeons. I come to you today in three capacities.

First, as a pediatrician who witnessed the measles outbreak firsthand, also as a full time physician who routinely writes medical exemptions for my patients and is a representative of California's pediatricians.

In the winter of 2014-2015, my community in Southern Orange County was at the epicenter of what became known as the Disneyland measles outbreak. At the time, vaccination rates in my community were around eighty five percent, far below the level needed to protect against an outbreak. I saw and cared for unvaccinated children who contracted and suffered from measles. We had babies, toddlers, and chronically ill children who were exposed to measles in my waiting room.

And most of all, I saw the havoc that such an outbreak caused in our community.

I care for many children with chronic medical conditions, weakened immune systems, and legitimate medical contraindications to immunization. Several of these children were unable to attend school or gather in community spaces for fear of being exposed to this highly contagious disease. Families stayed home, businesses suffered, and the effects extended far beyond those who actually contracted the disease. The California Department of Public Health estimated that that outbreak alone, which was about a 100 people, cost the state nearly $4 million in the public health response alone.

Outbreaks of vaccine preventable infectious diseases harm not only the children who become sick, but our communities as a whole.

I have practiced pediatrics for more than twenty years and have written many medical exemptions for patients with legitimate contraindications. According to CDPH, before 2016, the rate of permanent medical exemptions for children entering kindergarten was consistently between zero point one and zero point two percent, reflecting how uncommon medical contraindications are to routine immunizations. After SB 277 eliminated personal belief exemptions, medical exemptions increased five fold, reaching 1% in 2019. This raised concerns that medical exemptions were being issued for what were actually personal beliefs. Following SB 276 and SB 714, the medical exemption rate declined back to 0.1%, consistent with California's historical rates and those of our other states.

These numbers correlate with my own experience. I care for a few thousand children and generally write a few exemptions each year.

Remember that most children, the permanent exemptions only need one. I'm typically writing them for new patients or children with newly diagnosed medical conditions such as cancer, transplants, or immunosuppression. I find the CAIR-ME medical exemption system easy to use, and we were well trained on it when it was launched. The vast majority of my exemptions have been accepted, although I did have one that was revoked. When that occurred, I received feedback about the decision and subsequently had a discussion about it with the family.

They understood the medical reasoning behind the decision and had their children immunized without incident. This is how a functioning medical exemption review system should work. Finally, I come to you as Chair of the American Academy of Pediatrics California. We routinely hear from pediatricians throughout the state about challenges they incur... They encounter in practice.

Yet since CAIR-ME took effect, we have received zero complaints or questions about the process. No pediatrician has ever approached me because they were afraid of... No pediatrician has ever approached me because they were afraid of writing exemptions or did not know how to do it. Before coming here, I surveyed all 17 physicians in my practice, and none of them expressed any concerns. From those of us on the ground seeing patients and using CAIR-ME, the system is working well. And the stakes are enormous.

The United States has recorded more than five thousand measles cases in 2026 alone, more than double last year's total and the most since 1991. At least five children and teenagers have died, including infants. We are witnessing the return of preventable deaths from a disease that was declared eliminated in this country more than twenty five years ago. Meanwhile, California has reported less than sixty cases. More than eleven percent of the US population lives in California, yet we account for only one percent of the nation's measles cases.

California's immunization policies are helping protect our children, our communities, and our economy from the sickness, death, and disruption that measles has brought to other parts of the country. Our medical exemption system works. I urge you not to put California's families and communities at risk by weakening it. Thank you so much for your time.

Good morning, Madam Chair. My name is Dr. Nancy Graff. I'm a primary care pediatrician here in San Diego speaking today on behalf of the California Medical Association. I began my career when vaccines were not yet freely available to all children. My training occurred in LA during the worst of the last measles epidemic in 1988 to 1990 when there were more than forty thousand cases of measles in the United States.

I treated many children for measles who were miserably sick. Tragically, some patients with measles died. I also, at that time, treated children who were left neurologically devastated or died from infections from Haemophilus influenzae or strep pneumo before these vaccines were available. When childhood vaccines became a covered benefit and new vaccines were development... Developed, my colleagues and I rejoiced.

I hope parents never have to watch their children suffer through these illnesses. Vaccines are among the most effective tools we have to protect children from serious and deadly diseases. They are among the most thoroughly studied and closely monitored medical interventions, and decades of research have demonstrated their safety and effectiveness. High vaccination rates help protect entire communities. Nowhere is this more important than a day care and schools where children spend hours each day.

Vaccinating all eligible children protects everyone, including those unable to be immunized due to their age or certain medical conditions. CMA and our 50,000 physicians are strong proponents of routine childhood immunization as recommended by the American Academy of Pediatrics. Following the elimination of personal belief exemptions for children attending schools or day care, California saw a sharp increase in medical exemptions, raising concerns about whether the exemptions were being used in line with established clinical standards.

In 2019, CMA proudly cosponsored Senate Bill 276 to address these concerns and restore integrity of the medical exemption process amid growing concerns about vaccine preventable disease outbreaks, including the recent measles outbreaks. SB 276 established California's statewide medical exemption framework to review medical exemptions and provide meaningful public health oversight to ensure exemptions are consistent with the standard of medical care.

Since its establishment, we've seen the number of medical exemptions return to levels we expect to see given the relatively small number of children who have medical conditions that warrant an exemption. We believe California's medical exemption framework is working as intended. Physicians use their clinical judgment to provide valid medical exemptions when appropriate. Only a subset of exemptions are flagged for review by clinically trained professionals, and an even small... Smaller percentage are revoked.

When exemptions are revoked, it is often because they are incomplete or inconsistent with established clinical guidance, including those from the American Academy of Pediatrics. Families have the right to appeal revocations through an established process that includes review by an independent physician panel. These safeguards help ensure that medical exemptions are reserved for children who genuinely need them while maintaining the integrity of California school and immunization requirements.

We understand there have been allegations that certain health systems or medical groups have policies preventing physicians from using California's medical exemption system or issuing medical exemptions altogether. CMA takes these concerns very seriously.

In response to these allegations, CMA surveyed its membership and found no evidence of policies that categorically prevent physicians from using the state system or issuing medical exemptions. I can attest to having used the system and found it straightforward to use. I can also say that the medical exemption process is not a major topic of discussion among my colleagues. What does concern us is vaccine skepticism and the growing number of families choosing not to vaccinate their children.

Physicians will continue to work with families to answer their questions, address concerns, and counter misinformation.

At a time when Americans, mostly children, are dying from measles, we should focus on strengthening public confidence in immunizations and ensuring California's medical exemption framework continues to protect both individual patients and public health. We thank Chair Dr. Weber Pierson for convening this important data driven discussion of California's medical exemption framework. CMA looks forward to continuing to work with policymakers and stakeholders to ensure the framework remains grounded in clinical evidence, protects access to medically necessary exemptions, and safeguards the health of California's children. Thank you.

Thank you. Thank you all so much. I have a couple of questions. Senator Jones?

Yes. Thank you. Dr. Ball, in your test... Testimony, you mentioned the measles outbreak. Did you call it the Disneyland measles outbreak?

Okay. And you said there was about a hundred measles cases out of that particular outbreak. Is that correct?

There were a hundred and six in California.

Hundred and what?

A hundred and six that year in California. Yeah.

Do you have numbers on... Or statistics on how many of those hundred and six were previously vaccinated for measles?

I don't know offhand. The public health officers might... I know the vast majority were unvaccinated. The three patients that I personally took care of were all unvaccinated.

Unvaccinated. Unvaccinated. And so out of the 106, you took care of three?

I took care of three of them. Okay.

Alright. Thank you. That's all. Are those statistics available somewhere? Do you know?

I'm sure they are.

Yes. They do. Yeah. I'm sure Dr. Pan can address it.

Okay. Great. Thank you. The... You, you mentioned that you surveyed your...

The doctors in, in your medical group, and, and I appreciate that. Do you feel like... Is it, is it a possibility that some physicians are skeptical of bringing forward concerns about the exemption system in California, out of fear of rebuke from either their peers or from Department of Public Health or the media or any place else that... You know, we all, we, we all contend in that, in, in our professions.

