Madison Clarke
California allows for medical exemptions from mandatory vaccination requirements. However, the process for obtaining such exemptions has been streamlined and tightened in recent years. The state's Senate Bill 277 (SB277), implemented in 2016, eliminated non-medical exemptions for schoolchildren, including personal belief exemptions, while retaining permanent medical exemptions. The bill also amended the language surrounding medical exemptions, potentially influencing the decision-making process for physicians. As of 2021, medical exemptions must be filed through the California Immunization Registry (CAIR-ME), a centralised database, and any exemptions are only valid until the child enrols in the next grade.
| Characteristics | Values |
|---|---|
| Are medical exemptions from vaccines banned in California? | No |
| Who can grant a medical exemption? | A licensed physician or medical director |
| Who can request a medical exemption? | Students or parents on behalf of their children |
| What is required for a medical exemption? | A statement from a licensed physician, a statement on the medical condition, the duration of the exemption, and certification from the physician |
| Where is the medical exemption filed? | California Immunization Registry (CAIR-ME) |
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What You'll Learn
Medical exemptions for students at Caltech
California has not banned medical exemptions from vaccines. In fact, all states allow permanent medical exemptions to vaccination requirements. However, in 2016, California enacted Senate Bill 277 (SB277), which eliminated non-medical exemptions for personal or philosophical beliefs.
The California Institute of Technology (Caltech) allows students to request medical exemptions from vaccine requirements. This policy is in line with the state's legislation and is designed to protect the health of both students and the community.
To request a medical exemption, students must submit a Vaccine Exemption Form, which is available in the Student Health Portal. This form must include specific information, such as the vaccine(s) for which the exemption is requested and a written statement from a licensed medical provider. The statement must indicate the specific medical reason and the probable duration of the condition or circumstances that contraindicate immunization.
The requests for medical exemptions are reviewed by the Medical Director for Caltech Student Wellness Services (SWS). If the information provided is ambiguous or insufficient, the student will be informed, and attempts will be made to obtain additional details. If clarification or sufficient information is not provided, the exemption request will be denied. However, students can submit a written appeal to the Caltech Medical Director, who will review the appeal in consultation with relevant health departments and/or specialists in the field of vaccinations.
It is important to note that Caltech's vaccine exemption policy applies to vaccines such as MMR (measles, mumps, and rubella), Varicella (chickenpox), Tdap (tetanus, diphtheria, and pertussis), and Meningococcal conjugate. During the COVID-19 pandemic, Caltech required all students to submit proof of full vaccination against COVID-19, with exemptions only for medical contraindications.
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Medical exemption requirements
California has not banned medical exemptions from vaccines. In fact, all states in the US allow permanent medical exemptions to vaccination requirements. However, the state has implemented strict requirements for medical exemption requests.
In California, medical exemption requests must be documented on a Vaccine Exemption Form. This form must be completed by a licensed medical provider, such as a physician (MD or DO), nurse practitioner (NP), or physician's assistant (PA). The form must include specific information, such as:
- The specific vaccine(s) for which the exemption is being requested.
- A written statement from the licensed medical provider indicating that immunization is not considered safe or is contraindicated for the individual due to their medical condition or circumstances. This statement must include the specific medical reason and the probable duration of the condition or circumstances.
- Whether the exemption is permanent or temporary and, if temporary, the expiration date of the exemption.
- The provider's practice location address, telephone number, and license number.
- Any positive antibody titers showing immunity, which can be submitted in lieu of vaccination documentation for certain vaccines.
Additionally, as of 2021, medical exemption requests must be administered through the California Immunization Registry (CAIR-ME), a statewide database for collecting and filing medical exemptions for vaccinations. Parents or guardians can create an account in CAIR-ME and apply for an exemption. The CAIR-ME system requires additional information, such as:
- A statement acknowledging that the child received a physical examination and evaluation that meets the stipulated standards.
- The amount of time the issuing physician has been treating the child.
- A separate description of the medical basis for each vaccination exemption.
- An authorization to release information to the Department of Public Health.
- Certification from the physician confirming the accuracy and completeness of the provided information.
The medical exemption requests are reviewed by the Medical Director for Caltech Student Wellness Services (SWS). If the information provided is ambiguous or insufficient, the student and their medical provider will be informed, and attempts will be made to obtain additional information. If sufficient clarification or information is not provided, the exemption request will be denied. However, the student and their medical provider have the right to submit a written appeal to the Caltech Medical Director, who will review the appeal in consultation with public health experts.
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Medical exemptions for kindergarteners
In California, students enrolled in kindergarten through the twelfth grade in both private and public schools are required to obtain certain vaccinations. These include: MMR (measles, mumps, and rubella), Varicella (chickenpox), Tdap (tetanus, diphtheria, and pertussis), and Meningococcal conjugate (Serogroups A, C, Y, and W-135). Homeschooled students are not subject to these immunization requirements.
Before SB277, kindergarteners who were not up-to-date with their vaccinations could enter school with a personal belief exemption, permanent medical exemption, or conditional entrance. However, after the implementation of SB277, personal belief exemptions were eliminated, but permanent medical exemptions and conditional entrance remained.
