Are California Elementary Schools Prepared to Implement AB-2109, the New Personal Beliefs Exemption Legislation?

Nonmedical exemption from mandated school-entry immunizations is associated with increased infectious disease risk for both the individual and community. Personal belief exemptions and the ease of obtaining a personal beliefs exemption have been implicated in rising exemption rates and disease outbreaks, respectively. In an effort to combat these trends in California, the state passed AB-2109, which introduces more stringent requirements for filing a personal beliefs exemption request. Previously, parents were only required to submit a letter of affidavit stating immunizations were contrary to their beliefs. Under the new law, the state-mandated exemption request form must also be signed by a health care practitioner who has provided vaccine benefit and risk education to the parent no more than 6-months prior to the child being subject to the school entry immunization requirements. The purpose is two-fold: to provide an opportunity for vaccine education and to reduce convenience use of the personal beliefs exemption. However, successfully achieving these aims is highly dependent on how the law is enforced at the individual school level.

In this study, with ith the support of the California Department of Public Health (CDPH), we conducted a survey of California elementary school officials responsible for immunization tracking and compliance. We asked respondents to rate their general awareness and knowledge of the new law, enumerate their specific knowledge of the details of AB-2109, and discuss both their school’s plans for communicating the new requirements to parents and support needs for successful implementation. Respondents were also invited to comment openly about the new law.

Respondents rated themselves as having a low level of general awareness and knowledge about AB-2109. They also demonstrated low specific knowledge of the key features of the new legislation. On average respondents identified fewer than 1 out of 7 elements of the new legislation. According to our regression analysis using school and respondent characteristics, awareness and knowledge only differed across respondents’ role, with respondents in support staff roles scoring lower than those in health worker roles. In spite of the low ratings for awareness and knowledge, many respondents were able to identify their school’s communication plan. However, many respondents also reported the need for additional information and training on the law for school staff, additional information from the district regarding implementation plans, and various support materials for communicating with parents.

Our survey results indicate the need for providing elementary school officials with additional information on AB-2109. In particular, it will be important to ensure that this information reaches all school staff who will play a role in implementing the law, whether that be through enrollment, interfacing with parents or maintaining immunization records.

The full study can be found Marissa Wheeler and Alison M. Buttenheim, Ready or not? School preparedness for California's new personal beliefs exemption law, Vaccine, Volume 32, Issue 22, 7 May 2014, Pages 2563–2569.