You know, we have to sometimes watch what we say so that we don't cause a, a, a riot on the Senate floor.

I mean, I'm being a little bit provocative here. Yeah. So so I'm just wondering if that might be a case with some of these doctors that do have legitimate concerns. They're just afraid to bring them forward.

I guess that's certainly possible, but I could tell you as Chair of the American Academy of Pediatrics in California, I get an inordinate amount of emails, and our staff gets a lot of phone calls from pediatricians who have concerns about all manner of things, payments, and things that are more controversial than this, gender affirming care, things like that, and we hear about that all the time. I have literally never had anyone have any issues about the way the system has been working.

Thank you.

I, I really wanna thank you all so much because you hear a lot about what physicians are feeling, what they're doing, why they're doing something, or why they're not doing something. And so that's why I think that this panel is so very important because you all are the ones that are on the ground. You are the ones who are interfacing with families. And, Dr. Ball, you are the one who represents all of pediatricians here in California. You have a very, very significant role.

And I, I know that physicians will oftentimes use their society to complain about a lot of things. I use ACOG, as, as I'm an OB-GYN, and pediatricians will use the American Academy of Pediatrics. So I was very shocked to hear that you have not had any complaints about this system. You have not had anyone come to you to state that they're afraid to give vaccines, that it's complicated, that it's cumbersome, that it's difficult, or these vaccine exemptions that you, you haven't... No one.

No one. Okay. Alright. So that is interesting. And like I said, this is a, a hearing for facts and

I wonder what happens after today. And nothing.

Well, I, I... But I'm just... I'm saying, like, you know, we, we, we have a... We will oftentimes reach out to our academies or our societies. So, Dr. Ball, it's interesting because you...

I'm assuming probably all of you have done medical exemptions, but, Dr. Ball, you specifically touched on that yourself. And you had a review, so I'm going to assume that you give out more than five or you have given out more than five?

No. So they review... So according to the, the excellent information that was given to us before, so about sixty five percent of, of all exemptions are reviewed. So in review, just someone checks to make sure that they are, they are appropriate.

Okay.

So... Yeah. Go ahead.

So did that the fact that it was going to potentially be reviewed if you give out a medical exemption, did that make you concerned to give out a medical exemption, the fact that someone might review it?

No. Not at all. I expect that's part of the process.

Okay. So when you had one that was rejected, how exactly did... Can you walk me through that process?

Yeah. So the system worked well. So I have a lot of families who, you know, have questions about vaccines. We spend a lot of time. I have a lot of families who have nonstandard vaccination schedules.

So instead of following the, like, traditional schedule, they're getting a few shots here, a few shots there. So this was one of those families, and they were very slowly getting their child caught up on their vaccines before he started kindergarten. And at age four, I think, we got titers done to see whether he was immune to chickenpox, measles, mumps, and rubella. And as we... And chickenpox, he was immune to, and I wrote an exemption for that, which is accepted.

That's an acceptable review. I have a lot of patients who've had chickenpox when they were babies before they were vaccinated, and those kids all get exemptions. And then as you heard from... Before from Dr. Shah that actually titers for mumps don't really convey a good... They're not very indicative of protection against mumps and actually getting, you know, two vaccines is better than getting one and checking titers, and that's why those kids were getting three in, in the, in college.

So I was, so, so my review for the MMR got revoked, and I got an information from whoever the reviewer was and explained the situation, which was clearly on their website as well. So I had family and explained this to them, and they were like, okay. We don't want our kid getting mumps. We were trying to, you know, avoid getting an additional shot. But when push came to shove, they knew the medical reasoning behind it, and the kid got his vaccine, and he was fine.

Did you have any concerns that you may end up losing your medical license?

No.

Okay.

No. No.

Dr. Sawyer, you went through the contraindications or some of the contraindications for the vaccine. Appreciate for the vac... For vaccines. Appreciate that. And you mentioned that about zero point two percent of the population falls into that group that would have one of those contraindications.

Did I hear that correctly?

Right. Yeah. And that's sort of reflected by what their medical exemption rate was at its base... Baseline or lowest level and what it returned to when we eliminated the other exemptions.

Okay. So with our current level being around 0.1, 0.2, we're kind of at national level of what we would see for medical exemptions. We're not necessarily extremely below or extremely above

Right. I believe

nationally.

Yes. I believe the national numbers are exactly the same, somewhere between 0.1, 0.2% of children have some condition that warrants an exemption.

Okay. When we're talking about our medical exemptions. Okay. Alright. Well, thank you all so much, and thank you for what you do every day to keep our kids healthy.

We will now move to our next panel, that reviews the Medical Exemption Review Process and Disciplinary Action. We will be joined by Doctor Erica Pan, Director of State and Public Health Officer at the CDPH, and Kerrie Webb, the Staff Counsel for the Medical Board of California. Thank you all for being here, and you may begin.

Great. Thank you very much. Good morning, Chair, Doctor Weber Pierson, and Senator Jones, and the Health Committee. As a parent, a Pediatric Infectious Disease Specialist, and your State Public Health Officer, I thank you for this opportunity to share information on immunization requirements and medical exemptions in schools and childcare in California. This is a timely discussion.

As Chair Weber Peirson mentioned, as we speak, the Pan American Health Organization is reviewing The US measles elimination status declared in 2000, which we may lose. We've had thousands of cases this year in The United States and record breaking numbers of hospitalizations and deaths since the early 1990s.

This is preventable. Like all other states, California has required immunizations to attend licensed childcare in schools from transitional kindergarten through 12th grade with some exceptions.

We had 110 in California and 20 elsewhere linked to this amusement park. To address this, Senate Bill 277 was passed and removed personal belief exemptions in 2015.

I'd like to walk you through some trends in the first figure in your packet.

The personal belief exemptions in orange started to increase with a peak in 2013 at 3.2%. This increase was creeping towards concerning levels threatening community immunity. Then in early 2015, California had, as mentioned, the largest measles outbreak since elimination of over 130 cases.

Prior to SB 277, as you can see here in the green, the rate of permanent medical exemptions for children entering kindergarten was stable at about 0.1 to 0.2%, reflecting the rarity of conditions already mentioned, meeting standard medical contraindications to immunizations.

After that removal of personal belief exemptions, there was a fivefold increase in the medical exemption rate up to 1.0% in 2019, raising concerns that medical exemptions were being issued inappropriately for what previously had been submitted as personal belief exemptions.

As a local health official then, I remember seeing websites offering expensive online evaluations, and school nurses shared medical exemptions from antiaging clinics and hyperbaric medicine doctors rather than primary care providers. In response, SB 714, SB 276 enacted in September 2019 before the COVID 19 pandemic required a standardized process and criteria for issuing medical exemptions.

The California Immunization Registry Medical Exemption System was then built as a secure platform for physicians, parents, schools, childcare facilities, and health department staff to manage the standard medical exemption process.

Under these laws, the rate of medical exemptions for kindergarteners decreased again back to the 0.1%, similar to rates of medical exemptions before SB 277 and, as mentioned earlier, the same rates as nationally.

On your second page, I wanted to point out, Doctor Ball also mentioned this, but with our measles trends in California, we have a disproportionately low contribution to cases reported nationally. Strong immunization requirements and processes will help us sustain that success.

Next, I can walk you through the process for requesting an ME through the care medical exemption system to fulfill the health and safety code requirements. This is on page three of your handout.

Typically, a parent or guardian initiates the ME process by creating an account in the care medical exemption system, submitting the ME request, and notifying their child's doctor of the request. After creating the account, the physician logs into Care ME, locates the child's ME request, documents the medical basis for each requested vaccine exemption, and uploads any supporting clinical documentation.

Once that ME is issued, the physician provides an electronic or paper copy to the parent or guardian who submits it to the school or child care.

On the next page, we review when do we at CDPH review a medical exemption. There's a subset that we look at.

