Once more into the breach: AB 2109

Last night I was privileged to participate in a conference call about a piece of legislation moving its way through the California state senate, AB 2109.  What made it a particular privilege was having the chance to speak with both Dr. Richard Pan, a California pediatrician, state assemblymember  and the author of the bill, and also Dr. Paul Offit, who has done as much as anyone in recent history to promote vaccination for all appropriate children.  It is no disrespect to Dr. Pan to say that it was a special treat to speak with Dr. Offit, who is a person I admire immensely.  (This has been a great week for me for interacting with personal heroes.  I got to meet Barney Frank on Saturday.)  (It was also super-cool to hear your voice, Liz.)

Anyhow, AB 2109 would make it more difficult to cite “philosophical” objections as a reason to eschew vaccinating one’s child.  As of now, parents in California who opt out of vaccinating their children are required to do no more than sign a two-sentence statement citing a personal or “philosophical” objection to vaccination, and their unvaccinated children can attend school.  The law, if passed, would require a signed statement from a licensed medical provider (physician, nurse practitioner, physician’s assistant, school nurse, or naturopath working under physician supervision) stating that the parents have been informed of the risks and benefits of vaccination, and of not vaccinating their children, and have opted out of vaccinating anyway.  It would make it more onerous to opt out of vaccinations and still send one’s kids to school.

I have expressed skepticism about how effective a similar law in Vermont would be in lowering refusal rates, and I brought up my concerns along those lines to Dr. Pan.  While I now work in a practice that doesn’t accommodate parents who want to opt out of vaccinating their kids, at my last job I had a certain number of patients whose parents refused vaccines.  I spent lots of time talking about the benefits of immunization with them, and discussed their concerns about the health risks at length.  In my experience, very few people changed their minds.

However, Dr. Pan made some good points in response.  For some parents, opting out of vaccinations is kind of a default option, borne of convenience, and they haven’t really given it much thought either way.  The new requirement could well be effective in getting their children vaccinated.  And there are certainly some persuadable parents, for whom a slightly more difficult opt-out process and required conversation and statement might provide sufficient motivation to get their kids vaccinated.  From whatever combination of factors, a similar law in Washington state (which really needs the help) reduced refusal rates from 6% to 4.5% in just one year.  When it comes to maintaining herd immunity to vaccine-preventable illness, a few percentage points can make a significant difference.

Obviously, I hope AB2109 passes.  I’m likely to support almost any reasonable measure that makes it more difficult to not vaccinate one’s child.  There is absolutely no good reason that almost all children should not be vaccinated.  If this law protects more children from preventable disease, then I’m all for it.  But I suspect most of the benefit will be at the margins.  For the true believers, whose bizarre fears about one of the greatest public health advances of the past hundred years continue to confound me, I don’t think a conversation with a licensed medical provider will make any difference.  As I’ve seen in my own real-life practice, and as the occasional more strident commenter hereabouts (more of which I am now bracing myself for) has demonstrated, the non-evidence-based beliefs of the anti-vaccine crowd are unlikely to budge under the weight of all the evidence I can muster.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


  1. I remember when I started my graduate program and I needed to prove I was current on my tetanus-diptheria shots. The problem was, I was current (I had had the boosters about 4 years before), but I didn’t have the records, and I didn’t know how (and was too lazy to find out how) to get a blood test to prove my immunity. So I was going to state a philosophical objection just to get out of getting another shot. Unfortunately (for me), I could claim only a religious exemption, which I was unable to do. So I got the shot. In other words, it worked on me.

    (By the way, I’m due for another booster next year and am going to get one because it will have been ten years.)

  2. I was offered the opportunity to listen in on that conference call, but given that my academic credentials had nothing to offer to said conference, I reluctantly declined the offer.

    I think that those parents who decline vaccines from ‘convenience’ (the ones who just sign their names because it saves them a trip to the Dr’s office) are the most likely to be ‘brought over’ from a bill of this sort.

