California saw a surge in medical exemptions to school-required vaccinations after it passed a law in 2015 that is similar to the bill Maine Gov. Janet Mills signed last week banning all non-medical exemptions.

Parents who wanted to avoid school-required vaccines for their children exploited a loophole in the California law by finding doctors who were willing to grant medical exemptions under false pretenses, according to state health officials and news reports. Medical exemptions tripled after the law went into effect.

In Maine, public health advocates point out that California’s vaccination coverage is still vastly greater than before the law passed, and they say Maine may not experience the same implementation problems as California.

Maine joins California, West Virginia and Mississippi as the only states to ban all non-medical exemptions for vaccines that are required to attend school. Maine had permitted parents to forgo vaccines for their children by signing a form objecting on philosophic or religious grounds. Maine’s poor vaccination coverage among students entering kindergarten, and sky-high rates of pertussis, helped spur passage of the bill over the objections of some lawmakers, who claimed the measure violates parental rights.

Meanwhile, measles has come back nationally, spread by unvaccinated people, according to the U.S. Centers for Disease Control and Prevention. Measles is at its highest level in 25 years, as the U.S. CDC reports 940 measles cases in 26 states, with many of the cases in New York City and Washington state. Maine has reported one measles case.

A measles outbreak that started in Disneyland in 2014 prompted the California law that ended non-medical exemptions. Since then, California’s vaccination coverage has improved.

However, some parents are bypassing the law by obtaining medical exemptions from doctors willing to grant them for unjustifiable reasons – such as asthma and diabetes, according to news reports. Medical exemptions for vaccines are typically granted for children who have severely compromised immune systems, such as students with leukemia.

After the law went into effect, medical exemptions in California more than tripled, from 0.2 percent in 2015-16 to 0.7 percent currently, according to state health statistics. Dozens of California schools reported very high rates of medical exemptions – 20 percent or higher – which was statistically improbable.

Maine’s law will be implemented for the 2021-22 school year, giving health officials time to iron out the details.

Peter Michaud, general counsel for the Maine Medical Association, which helped draft the language for the law, said Maine and California are very different states, so implementation may not follow the same path.

“We shouldn’t start with the presumption that the medical providers can’t do this properly,” Michaud said. “Let’s see how this goes first.”

In California, the state Legislature is considering a bill to clamp down on false medical exemptions by requiring medical exemptions to be reviewed by the state. State officials in California have estimated that 40 percent of medical exemptions would be rejected if there were a state review process.

Maine’s new law – which cleared the state Senate by one vote – spells out that the Maine Department of Health and Human Services is barred from reviewing medical exemptions.

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