If the school or child care facility immunization rate falls below 95% or they're not reporting to our department, if a Doctor issues five or more medical exemptions in a year. We also have the authority to review medical exemption if we determine it's necessary to protect public health, but we have not yet needed to exercise this criteria to review. Now I can walk you through our review process in figure five.

Two, CDPH clinical reviewers determine if medical exemptions meet the applicable American Academy Pediatrics criteria for appropriate MEs and are consistent with the relevant standard of care. These clinical reviewers often request additional medical information from the issuing physician when needed, and they must make these determinations based on the information submitted.

If CDPH revokes a medical exemption, the parent or guardian has 30 days to appeal, and they appeal the decision to the California Health and Human Services Agency. At that point, an independent expert review panel convened by CalHHS evaluates these appeals, also using the AAP guidelines and relevant standards of care.

This panel can also request additional information and medical records from the parent regarding the child's medical condition. CalHHS issues that independent expert review panel's final determination in writing to the child's parent or guardian.

Also of note, a child can remain in attendance at school or child care once an ME has been submitted, including while they're under review, and when an appeal is pending, and when an appeal is upheld, and for any issued MEs that have not been revoked.

On the next page in figure six

Real quick. How many peoples, you said that two reviewers. How many people sit on that panel?

For the CalHHS panel?

For the ME initially revoked, if two reviewers find that the medical exemption does not meet criteria in California, how many reviewers are there?

Sure. So the initial review at CDPH is typically a nurse and then a physician. So it's two typically for that.

Okay. So two out of two. If they agree that that's not appropriate, then it's revoked.

Correct.

So moving on to page six. The medical exemption is permanently revoked if the panel determines that the medical exemption doesn't meet applicable criteria or if an appeal is not requested by the parent or guardian within 30 days of the revocation. Appeal decisions are not subject to further administrative review. And that. At that point, physicians who have at least 5 medical exemptions revoked within a year are reported to the Medical Board of California.

So what has this translated to in implementation over the last five years when we look at the numbers? As you can see from figures 7 and 8, over 90% of the 33,000 medical exemptions issued remain valid. About two thirds of these medical exemptions are reviewed by CDPH based on the criteria I outlined, and about 9% of those submitted have been revoked. 876 have been appealed, and most of those are denied of the appeal. About, our updated number.

Sorry. There's a a small typo on that. We'll get updated figure for you. But a 132 of those appealed were upheld, and some are withdrawn. In closing, thank you for the opportunity to share the importance of robust vaccine requirements and our commitment to a fair and transparent process to uphold California laws supporting the appropriate use of medical exemptions for school and child care attendants.

Thank you.

Thank you. And before you begin, we just want everyone to know that the slides, will be posted to the website so that everyone will have access to these these figures. Okay.

To the Senate website?

Yes.

Good morning, Doctor Weber Pierson and Senator Jones. My name is Kerrie Webb. I'm the Staff Counsel for the Medical Board of California. Thank you for the opportunity to discuss the board's investigation and enforcement process relating to physicians referred to the board by the California Department of Public Health pursuant to Health and Safety Code section 120372. The medical board's mission is consumer protection.

The board protects patients through the licensing, regulation, education, investigation, and discipline of California allopathic physicians. As you know, the legislature enacted the current medical exemption framework after identifying concerns that some physicians were issuing unusually high volumes of medical exemptions that appeared inconsistent with accepted standards of medical practice.

Health and safety Code section 120372 sets forth a standardized statewide system for documenting medical exemptions through the CareMe platform and creates mechanisms to identify exemption practices that may warrant further review.

Importantly, the law also provides the board access to medical records necessary to evaluate whether a physician complied with the standard of care in issuing a medical exemption. When CDPH refers a physician to the board, this referral prompts the board to conduct an independent review to determine whether the physician may have violated the medical practice act.

As with all quality of care cases, the board's process begins with obtaining the relevant medical records and providing the physician an opportunity to submit a written explanation of care provided I'm sorry. An explanation of the written. An explanation of the care provided and supporting information they believe is relevant to their medical decision making, leading them to issue a medical exemption for their patient.

That information is reviewed by a medical consultant who is a physician with relevant education, training, and experience. If the consultant determines that the evidence does not support a potential violation of the medical practice act, the matter is closed.

If the medical consultant determines that further review is warranted, the matter proceeds to a field investigation. Depending on the circumstances, investigators may obtain additional records, interview the subject physician and witnesses, and gather other relevant evidence.

The completed investigation is then reviewed by an independent medical expert who evaluates whether the physician's care and treatment met the standard of care.

For the board to pursue disciplinary action in a quality of care case, the evidence must support allegations such as gross negligence, repeated negligent acts, incompetence, or other forms of unprofessional conduct.

These cases must be proven by clear and convincing evidence. If the board's expert concludes that the physician met the standard of care when issuing the medical exemption, the case is closed. If the expert concludes that the physician departed from the standard of care, the matter is then referred to the office of the Attorney General for review. If the OAG determines that there is sufficient evidence to proceed, an accusation that sets forth the detailed charges may be prepared and filed.

The physician may retain legal counsel, is afforded the right to contest the charges before an administrative law judge. They may present evidence, call their own witnesses, including their own expert witnesses, cross examine the board's witnesses, and appeal a final disciplinary order to a state superior court.

If the physician does not wish to contest the board's charges at a hearing, they may enter into a stipulated settlement to resolve the case. As indicated in the background paper, as of 10/20/2026, this enforcement process has resulted in the discipline of 34 physicians referred by CDPH to the medical board.

Those disciplinary outcomes range from surrenders to probation to public reprimands. Additionally, there are five accusations that are currently pending.

Pending board accusations and disciplinary orders are posted on a physician's profile page on the board's website as required by law. Physicians whose licenses are revoked, surrendered, suspended, or who are otherwise prohibited from practicing medicine are prevented from accessing the CareMe system and therefore cannot issue medical exemptions.

Similarly, physicians with pending accusations who are currently serving probate or who are currently serving probation related to immunization standards of care are also prohibited from issuing medical exemptions.

Thank you for the opportunity to provide this overview, and I would be happy to answer any questions.

Thank you so much. We will go to questions. Senator Jones.

Alright. Thank you, Doctor Pan. Nice to see you in person. I appreciate your being a part of my COVID journey when I was one of the first legislators to catch COVID and walk me through the process of dealing with that. You were very helpful.

Nice to see you under different circumstances.

Yeah. I'm a survivor. Back to the Disneyland example regarding the measles outbreak there, the question was, how many of the 106 were previously vaccinated?

Sure. We can send you kind of a publication on that outbreak, but in that publication, only 7 of those over a 110 or so actually had any. Had documentation of at least two doses of MMR vaccine.

Okay. And the current MMR dosage is three. Is that correct? So would you. You would say those were incomplete vaccinations or?

No. Those were complete. Those would be concerned.

Okay. What's. If you can share the medical science behind, you know, the 7 that were vaccinated, how would they catch the disease?

Sure. You know, no vaccine is a hundred percent, unfortunately. We have some that are very close, like HPV actually is close. But measles is.

It's after the first dose. Actually, I'm blanking on that, but over 90%. And then after the second dose, it's, I think, over 95%. I'm sure Doctor Sawyer or others has it at their fingertips. But it's not, you know, a 100%.

There are very few things in medicine that are a 100%. So we do have breakthroughs, especially with such a highly infectious disease like measles.

Okay. Great. Thank you. And and, you know, as I'm sitting here this morning, I'm trying to like, drill down to the bottom line of what my concerns are in this whole conversation. And I was reminded, you know, the point of the SB 1377, which was coauthored by myself and a couple of Democratic colleagues who was a bipartisan bill.

I think the concern that I have in. The, my bottom line concern in all this is the five or more medical exemptions kicking in an automatic review of that physician if they issue five. What, do you know.

And I know it's gonna range, you know, but a typical pediatrician. How many patients do they have in their roster on an annual basis? Do you know?

I think it really varies based on what percent time they have. I'm trying to think of my husband's practice, which I think is over 25,000, I think, patients on his panel, something like that.