    Let’s face it; as a species we’re a bunch of lazy bastards. We’re programmed to get the most out of doing the least amount of work or giving the least amount of effort. There are also those individuals who are truly ignorant of the risks of vaccine preventable diseases. Those are the, “Oh, people don’t die from that anymore and it’s rare enough to see here where I live…” they don’t realize that measles, etc are often a short plane ride away from them. Having to sit down with their child’s pediatrician (or equivalent) to discuss the risks of disease vs the risks of vaccinating might just open their eyes.

    I agree with your assessment that those parents who are hard-core anti-vaccines will never be swayed. Short of the death of one of their own children or relatives from a vaccine preventable disease (and even then, it’s iffy), they will continue to deny, disparage and disregard the immense benefit that vaccines have had for our society.

  3. Hi Russell! I was excited to hear you were on the call, too. I live in California, and have been doing what I can to influence our legislators to vote for AB 2109.

    Darwy, I’m not a physician or an academic — just an in-the-trenches blogger who has been a vaccine advocate since someone dear to me first was on chemotherapy in 1998. It turned out that a large section of our acquaintance with young children were vaccine-refusers. My dear one was advised by his oncologist to refuse to be in the same room with unvaccinated people.

    My sense is that Dr. Pan (unlike Dr. Offit) was naive about the … passions, I suppose, of anti-vaccination activists. Their objections are nonsensical but deeply felt. For some of the nonsense, you might want to read David Gorski’s account of Steven Novella debating anti-vaccinationist physician Julian Whitaker and Gorski’s “friend” Orac’s account of <a href="http://scienceblogs.com/insolence/2012/07/19/battling-antivaccinationists-at-freedomfest-part-2-dr-whitaker-responds/"Dr. Whitaker's feeble attempt to rebut..

    One of the other participants in the call was my colleague at The Thinking Person’s Guide to Autism, Shannon Rosa, whose son Leo is intensely autistic. Her account of, well, recovering from the vaccines-cause-autism myth is a widely-reprinted essay, Why My Child With Autism Is Fully Vaccinated.

    Russell, I wish Dr. Pan would have addressed your second question, which was something to the effect that, “Is AB 2109 the first step toward eliminating all exemptions?” I am pretty sure that Dr. Offit would like philosophical exemptions, religious exemptions, and personal belief exemptions removed, leaving only valid medical exemptions, but my sense is politically speaking, that isn’t currently possible, at least in California.

    I’m currently taking Dr. Offit’s course on vaccines. If Coursera offers it again, I’d encourage anyone interested in public health to take the course.

    • I’m taking the Coursera Vaccine course as well.

      Not surprisingly, Jake Crosby has already been there (and been removed if I understand things correctly). There’s a few anti-vaxxers present there but for the most part they’ve been soundly trounced by folks who have the data and science to back up their claims.

    • I occurred to be afterward that it would have been impolitic for Dr. Pan to have addressed my second question. Dr. Offit, not being an elected official and not directly responsible for the legislation making it into law, was freer to speak his mind. It wouldn’t serve Dr. Pan’s purposes to go on the record and say that AB 2109 was just the first step in trying to eliminate parental exemptions in toto.

  4. Thank you for confirming the obvious for all of us regarding the incestuous relationships that abound.

    It is horrifying to live on the same planet as you people. You are disgusting human beings. May each of you get exactly what you deserve.

    In looking at my site stats this morning, I couldn’t figure out where on earth the outclicks to “upyours.com” had come from until I noticed the URL associated with this comment. I’d just like to make clear that I didn’t, out of pique, modify the link in any way. No, that was Samantha’s own charming contribution. — RS

    • Dear Samantha:

      Don’t let the door hit your ass on your way out.



    • May each of you get exactly what you deserve.


  5. Aren’t there enough vaccine injured children that our medical community and government are not taking responsibility for??? I for one, have seen the damage from a vaccine injury! No thank you. Pharmaseudical companies regulate and sell vaccines. Where are the pharma-cokinetic safety studies? One size fits all?? 8 vaccines in one day is a bit much for a child under the age of 2 and even for an adult. Where are the studies that vaccines are safe and effective. Herd immunity is a farse.

    • Pharmaceutical companies don’t regulate the vaccines. They produce, test and market them. The government regulates the vaccines and evaluates the vaccine schedule for its citizens.

