California legislators are reigniting an ugly fight over child vaccination requirements with bills that would mandate COVID-19 vaccinations, eliminate the personal belief exemption for COVID-19 vaccines and allow some minors to get vaccinated without parental consent.

These bills together constitute one of the most aggressive campaigns in the country to vaccinate more children.

It’s possibly the most intense, emotional and potentially explosive issue the Legislature will take up this year. In previous years, lawmakers have been threatened and assaulted over their attempts to pass stricter vaccine rules. In 2019, a voting session for a vaccination bill was disrupted when an anti-vaccine protester threw what appeared to be a menstrual cup full of blood onto the Senate floor.

With an ever-changing pandemic, a new vaccine that isn’t completely preventing transmissions and parental reluctance, the stakes are even higher.

Democratic authors of the new bills and local school district leaders expect the rhetoric and violence to only escalate in this next stage of the fight over vaccine requirements. Their response will likely be more of the same: statewide information campaigns paired with small-scale community outreach.

Here’s how this year’s battle’s shaping up:

The lawmakers

State Sen. Richard Pan of Sacramento, a pediatrician and chair of the Senate Health Committee, is leading the offensive. If signed into law, his bill would require all children attending schools or enrolled in child care in person to be vaccinated for COVID-19 by Jan. 1, 2023. Most importantly, the bill would eliminate the personal belief exemption allowed by Gov. Gavin Newsom’s student vaccine mandate issued in October.

“There’s lots of evidence that vaccine mandates work,” said Pan, citing an increase in vaccination rates after his 2015 bill eliminated the personal belief exemption for the 10 other immunizations required for students.

The bill also goes a step further by no longer requiring personal belief exemptions for any future vaccine mandates coming from the governor or the California Department of Public Health. Under the current plan, parents can request exemptions by saying, for example, that they have religious or political objections to vaccines.

The intent, Pan and other supportive legislators said, is twofold. In the short-term, it would give public health experts the flexibility to respond to future COVID-19 surges and variants. In the long-term, it would give state experts more authority to make public health decisions without the loophole of personal belief exemptions.

If Pan’s legislation passes, parents who still wish to keep their children unvaccinated would be unable to have those children attend school or child care and would have to seek independent study if they wanted to keep their children enrolled in public school.

“I think what this bill does allows for a little more flexibility,” said Assemblymember Akilah Weber, who co-authored the bill. “Having to go through the Legislature for every vaccine is not necessarily ideal.”

So far, state public health officials have highly recommended but not required the vaccine for children. A handful of school districts like Los Angeles Unified and San Diego Unified tried to mandate it but faced challenges. Vaccines for children rolled out last year, first for teenagers and later for 5- to 11-year-olds on an emergency use authorization.

In California, as of Jan. 19, 35% of children 5 to 11 have received the first dose of the vaccine. Among those 12 to 17 the number is much higher, with 82% having had their first shot, according to the Centers for Disease Control and Prevention.

A related bill by Democratic Sen. Scott Wiener of San Francisco would allow those 12 years and older to get vaccinated without parental consent.

Pan says he’s open to thoughtful policy debates, but he also expects the same threats and vitriol he’s received in past years.

“When people are making outlandish claims, relying on personal attacks and death threats, that’s not good policy,” Pan said. “That speaks to the poverty of their proposals.”

The opposition

Some say the number of breakthrough cases among vaccinated people and the relatively low number of serious illnesses among children makes the vaccine mandate both ineffective and unnecessary.

“This should be something that families should be able to make their own personal decisions about,” said Sharon McKeeman, founder of Let Them Breathe, a COVID-era parent coalition opposing mask and vaccine mandates. It was a lead plaintiff in a successful lawsuit to overturn San Diego Unified School District’s COVID vaccine mandate — the district is appealing — and McKeeman said her organization would sue the state if Pan’s bill becomes law.

Children 0 to 17 account for 1.2 million COVID-19 infections in California, or 17% of all cases, since the pandemic began. Of those minors, 47 have died and 790 kids have been diagnosed with a rare complication known as multi-system inflammatory syndrome in children, or MIS-C.