25.

Yeah.

100 that.

25,000.

We're getting some consensus from the crowd. It's around 2,000. Okay.

Apologies.

And that's fine. And I'm not asking for like, a real. I mean, I'm asking for a real number, but not a specific number without having the opportunity to. I googled it. Google says 1800. So

Okay. Doctor Balsgaard.

So I guess that's what my concern is, you know, and was what raised with 1377 is 5 is not a very big number for a pediatrician or any doctor that's treating, you know, 1,500 to 2,000 people. It's a small percentage. And so, I, you know, that's kind of the direction we were trying to go last year with this was just giving the the physicians a little bit less onerous oversight from the Department of Public Health on the. Based on the numbers of exemptions.

I appreciate the previous panels, testimony. I thought it was very well laid out on the process and how it works and, the appeal process and all that, which I think is good. And I don't know.

I'm not.

I don't know if I'm going to a specific question here or just, you know, what my concerns are personally. Is five the right number? Can it be a bigger number? Is is the public health really drastically, affected if the number is 25 or 30 or even 50 out of a 1,000 or 2,000 patients? That's my concern.

I don't know if you wanna respond to that. That's not really a specific question, but if you wanna respond to that, that'd be fine.

Sure. I'm happy to respond. I think, you know, the important point here is that the work is actually on the Department of Public Health. If there are five or more medical exemptions issued by a single primary care provider or provider, if all of those meet standard AAP criteria, there's no other work needed for. If all the documentation is there, there's no other work needed from the pediatrician necessarily.

So, so it isn't. I think the burden is if there's inadequate documentation. So sometimes that happens. And I did wanna also mention that I think of my understanding of what some of the appeals that have been upheld are because when our team tried to follow-up and get more documentation, there was no response. And then there's a closeout period after a certain number of attempts.

And then, once the ME was revoked, then when to appeal, they are more responsive to get that information. And then once the information is there, showing what the medical rationale and clinical documentation is, then those are typically the ones that are upheld.

Okay. Thank you.

So thank you so much for both of your presentations. As far as is it the correct number, our amazing, fellow who we're gonna miss, just did the calculations. And so if you have about 2,000 patients and we know that there's a 2%, a .2% population that should be contraindicated, that's about four patients. So the fact that, that's five, it's right there.

But can someone clarify

Part of the concern on this, and I missed it. Again, I'm bringing this all back from memory. It's not five patients. It's five exemptions. So 1 patient out of those 2,000 could consume all five exemptions.

So I think that's an additional concern that might be one of the

Well, can someone clarify for me, is it triggered if you give five exemptions, or is it triggered if you have five exemptions that were revoked?

Senator, are you asking about who is referred to the medical board?

Yes. It's five revocations. So let's, let's is it a physician who does five medical exemptions, or is it a physician who has done five? Who has had five medical exemptions revoked?

Revoked.

So I can. Well, I mean, I'm not a pediatrician. But if I was, if I, you know?

You're a great one.

Despite what people think. Since I'm at the children's hospital, I am not a pediatrician. So I can do 20 medical exemptions. And if none of them are revoked, then I will never be referred.

Exactly.

Okay. So it's not the number. It's about the amount that it's actually revoked because it has been reviewed and determined Inappropriate. That it was inappropriate.

Yes.

So I wanna say that again so everybody can understand. As a physician, you can write as many medical exemptions as you want. You are not limited by five.

Right.

The trigger occurs if you have five exemptions that you have written that have been reviewed and revoked. At that point, it is referred to the medical board.

That's correct. So. And just to restate it one more time. So the five, as far as issuing more than five in a year, just means that is. You know, of those sort of two thirds that are reviewed, that might be one of the criteria, or it may be because of a childcare or a school that has a low vaccination rate under 95%. So if you happen to issue six, our team will look at that. And if all of those are.

If none of those are revoked or actually, you know, if. Even if four of them are revoked, it didn't. It wouldn't get referred to the medical board.

I think that's also an important distinction to make too, and I appreciate the Chair clearing that up. But if you write five exemptions on the sixth one, you're automatically kicked into review.

Yes. But it doesn't slow the process down.

It just means that we're reviewing the medical exemptions. And then if they're inappropriate, then they're revoked, and then there's a process.

Yes. And I appreciate that. And my point remains the same that that still is a chilling. Yes, you can write 20, but number 6789, 10 through 20 are gonna be reviewed automatically. Is that correct?

Yes. Once once a physician is issued more than five. Yes. That's.

Okay. Thank you.

Issued. That means issued by that physician are reviewed. Yes.

And as a physician, I just wanna say that our charts are reviewed for a variety of things on a regular basis, and that does not, prevent us from doing things. The fact that I, my charts get reviewed to make sure that my billing is correct doesn't mean that all of a sudden I'm gonna stop seeing or billing patients. It is just a part of health care to ensure that we are providing the appropriate treatment.

We are providing the appropriate medication, that we are billing correctly.

It is about transparency and oversight that everyone wants within the health care system to ensure that there is not waste, fraud, abuse, and that we are not mismanaging any of our patients. So that. That's just a part of health care. I do want to ask about, of the physicians who have had their MAs revoked, five or more revoked, and it has been referred to the medical board. How many physicians have had their medical license removed?

Two of those physicians have surrendered their license. The board has not revoked any licenses based on these referrals.

And is that of the 34 you were talking about?

Yes.

Okay. So of the 34, two have voluntarily revoked or surrendered their license, but the medical board has not, at this point, removed anyone else's medical license from practicing?

Correct.

Okay. And looking at a table that we have in our chart, it says, for this year so far, physicians with five or more medical exemptions revoked that have been sent over. Is that just one physician so far this year? Am I looking at that correct? I don't know if you have.

No. It's in the Senate.

Oh, those are CDPH numbers. So you're not asking the, about medical board action.

Oh, okay. So physicians with five or more medical revoked in the calendar year. There's been one this year.

I believe that's right, but we will quadruple check that.

And since this has been monitored, there have been no physicians that have been deemed or contributing to a public health risk by CDPH.

That's correct. We have not exercised that criteria.

Okay.

Have you all heard of any concerns, complaints about the process being onerous, difficult, something that physicians fear of having their charts reviewed?

That has not been brought to my attention.

Anyone from the medical board?

Physicians who are referred to the medical board, obviously, it's distressing. But, our burden of proof is high. Clear and convincing evidence, it's more than preponderance of the evidence. And so there does have to be compelling proof that the physician violated the standard of care. And so physicians are afforded significant due process rights.

Okay. Alright. Anyhow.

A couple just clarifying questions. When the review is kicked in for whatever reason, are. In that physician's office, are only the vaccination. But what's reviewed? Just the vaccination practice of that physician, or is his or her entire practice reviewed?

What all is looked at when that happens?

So there's this new sort of care, California Immunization Registry Medical Exemption platform, that was created with the bill. And in that platform, when there's a flag, once a physician has issued more than five within a year, then all the medical exemptions issued in that platform from that physician are reviewed. That's it.

So the rest of the practice isn't reviewed for any particular reason or looking for anything? Okay. Alright. Thank you.

Doctor Pan, do you know, is it similar to our Cures database where if a physician is potentially prescribing narcotics too much that they're flagged?

That's a great question. I am not sure, but we can follow-up with you on that.

Okay. Thank you. Alright. Well, seeing no other questions, I really wanna thank you all so much for coming. I think you have, at least for me, answered a lot of questions, that I had and a lot of things that I had been hearing about.

It's always really important to actually see the data. And, just to remind everyone that we will post, these slides to the, to the Senate Health website. So thank you. Thank you both.

Thank you for the opportunity.

We will now move to public comment. You all will have one minute per comment.

Hold on just a moment. Okay. Sorry.

You may begin.

Chair, Senator Jones. My name is Angela Hill. I'm here as a legislative advocate on behalf of the California Medical Association. I'm also providing public comment today on behalf of the following organizations, the American Academy of Pediatrics California, the Children's Specialty Care Coalition, the California Children's Hospital Association, the California Academy of Family Physicians, the California Primary Care Association, the County Health Executive Association of California, and the Planned Parenthood Affiliates of California.