      Each vaccine added to the schedule is tested; the data is available to the public.

      Herd immunity is not a farce, although your English skills are rapidly approaching that designation.

      The number of vaccines has indeed increased – while the number of antigens has decreased (by an order of magnitude). Despite this, our children are exposed to more bacteria and viruses on a daily basis than they ever will be via a vaccination.

      There are plenty of studies which indicate both the safety and efficacy of vaccines. You just need to step away from Whale.to and look for them.

      • There’s a difference between pharmaceutical companies and government regulaters? I did not know that. I do know that exactly one year after she destroyed the CDC Dr. Julie Gerberding was hired as president of Mercks vaccine division. Doesn’t Merck make 90% of our mandated vaccines. Wasn’t Gardisil (over 27,000 adverse events reported to date) brought to market by Julie? Hasn’t Paul Offit recieved over $25 million from Merck in the last 5 years?

        • I wish anti-vaccine activists like Penny would indeed, “do their research”.

          Dr. Offit spent the bulk of his career developing a vaccine against rotavirus, in the process saving millions of young lives. Yes, he benefited from the resulting patent, but nowhere near $25,000,000. Since I doubt Penny will click over, I will paste it in below. It’s a post from January 5, 2011:

          A Statement from Paul Offit MD

          Just for the record: I no longer financially benefit from the sales of RotaTeq. My financial interests in that vaccine have been sold out by either The Wistar Institute, The Children’s Hospital of Philadelphia, or me. I will, however, continue to stand up for the science of vaccines because unfounded fears about vaccines have hurt children. That is why I do what I do and why I have always done it. And I will continue to closely follow the distribution of rotavirus vaccines because these vaccines have the potential to save as many as 2,000 children a day, which is why I joined the research team at Children’s Hospital.

          It’s not clear when the patent was sold — possibly as early as 2008.

          From a post by David N. Brown at LeftBrain/RightBrain, posted December 22, 2009

          Dr. Offit’s statement to [David N. Brown]: “CHOP sold its patent for $182 million. This information was made publicly available and was published in the Philadelphia Inquirer at the time. The inventors, Fred Clark, Stan Plotkin, and me split 10 percent of that three ways. This means that we each received about $6 million.”

          Why is it that anti-vaxxers play so loosely with the facts?

      • I sense a personal attack in your comment. I have a child with vaccine injury, I have a right to speak my mind. Why would you be offended? 8 vaccines in 1 day is still over the top in toxicity. You go ahead and vaccinate your children and grandchildren, you will soon find out why we are so against the forced vaccination issue. So the same people that test and produce and market vaccines are the same people who profit from them, correct? Isn’t that a conflict of interest?

        • Except absolutely no vaccine has any compound which is toxic in the amounts present.

          The amount of aluminum adjuvant is not toxic, nor is the amount of formaldehyde, or thimerosal.

          You are not ‘forced’ to vaccinate. AB 2109 will not FORCE you to vaccinate.

          As for Penny’s comments; she really should examine who receives the profits from the patent of the rotavirus vaccine, and she should provide proof of her claim, “I do know that exactly one year after she destroyed the CDC Dr. Julie Gerberding was hired as president of Mercks vaccine division”

          The use of VAERS is, of course, a red herring. 27,000 adverse effects…. yet for all those reports, not one has been conclusively linked to the HPV vaccine. Nor have any of the deaths which have occurred after vaccination.

          As usual, it’s a case of correlation does not equal causation. But Penny doesn’t want to understand the concept so she ignores it.

          • What about mercury is non-toxic at any amount injected into a human?

          • Again, Thimerosal != mercury

            Thimerosal does not share the same toxological profile as elemental mercury. There is a difference between an element and a compound.

            If not, your mouth would explode when you ate anything salty, as sodium (Na) explodes upon contact with water.

  6. Can we get one of those hot blonde pharmacuitical sales reps riding around in Cadilac Escalades to sign the form? They give out the same exact information as the pediatricians anyway. Why waste the pediatricians precious time when they can be giving out ritalin, adderal, statins, prozac and all the other good things for our children.