To obtain a medical exemption for a child, a doctor must provide a description of the medical basis for the exemption and certify that the information provided is accurate, correct, and complete. The exemption must be submitted electronically directly into the California Immunization Registry (CAIR) and can be granted for reasons outside of the CDC, ACIP, and AAP guidelines, including family medical history.
It is important to note that medical exemptions are reviewed by the California Department of Public Health when a school or childcare facility's immunization rates drop below 95% or when a school fails to provide reports of their vaccination rates. Additionally, a medical exemption that does not meet the above criteria may be reviewed on a case-by-case basis if it is necessary to protect public health.
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Medical exemptions for homeschooled students
In California, homeschoolers are generally exempt from immunizations. However, this exemption does not apply to hybrid programs or previously homeschooled children who transition to traditional schools.
Before delving into the specifics of medical exemptions for homeschooled students in California, it is important to understand the broader context of vaccine exemptions in the state. California was the first state in 30 years to eliminate non-medical exemptions, doing so in 2016 through Senate Bill 277 (SB277). This bill removed the phrase "that contraindicate immunization" and replaced it with "including, but not limited to, family medical history, for which the physician does not recommend immunization." This change expanded the scope of acceptable reasons for medical exemptions.
The California Health and Safety Code stipulates that students must be fully immunized for their age to be admitted to any public or private school for the first time or to advance to the seventh grade. However, pupils enrolled in home-based private schools or independent study programs without classroom-based instruction are not subject to these mandatory vaccination requirements. Establishing a home-based private school by filing a private school affidavit further reinforces this exemption.
While homeschoolers are generally exempt, there are specific circumstances where medical exemptions may come into play. For instance, if a homeschooled student transitions to a hybrid program or a classroom-based learning environment, their immunization status becomes relevant. In such cases, medical exemptions can be obtained through a licensed physician, who provides a written statement indicating that immunization is not considered safe due to the child's medical condition or circumstances, including family medical history. This exemption must be submitted electronically to the California Immunization Registry (CAIR) and is reviewed by the California Department of Public Health (CDPH) under certain circumstances, such as when a school's immunization rates drop below 95%.
It is important to note that the CDPH does not review every medical exemption, and the decision to grant exemptions remains at the discretion of physicians. Additionally, medical exemptions are only one type of exemption, with California also offering special education/IEP exemptions for students with disabilities.
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Medical exemptions for students with disabilities
California has not banned medical exemptions from vaccines. However, it was the first state in 30 years to eliminate non-medical exemptions for school-entry vaccine requirements. This was in response to the "Disneyland" measles outbreak in 2015, after which California enacted Senate Bill 277 (SB277) in 2016.
Students with disabilities in California are entitled to be placed on Individualized Education Programs (IEPs) and receive special education services. A lack of immunization cannot prohibit students with disabilities from accessing these services. This means that students with IEPs may access any special education and related services without providing proof of immunization. However, this exemption does not automatically apply to all students with IEPs.
To obtain a medical exemption for a child with special needs but without an IEP, families must seek a medical exemption directly from a licensed physician. The physician must provide a written statement indicating that immunization is not considered safe due to the child's physical condition or medical circumstances, including family medical history. This statement must specify the nature and probable duration of the condition or circumstances.
Medical exemption requests must be documented on a Vaccine Exemption Form, which can be found on the Student Health Portal. The form must include the specific vaccine(s) for which the exemption is requested and be signed by a licensed medical provider. The medical provider must also include their practice location address, telephone number, and license number.
Requests for medical exemptions will be reviewed by the Medical Director for Caltech Student Wellness Services (SWS). If the information provided is insufficient or ambiguous, the student will be informed, and attempts will be made to obtain additional information. If sufficient clarification is not provided, the exemption request will be denied. However, the student and their medical provider may submit a written appeal to the Caltech Medical Director, who will review the appeal in consultation with the relevant health departments and/or specialists in the field of vaccinations.
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Frequently asked questions
No, California allows for medical exemptions from vaccines.
Families must seek a medical exemption directly from a licensed physician. The exemption must be administered through the California Immunization Registry (CAIR-ME), a state-wide database for collecting and filing medical exemptions.
A separate description of the medical basis for each vaccine exemption and a statement as to whether the exemption is permanent or temporary are required. The California Department of Public Health must, by law, review exemptions in CAIR-ME when a school or childcare facility's immunization rates drop below 95%.
No, the California Institute of Technology allows for exemptions to immunization requirements based on a medical condition that is a contraindication to vaccination for specific vaccines, including MMR (measles, mumps, and rubella), Varicella (chickenpox), Tdap (tetanus, diphtheria, and pertussis), and Meningococcal conjugate.
California law states that students are required to obtain COVID-19 immunization for in-person learning only at the start of the term following the Federal Food and Drug Administration's (FDA) full approval of the vaccine for their grade span. Thus, any COVID-19 immunization requirements would only take effect after full FDA approval.