We all wanna thank you for this conversation today, as well as staff for a really great analysis.

As stated today by our physician, we do believe that the framework here in California is working well and as intended, and it's protecting communities and the most vulnerable students from preventable infectious diseases. Thank you again for this conversation, and we're available if there are any questions. Thank you.

Thank you.

Hi there. Zach Flowers with the Health Officers Association. We are... HOAC strongly supported SB 276, and we appreciate all the state has done, to implement this law, which protects our communities. We align or we stand with, the comments made by CMA and AAP, and we are in support of vaccines and in support of the framework to provide, necessary exemptions. Thanks.

Hello. Catherine Flores, executive director for the California Immunization Coalition. I wanna thank you, Doctor Weber Pearson, for holding this hearing. It's, raised a lot of conversations in our world, you know, protecting our communities and supporting our physicians, clinicians. And knowing that there's, not a lot of discussion or any, as Doctor Ball and others have said about our concerns.

We also work very closely with school nurses. We have not heard a lot. We've only heard, like, this is so much more concise and clear for parents that they work with, and for themselves, and physicians. But but we're here, folks. We welcome questions.

We welcome the the dialogue, and it's given us a chance to look at maybe there's some ways that we need to, as a coalition, help those physicians that are not as clear about the process and may fear the process. And we want to be a conduit for that information. California is the envy of, you know, when it comes to policies, the envy of, the country when it comes to our strong policies. And the legislature and the governors have done an amazing job.

And that's why we have not seen these, these diseases recur in California as strongly, but it is it is on its way, and we need to be mindful of that. Thank you very much again.

Hello. I'm Doctor Azadeh Khatibi. I am here to talk about the inadequacy of this hearing. We need more transparency on how CDPH and the independent review panel apply SB 276's relevant standard of care requirement when evaluating medical exemptions. The law was intended to give physicians discretion beyond the narrow AAP guidelines, and now those guidelines are going and separating from what the CDC and AAP is saying.

There's some gray areas now. We need to confirm that these public health agencies are acting in line with what's legally allowed for patients and doctors, and not all doctors have to be PCPs and, pediatricians who write these. The intended latitude granted to physicians and the public health agencies responsibility to maintain them need accountability and oversight.

Furthermore, I appreciate that we need to have fact based discussions. We need facts. We need facts on real world barriers exemptions, including physician refusal rates, corporate and organizational policies refusing exemptions. Look, a survey of the CMA, which is an organization that doesn't even represent half of the doctors, and it's a biased lobby organization that has backed unconstitutional laws in California.

I know because I had to sue the government for that.

Thank you. Thank you.

Good morning, madam Chair, Senator, Melanie, and Natalie. I'm... My name is Brena Sheehy, representing Informed Policy Advocates, an advocacy organization whose three main pillars are informed consent, consumer protection, and civil rights. Over the last several years, IPA has shared their own personal stories and those of families who have struggled with medical exemptions. They've also heard from pediatricians who have had their own challenges with the medical exemption process.

IPA has respectfully met with legislators, their staff, and various stakeholders to have their voices heard and to find solutions. Like you, Madam Chair, IPA is data driven. We look forward to working with you in the future to find common ground on medical exemptions and related issues.

Thank you.

Thank you.

Good morning, Madam Chair, Senator Jones and committee staff. Tom Sheehy here on behalf of the Informed Policy Advocates. About this time last year, my client and I started working directly with your colleague, Senator Ben Allen. And he had a number of concerns with some of the issues that have been raised today, in this discussion, and it resulted in a letter that he wrote in January. I have that letter here.

I have two copies of that letter I'm gonna give to the sergeant to enter into the record. This letter identifies about a dozen different questions, two or three of which were touched on briefly in this hearing, but the rest of which have never been answered. In fact, Senator Allen, if you ask him, he will tell you he's never gotten a written response to any of the information in this letter.

I'm bringing this up because we would like to continue working with you, the new members of the committee, when you reconvene and with your committee staff, because we think these questions are good questions. They're not, they're not hyperbolic.

They're just good, solid questions to get more data. We'd like to work with you and your staff to get answers to all of these questions.

Thank you.

Thank you very much.

And Senator Allen was invited to the hearing today.

Good morning, Chair. Thank you so much for having us here today and to opening this robust discussion. I'm here really... My name is Jessica Cabrera with Informed Policy Advocates. I'm also one of the founders.

I think we're here really representing the parents that were not, a part of the actual structural, process of building these types of policies. We're here representing the families that have been caught in that crossfire, and, unfortunately, we see with our children, you know, the gaps that are going on in these policies where our children actually cannot get into school.

You know, we're having these bars where we, having overburdensome policies where we can't get even medical exemptions with some of our doctors who don't wanna treat patients that are not completely immunized either. This is creating generational disparities within our communities, and a lot of our families just wanna make sure that we can find a remedy to the solution. To your point, nothing is a 100%, you know, but that should never come at the cost of our children and their education.

So I just ask that, you know, you involve more parents at the table, have a better robust discussion about how we can balance public health as well as ensuring that our children have a really a really solid future in their educational choices as well.

Thank you.

Thank you.

Good morning, madam Chair, Senator Jones, and committee staff. I'm Chris Dukes, Co-Founder of Informed Policy Advocates. California law technically permits physicians to issue medical exemptions, but fear of professional consequences has created a chilling effect. My daughter experienced severe reactions following vaccination as was subsequently diagnosed with encephalitis and permanent brain damage. When I requested an exemption, her pediatrician told me he could not write one because he needed to be a team player and with his medical group and had bills to pay.

He knew her medical history, yet he felt he could not act upon his medical independent judgment. How many exemptions were never written because physicians feared these consequences? Consider that data you're talking about that was mentioned earlier about the 1% that it rose to after personal belief exemptions were eliminated. Some of those families use went over to the medical exemptions because they still needed those exemptions. That 90% reduction does not prove that their exemptions were fraudulent, but most likely because of over restricted policies have deterred access.

Thank you.

My name is Darlene Alkiza of IPA, and my first daughter suffered severe adverse reaction to vaccination at six months. She was granted a permanent medical exemption that was grandfathered in after two seven six, but it became invalid at the seventh grade span checkpoint, which violates federal ex post facto laws, actually. The nurse at the network where she was born told me that they don't do exemptions in the care system. Now every day my daughter is missing school, She's being excluded without being sick.

Discriminated based on fear of perceived contagiousness where, when HIV children and/or children with HIV and children with the Hep B are legally guaranteed their right to be at school. They cannot be discriminated, but my daughter is. And this is why I advocate for families.

Madam Chair, I respectfully submit to the committee a letter from my school principal sharing her concerns about my daughter being impacted by the exclusion and her ability to now thrive. Thank you.

Thank you.

Hello. Good morning. My name is Katerina Melletaro, and I am reading this letter to share my personal story about the vaccine policies. Our now eight year old daughter, Rebecca, started losing weight as an infant. She stopped growing to the point where she fell off the growth chart.

Her doctor put her on a delayed vaccination schedule to allow her body to to recover, and it worked. And, we decided that it will be the best for Rebecca to keep her on the schedule, which included the second dose of the life vaccines MMR in Varicella as close to the age 5 as possible, which was in October. In spring in 2023, Rebecca was enrolled in to start the transition in kindergarten and, on contingent on having her two final vaccines on the scheduling calendar.

However, four days before the school started, we were advised that the rules changed and Rebecca cannot attend school until she has all of her immunizations. This led to Rebecca being...

Thank you. Thank you.

I just wanna say that Rebecca...

Ma'am, I'm sorry. Everyone has one minute. There's a line behind you, but thank you so much. Thank you, ma'am.

You can submit a letter in the portal.

Pharma got an hour and a half. We're getting a minute. So, anyway, I had to cut my things short, but vaccines have been a liability free product since 1986 because they're going bankrupt from all the vaccine injuries and deaths. I'm a play what they thought about the measles in 1962.