Christina Hildebrand, head of the opposition group A Voice for Choice Advocacy that has fought to keep exemptions to vaccine mandates since 2015, said she’s been gearing up for this battle for months. “This is premature,” Hildebrand said about the proposed mandate. “We don’t know where COVID is going to go, it changes week by week.”

When people are making outlandish claims, relying on personal attacks and death threats, that’s not good policy.
— Sen. Richard Pan, Democrat, Sacramento

She would prefer to see the Newsom administration’s mandate stand because it’s flexible, allows parents to use personal belief exemptions and can be changed by the state Department of Public Health. If Pan’s bill advances, her organization will push for an amendment to allow a religious exemption for students, to mirror exemptions being given to school staff and other workers.

Nationally, three in 10 parents of 5- to 17-year-olds say they will “definitely not” get their child vaccinated for COVID-19, according to a Kaiser Family Foundation survey of parents published in early December.

Hesitant or opposed parents are most concerned about safety and potential side effects, the survey found. About a third of responding parents of 5- to 11-year-olds want to wait and see how the vaccine is working.

Some experts also question the effectiveness of such a mandate because the vaccine is so new and the infection still evolving.

A mandate could harden those who are vaccine hesitant against the vaccine because they feel forced, said Neeraj Sood, director of the COVID Initiative at the USC Schaeffer Center for Health Policy & Economics.

“Overall, the risk for kids is very low so it does not require the government to come in and mandate,” Sood said. “It’s not like a measles vaccine, where you take it and it offers lifetime protection.”

Pan’s legislation to close personal exemption loopholes for the measles vaccine in 2015 was driven by an outbreak at Disneyland. Roughly 1 in 1000 children infected with measles die, according to the CDC. Nobody died as a result of the Disneyland outbreak.

Outreach efforts

Despite the showdown looming at the state Capitol, vaccine proponents are pushing ahead elsewhere.

San Diego Unified, the state’s second-largest school district, is relying on one-on-one communication with parents to combat vaccine misinformation — while hoping its appeal reverses a local court and allows its mandate to proceed. The district has also partnered with community organizations like Alliance San Diego and the Chicano Federation in a door-knocking campaign.

“It’s going to require direct outreach,” said school board president Richard Barrera. “Our school staff is calling, texting and emailing parents every day.”

Already the district has gone from 70% of students vaccinated against COVID before its mandate to 82% of students vaccinated now, according to Barrera. It

Vaccines have been so politicized that our kids are nervous about them
— Dorit Reiss, professor, UC Hastings

Catherine Martin, the executive director of the California Immunization Coalition, said her organization is hosting webinars to train pediatricians and health care providers on the best strategies for reassuring parents about the vaccine. She said parents are more likely to listen to someone they trust, like a family doctor.

“We work mostly with physician groups to get the word out,” Martin said. “I think we need to encourage people to ask questions.”

The governor’s next move

It remains unclear how enthusiastic Gov. Gavin Newsom is about Pan’s bill. A spokesperson for the governor said his office is still analyzing it.

Barrett Snider, a lobbyist for school districts, said the risks for the governor are a question. While it is an election year, the fallout from a vaccine mandate without personal belief exemptions might anger just a vocal minority.

“I feel like these issues of schools and COVID-19 were largely litigated in the recall election,” Snider said. “And there’s no apparent contender for him in the upcoming election.”

Given the anxiousness many Californians feel, leaders should tread carefully, said Dorit Reiss, professor of law who focuses on legal and policy issues related to vaccines at UC Hastings College of the Law in San Francisco.

“Vaccines have been so politicized that our kids are nervous about them,” she said. “Moving forward with the mandate could exacerbate and push parents who are not anti-vaccine into the arms of the anti-vaccine crowd.”

The division could lead to more pressure on the Legislature, Reiss said.

“Everybody is nervous, stressed or tired and everyone is vulnerable,” she said. “And they are going online. It’s a moment of opportunity for people who want to scare other people.”

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