Well unfortunately, it's not playing, but they used to laugh about the measles on the TV shows in the 50's and 60's. Vaccines are a liability free product. Vaccine ingredients are aluminum, formaldehyde, abortive fetal cells, animal DNA, and many chemicals. How much is poison is too much? And there are so much vaccine injuries, and everyone should have a right to not inject foreign matter.

Everyone should have the right to live naturally. And I'm gonna send you this episode of The Brady Bunch and a show from the 1950's, where they're laughing about the measles. They're calling it kid stuff. So death by illness had declined over 90% before vaccines were ever introduced to The United States. Death by illness had declined...

All illnesses had the same decline in death whether it was a vaccine or not. That's because of sanitation, clean water, plumbing, and proper nutrition per the CDC.

Thank you ma'am. You can sent that video in.

Good morning, Chair and member. I'm Karen Amagon, grassroots director of A Voice for Choice Advocacy. Today's panels lack dedicated testimony from affected parents and physicians whose medical judgment have been overridden. Brief public comments cannot replace their testimony or your questions. We request a second hearing in Sacramento next session with dedicated panels addressing barriers to exemptions and education.

A Voice for Choice Advocacy recently secured a legal win supporting a physician's use of positive MMR and Varicella titers as a basis for medical exemptions from further doses. Children who have documented immunity should be allowed to attend school without unnecessary additional vaccination. We ask CDPH to publish clear guidance confirming that this evidence can support valid exemptions and explaining the documentation required. Other states recognize this evidence. California families and physicians deserve clarity. Thank you.

Thank you.

Hello. My name is Jim. I'm a retired trauma critical care nurse at LA General. Two years ago, I've seen multiple deaths from clotting and bleeding out from people who are previously COVID vaccinated one, two, or three times. They had no other pathologies.

When you look at the virus site, there is 19,770 deaths on American soil. And per official Harvard study, those, that is only 10% of the people that actually report, so you have to make that one hundred and ninety something thousand deaths. When considering the autism, they found a direct link between autism and MMR, measles mumps rubella vaccine.

I have a, my second son is autistic, and they found out that it costs about a $500,000 to $1,000,000 to treat that child or help that person through their life cycle. So for every million children, that is 27,000 children costing $13,500,000,000. My third son died of SIDS at age 1.5, and they found out a Japan study said when they stopped the the DPT vaccine, their SIDS rate went to zero. Oh.

Thank you. Thank you.

You look like you look like Robert Redford.

Never heard that one before.

Hello. My name is Laurie Flavella. I'm the mother to a 27 year old severely vaccine injured son, administered the day after his first birthday. He now requires 24-7 care, and, it adds significant insult to injury to know that I'm the one who held his perfect body down to do what I was told was right.

At the time of his injury, we were at least provided with a fortunate circumstance of living in a progressive state that acknowledged vaccine risks through its philosophical, religious, and medical exemptions, all of which were applicable to my son's situation. It's been surreal to witness the erosion of the rights, first through SB 277 and subsequently through SB 276, the fallout of which, is the reason for this hearing.

Is it any wonder that, for those of us who 0.2% of children previously to 1% when we were forced to use medical exemptions, which are now being effectively blocked by what it... The pressure that's being put on physicians to not right them.

Thank you, ma'am.

Hi. David Bullock, SFP Alliance, and Moms for Liberty. I wanna thank you, Doctor Weber, for putting on this committee hearing today so that we could get facts based evidence on what's happening.

I do wanna comment specifically on Doctor Bull's testimony. The AAP's website states that they have 3,000 members. The United States Bureau of Labor Statistics states that there is 6,680 practicing pediatricians in California.

That means when he states that there's no problems from his membership state saying that with getting exemptions, there's approximately 3,700 pediatricians in California that he does not represent. So their voices are not being heard here today. I encourage everybody here today that have issues with the way this committee hearing went today to submit letters, and I hope you do too, to the committee so that those concerns can be addressed.

And we also align our comments with A Voice For Choice for more hearings in the future.

Thank you very much.

Thank you.

Amy Reichert, Restore San Diego. I know many of you are parents and grandparents, so I hope that you will listen to this San Diego family story with an open heart. A San Diego family reached out to me about their kindergartner daughter. She had a severe allergic reaction to her fourth Tdap dose. She has a documented adverse reaction on her medical record.

She is otherwise fully compliant with every vaccine requirement. She is only missing her fifth Tdap dose. Two board certified pediatricians independently advise against a fifth dose because of the risk of a more serious, possibly life threatening reaction. Her pediatrician submitted a medical exemption. The state denied it.

They were sent to an allergy specialist who said the published guideline only covered a local reaction, redness, swelling, or fever, and that her reaction was far beyond that. But he said he could do nothing because it's the law, and if he wrote the exemption, he'd be audited, and he could lose his job and license. The girl was kicked out of kindergarten a week before graduation, and now they do independent learning through a charter school. She's currently in second grade. I hope you'll help families like these.

Thank you.

Hi. Good morning. Mary Davis with the Public Education Oversight Project, and I wanted to first state on the record that this, is deficient. This hearing is deficient. You have not presented anybody with an alternative opinion nor nor with the financial profiteering that goes in this industry or record of vaccine harms.

Second of all, true informed consent, the government... So... I'm sorry. Out of order here. I went to the American Academy of Pediatricians Convention, and, the quiet pushback for, was palpable. So I just wanted to talk about that, for another issue. And then respectfully to the chairwoman, you indicated the purpose of the hearing was it, meant the good of the one over the good of the many or vice versa. But I would say true informed consent. The government dictates that the vaccine injured person lives with the consequences on their own.

So either you believe in bodily autonomy or you don't, and that has to carry over to vaccines. Thank you.

Thank you.

Hello. I'm Beverly with the Children's Health Defense California Chapter. Our organization is dedicated to protecting children, exposing harms, and seeking justice. Many parents come to us with children with vaccine injuries and look for support when medical protocols and mandates do not serve their child, or believe their concerns are heard. Let's talk about the encephalitis in the room.

California has 1 in 12.5 boys who are on the autism prevalence. This is in the most strict state with the mandates and having it very difficult for parents to be able to make their own choice. It is the swelling of the brain. You will see that in the vaccine inserts as one of the side effects.

You will see that most kids with autism have some sort of encephalitis, and the symptoms are from the swelling of the brain. We have, back when the 1986 Act came, when they made the... As you can see from the chart, they made the the loss, no. They made it not liable.

Thank you. Thank you, ma'am. You're at a minute. Next speaker, please.

Hi. My name is Amy Bond, and I'm the president of a parent advocacy group called PERC. We asked the committee to consider both what the data show and also what the data cannot show. How many revocations were medical judgments, and how many were paperwork errors? Where are the children whose exemptions were revoked being educated today?

What should a family do when no California physician will evaluate their child according to that family's experience? How many exemptions were never written, and how many families cannot find one?

Since September 2026, we did our own survey around, just over 750 parents who answered that survey on how they experience vaccine recommendations, and well over 100 of those respondents reported that they were being denied a medical exemption for reasons such as their physician was afraid to give it to them, or that the physician was afraid of being punished, or that they would lose their practice and that the doctor's hands were tied and could not or would not write them.

So I ask that you work with us to handle this issue further. Thank you.

My name is Mike. Thank you so much for your time. I'm a father of four kids, and I'm a husband. And what I care about is this is a hearing. And what bothered me today is 98% of the people who spoke besides the Senator was all against this.

And so this needs to go to the public because I can see the public, and they're all very clear about their stories. And so my request to the committee is I would like the department on record to show how families should proceed when no California physician will ever be able to evaluate their child. These kids need... I taught high school. I'm a marriage and family therapist.

I can't take sides between husband and wife. Why are we taking sides? This is to the senator's point. There are no sides here. The side is the children, and we all need to come together and not cause this chilling effect against the doctors.

Thank you.

Hi. Thank you, senators. Thank you for this hearing today. My name is Amy Rickabas, and I'm representing the Free Now Foundation. And I'm speaking as a mother of five school aged children in California.

For six years, my children have been denied access to traditional schooling because of medical concerns surrounding vaccination. I am your constituent. I am the one who's been affected by this. It is me. It is our children.

SB 277 allowed physicians to exercise individualized medical judgment, including consideration of family medical history. SB 276 fundamentally changed that process through increased state oversight, documentation requirements, and scrutiny of physicians issuing ex... Exemptions. Although family history was not expressly eliminated, accessing exemptions became extraordinarily difficult in practice. My children had exemptions before SB 276.

Afterward, I could no longer find a physician willing to navigate the process. Our only option has been homeschooling for the last six years. There is also a larger consumer protection issue, the National Childhood Vaccine Injury Act.

Thank you.

Thank you.

Hi. My name is Joel. I'm a physician in Los Angeles. First, I wanted to thank you guys for having this and all the amazing public health individuals for being here. I know the word vaccine brings up a lot of emotions, but I think it's important to have these meetings and continue to have them.

I wanted to speak on behalf of a lot of the families who I think are having a very difficult time having the system even though, some people think that they are not here. A lot of doctors in California do not take patients who don't vaccinate. So I don't think they know what those issues are, and the ones that do, they hear a lot of these stories.

And there's a lot of patients in that gray area that have contraindication that don't have a clear contraindication, but an autoimmune condition, a genetic condition, or maybe a previous history of a reaction that was never documented. And so my ask to you guys is to please consider those patients and to hear those stories and to not assume that every family who should be able to get an exemption is able to get those, I think we need clear guidelines on what is acceptable as a contraindication.

Thank you.

What I've just heard here in regards to what physicians are subjected to, I find frightening, and also for their parents, for parents and children. Now, the premise on vaccination is to provide immunity. For instance, if someone has a measles vaccination, they should be... They should have immunity and not be worried about catching that disease.

Now, this California law that makes for coerced consent, not informed consent, is a violation of the US Constitution, Fifth Amendment due process. It, so, it penalizes citizens, including doctors, for exercising this right. In addition, this law violates the Nuremberg Code. I urge you to uphold your oath of office in defending The US Constitution Bill of Rights and fifth...

Thank you. Thank you, ma'am.

Hello. My name is Tara. I am a concerned mother. I would just like you to imagine for a moment that your child has experienced a terrifying medical reaction to being vaccinated. Experienced a terrifying medical reaction to being vaccinated.

Imagine your child watching your child struggle to breathe, perhaps lose the ability to speak, or face lifelong medical challenges. Now imagine approaching your doctor concerned about your child's medical history only to find that your physician is afraid to help because their medical license could be revoked. And that fear is not hypothetical. Many of the doctors I contacted about attending today's hearing were unwilling even to appear and speak publicly for fear of exposing themselves to professional scrutiny, let alone consider writing a medical exemption.

That is how serious the chilling effect has become.

We've heard today that the medical exemption system is working well, but many of us here have experienced something very different. We've heard extensively from one side of this discussion today. Where are the physicians and families who have experienced...

Thank you ma'am. Thank you. Next speaker.

My name is Michelle. My name is Michelle Velasquez. I am a mother of two and acupuncturist for almost thirty years. And, the bottom line is that is that there's no, you know, liberty and justice for all when our parental rights to make medical decisions for our family are stripped from the start. I feel like the only reason that I am not one of these parents with a children

With a child with a vaccine injury is because my doctor respected that right, and she is completely fearful to lose her license. She's being reviewed right now. She's facing fines and suspension, and that is a reality. I felt that the system was very, was actually difficult.

We did have a revoked exemption, and the appeal was denied. I thought that it didn't make sense that a doctor who didn't know me or my family or ever saw my child could make that decision. And even though we recognize that childhood, illnesses are serious, my husband and I couldn't live with ourselves if we made that choice to have them vaccinated even though our family history and their conditions put them at risk.

Thank you, ma'am.

Thank you.

Hello, my name is Michael Lin. I'm a concerned citizen. I got my degree from UC Irvine in Public Health. I used to be a believer in vaccines. However, I am no longer.

I have seen so much evidence of vaccines just being harmful. There is no vaccine that is good anymore. And shame on the lies that we're told by this panel today because it was all lies and it's so disgusting. They are shills for big pharma. Big pharma makes their money off of injuries and people being ill, not people being healthy.

And, unfortunately, they're in the back pocket the back pockets of big pharma. I work at a school district. I work at four elementary school sites and all I see are vaccine injuries now. Almost a third of the kids are pretty much debilitated.

And it's so sad because all these special needs and then all the other, everything that I see, it's all tied to the vaccines and it's sad because these parents who many are in low income, communities, they don't have the means to be able to fight back. They don't have the means to be able to, occupy resources.

Thank you. In order to allow for everyone to be able to speak, then we must stick to the one minute. I do not like having to cut people off, and I don't like for the sergeants to have to come up. We wanna be able to hear from each and every person, so I just ask that you respect those who are behind you and adhere to the one minute. Thank you.

Good morning. I'm an impacted parent with impacted children. I strongly urge you to consider... Reconsider the care medical exemption process. This one size fits all process places an unnecessary and overwhelming burden on families whose children are already facing ongoing medical challenges.

Due to this rigid process, my son will be excluded from public school because of his medical condition, because he's sick. My child has existing health conditions requiring continued care from multiple specialists, including an allergist, endocrinologist, gastroenterologist, and DO. This process required numerous medical scans, repeated laboratory testing, and extensive evaluations, adding unnecessary stress to a child who is already managing complex health issues.

What is especially troubling is that his allergies acknowledge titers, yet refused to sign the medical exemption because he's scared of these people, because he's afraid of the board. That's what she told me to my face because of the board.

How can parents have confidence in a medical exemption process when even a doctor's medical judgment is not enough? Children should not have to be put through unnecessary medical procedures just to have legitimate health concerns acknowledged.

Thank you, ma'am. Thank you, ma'am. Thank you, ma'am.

Hello. It's it's really hard for some of us that sat through the paid professional opinions over here and not hear what's really happening out there. I have letters to submit on behalf of people who could not make it here today. I have a few doctors, pediatrician, immunologists in practice, good standing for thirty to forty years that have issues with whether it's the five that they could write or just issues in medical exemptions on their own.

And it's significant to note that these physicians on this list are too intimidated to include their names, which illustrates one of the most essential reasons for this hearing.

Doctors are now unable to provide a professional opinion without fear of reprimand, completely annihilating the capacity to speak for their most vulnerable patients. I also have a friend's testimony. She has... She could not make it here today. She has two vaccine injured daughters.

Her youngest is now unvaccinated, underlying mitochondrial issues, and she has been warned that vaccinations would harm this child. She cannot get a medical exemption. She cannot have a doctor write it for fear.

Thank you, ma'am.

I'd like to submit this to, the Chair of the Committee.

Thank you.

Hi. My name is. I was disabled for four years because of the COVID vaccine. I couldn't walk. I couldn't breathe.

I couldn't think. All the medical community ignored me, refused to help me, gaslit me, basically tried to kill me. So I'm here speaking for all the children who can't speak for themselves, all the other people who are still disabled, and the millions who are dead because of these vaccine mandates. Thank you very much.

Thank you.

Hi, my name is Susan Dea. I'm a family and children's lawyer of 25 years, and I stand here today once again. My concern with the broad chilling effect of the statute and particularly, I'll be submitting, for your review, a CDPH list of more than 9,000 physicians provided to school principals and nurses. On 08/19/2022, CDPH issued a notice directing schools not to accept pre 2020 medical exemptions from physicians appearing on this list because they face disciplinary action by their licensing board, even when that discipline was unrelated to vaccines.

So you can... I'm... If I may submit this, I think this is this is very unfair. Obviously, there were exemptions that were made based on need, and this completely just just wipes them all out. So I wanted to submit that. It's another... Thank you.

Thank you.

Hi. My name is Natalie Raschke. I'm a mother of four. I'm insulted. I'm insulted by the fear mongering that went on.

I'm insulted by the... What it appeared to be, like, the lack of intelligence of the human mind and the body and how it's meant to heal. A 100 cases at Disneyland? How many deaths? I'm a mother of four.

So you know that the loophole is you pull your kids and you homeschool. I sacrifice income so I don't have to subject my child to fetal aborted baby cells. I do not wanna inject my child with an aborted baby cells or fetal calf cells of a pregnant mother cow, then they kill the calf. Do you know how they do that? They stab it in the neck.

Thank you, ma'am.

Good morning. Sunbury Solutions. My son has complex medical needs that prevent him from attending school, but could have put him and his doctors at risk of repeated exemption reviews, delayed care, or barriers to education. You asked, are we achieving our goals for children's health? And two, are families affected by these laws getting their needs met?

Three potential tools. First, publish one annual public table from 2000 to the present showing, one, exemptions and medical contraindications, two, vaccination rates, three, vaccine preventable diseases, four, medical exemption reviews and impacts on children with special needs, And five, federal and state spending on children's health care, which is our best proxy for their health. Second, create a public parent portal to report experience, concerns, and outcomes. Third, create a physician portal to report clinical observations, contraindications, and patient outcomes, publish anonymous aggravated results with original sources and clear definitions.

One table, two portals. Californians deserve to know what California required, what diseases were reported, what California spent, what happened to the children. And if we aren't counting, why not? Thank you.

And you can always submit it in the portal so we can see the full, scope of your comments if you didn't get a chance to finish. Go ahead.

Hi. My name is Vicky, and I'm with my son, Michael, who's 32 years old, still nonverbal. I'm here today because of how difficult it is to get your child a medical exemption for vaccines when necessary in this state. The process isn't the whole problem. It is also the allowable reasons for medical exemptions.

It is too few. Our children should not have to be extremely hurt or die before a doctor will write one. A parent shouldn't have to move out of state just because their kid is at risk of getting hurt with vaccines. I believe vaccines should have never been given to my son. I found out after his autism diagnosis is that he has a genetic condition called Factor Five Leiden.

Having that puts you at a high risk of blood clots under certain conditions knowing that we should never have taken that risk of... We should never have taken that risk with vaccines. If he was school age, he would not be able to get the medical exemption he needs. The CMA president, Doctor. Renee Bravo, put out a statement included that no medical intervention is perfect.

Because of this point, informed consent and consumer protection are vital to protect patients. Risk benefit assessment is an integral part of the standard of care for physicians. Thank you.

Thank you.

Hi. I'm Pam. Did you all notice no one applauded for the experts when they spoke? Anyway, couple questions that were not asked or commented on is we have Doctor Ball, Chair of the AAP in California, who wrote a vast, his word, number of exemptions and only one revoked.

Is there a conflict of interest there? I wonder. Doctor Sawyer said he saw 100 exposed patients in his office regarding measles. If you've been exposed, are you supposed to go to the doctor's office?

Just wondering. Then we listened to the experts decry, declare their praise of vaccinations, but the merit of vaccines should not require mandates, coercion, and threats. The process doesn't work when doctors are threatened with discipline, parents are punished with revocation of their parental authority and rights, and most importantly, when the children are the target, the pawns, and harmed.

Thank you.

Hello. I didn't plan on speaking today, but after listening to the panel, I'm urged to speak and ask you to consider the following questions. At what point will we stop or limit the amount of vaccines that are mandated to our children? 100, 150, 200? How can we have a society and system that allows for informed consent, yet once implemented, the family and children are cast back into society and prevented from attending school, getting kicked out of medical practices, and discriminated against?

We heard testimony today of a pediatric practice of 25,000 patients. What kind of data has been obtained from a practice such as this to identify those children who have suffered from vaccine injuries? Further, has an audit been conducted to verify that VAERS reporting has been conducted by the same physicians who administered the vaccines? We heard testimony about the cost of treating those who are unvaccinated. What about the cost for those who are vaccine injured?

How many of these practices received bonuses from pharmaceutical companies or insurance companies backed by pharmaceutical companies? Do you still think the system is fair and balanced?

Good morning. My name is Melissa. I'm a mother of three healthy and thriving boys. To those asked to speak on the panel this morning, your elitism is showing. Where is the data on the unvaccinated?

Since these laws were passed, there's a huge segment that's very afraid of being, let's see, demonized by our laws, and they are some of the healthiest children in California, but you don't know they exist. And why do these hearings never acknowledge adverse events ever? This is a civil rights issue. This is a body sovereignty issue.

This is a religious freedom issue. This is an issue of big pharma entanglement owning California help public policy. Alexian Pharmaceuticals Inc. Paid Radius over $5,000,000. AstraZeneca owns the the company and paid Doctor Sawyer for consulting.

Let's stop pretending we're being honest here. It's a corrupt system where laws are purchased and the people are not represented. Thank you.

Hello. Laura Jones here speaking on behalf of WeThePeople.team grassroots volunteers and in support of the Make America Healthy Again movement. I have a statement here from my friend, Ben Saville, who has two disabled children. He actually was one of the folks that was able to get a medical exemption, but he had a battle in doing that.

His doctor said it's very difficult for me to ask him to write a vaccine medical exemption for my children knowing that he could potentially be subjecting himself to professional scrutiny, discipline, and possibly even the loss of his medical license.

And he knows many, many other children and families that struggle to successfully get the exemptions in the special needs community. And I will leave you with RFK Jr's comment. We need to love our children more than we hate each other. Thank you.

Thank you.

Matthew 18:6 and Luke 17:2. Shame on you guys for stacking the deck like you did and then sit here and say it's our duty to protect children because you are putting them into harm's way. You tell me one thing that's good in those vaccines. One. Because I've looked into them, and there isn't one thing.

They're toxic. The people that make them tell their family not to take them. They shouldn't even make them, but they know that making them. And you guys say here, you don't have any information on another side showing the injuries that occur from these vaccinations. And the fact that you are debating whether or not parents have the authority over their children, shame on you.

Because if I were to tell you what you do with your children, you would tell me to get out of the room. But you're sitting here and you're determining what is best when children are dying. Aluminum and mercury together are corrosive. And the fact that you think that autism is not caused by these vaccines, shame on you, and woe to you. It'll be interesting to see when you meet our maker because you guys are pushing things.

These are genocide shots, and you have a choice to course correct. And I would encourage you to read Matthew 18:6 and Luke 17:2.

Ma'am. Well, I wanna thank everyone who came to this hearing. I wanna thank our panelists. I wanna thank those who came, to give public comment. I really wanna thank, Senator Jones for coming.

And it means a lot to actually have another colleague here, especially since this was, something that was sparked by your bill, which focused not so much on vaccines themselves, but on the actual, exemption process. And would you like to say something?

Yeah. Thank you. I do want to thank the chairwoman for conducting this hearing, and I would like for the public to understand and know that she's under no obligation to ask for this hearing, to conduct this hearing. And then, fortunately, for me, have it here in San Diego, where a lot of folks from Southern California, they don't have the opportunity to go to Sacramento to have their voices heard, be able to come down here to the San Diego County Administration Building and do that.

So I do want the public to know that Doctor Pierson is professional about this issue, caring about this issue.

The reason we're having this hearing is because she wants the information out there. I do understand some of the concerns that people brought up today. As the Chairwoman shared, you have the opportunity to go into this Senate health committee portal. If you weren't able to have all of your concerns heard, you can submit a letter to the portal. I would encourage everyone that has concerns about this, whether the exemptions specifically or other issues to engage with the Health Committee next year.

There will be new members on the committee that may or may not be familiar with this issue that will need to hear your voices, and I appreciate that, for the most part, everything was, polite and professional today. I understand that there are strong emotions that run on both sides of this issue, but for the most part, we were able to have a professional and, I think, productive hearing today. And I just wanna thank the Chair, for putting this together. Thank you very much.

Thank you. Also wanna thank the Health Committee staff and the sergeants who came down from Sacramento to help with this hearing as well. Have a great day.