  7. Well, it’s reassuring in its way that I can still expect that anti-vaccine partisans will arrive sooner or later when I post on the subject.

    To all of my new readers, it’s lovely that you’ve stopped by. You are, of course, welcome to post anything you wish in comments, provided it is not openly defamatory.

    However, since I’ve dealt with the topic of vaccines before, I have a sense of how the conversations tend to go. They go… not well. I can see things shaping up along those lines in the comments that have already been offered. I am, it seems, in an incestuous kind of relationship with people I’ve never actually met, and only spoke with for the first time a few nights ago. I get all my information from pharmaceutical reps. Etc.

    Life is, as they say, too short. I know that there isn’t a blessed thing I can say to change the minds of true believers on this subject. If you believe that the CDC is innately corrupt, for example, then there’s little I can offer by way of an information source that you are likely to consider valid or upstanding. And I can assure you that the likelihood that you will change my mind is fleetingly remote. So I will let you post what you like, and may respond here and there, but I really have better things to do with my time than engage in an argument.

    However, please note that a few things are strictly off limits. If you attack my character or resort to insults, I will delete your comments. If you compare me or my colleagues to the Nazis or any other monsters of history, I will delete your comments. If you cannot make your points without recourse to personal attacks, then the world is no poorer for my expunging them.

    • So you are trying to innoculate yourself against crazy defamatory anti vax posters.
      +1 for irony

  8. The question is do activists try to eliminate non-medical exemptions or do they advocate legislation that makes exemptions harder to get. That is a major bone of contention among some leading people who work for science-based medicine.

    I personally think the pro-vax forces should go for excluding the religious and philosophical exemptions, as is already the case in two states. AB-2109 type of legislation can be undermined and fiddled with, as is AB–2109 with the addition of naturopaths as vaccine educators. Yes, opposing these exemptions would not be easy, but isn’t it still the right thing to do?

    Did Dr. Offit, in this conference call, make a stand on this issue? Does he believe we should go for eliminating exemptions or making them harder to get?

    • I am loath to speak on behalf of anyone, certainly not someone as prominent and controversial as Dr. Offit. Lord knows he generates enough heat on his own, and the last thing I’d want to do is give him a needless additional headache to deal with because I misrepresented his views.

      So, with a gigantic disclaimer that this is only my impression and I may be mischaracterizing his views, I got the distinct impression that Dr. Offit supports eliminating exemptions outright. He offered very specific criticisms of both the morality legality and the theology underlying religious exemptions, and I came away with a pretty clear notion that he feels they should be done away with. (Dr. Pan, as noted, was much more circumspect.) I share these sentiments, for what it’s worth, and agree that AB2109 has a lot of room for people to subvert its intentions.

      Edited to reflect what I meant to write the first time.

  9. You offend me and my beliefs. I, nor my beliefs, are bizzare !

    • Well, I commend you and your offended beliefs to the vastness of the Internet, Jay. I believe russellsaundersisatotalmoron.blogspot.com is still up for grabs.

  10. i don’t dip my toes into these crazy waters too much, but how do anti-vaccination folk explain the widespread disappearance of, for example, polio?

    • Oh, they claim either it was improvements in sanitation (Really, how much improvements in sanitation came in the US in the 50’s? ) or all the polio cases are now diagnosed as a different case, etc.

      There’s no limit to the level of conspiracy nuttery they’ll stoop to.

  11. Answer these 3 questions for me…

    1. Why did the government set-up the VAERS (vaccine adverse event reporting system) to protect pharmaceutical companies from lawsuits from vaccine injuries, if vaccines are totally safe?
    2. Why is the CDC (full of people who have direct and indirect financial ties to the pharmaceutical companies) to be trusted to ok vaccines and drugs? (Any person with common sense could see this to be a HUGE problem. It’s too bad money is more important than anything else.)
    3. Why do doctors allow big-breasted, blonde pharmaceutical reps to spoon-feed them canned vaccine information to pass on to their patients without really looking into the ingredients, possible side-effects, and study safety information? Also, why won’t doctors consider that there could be side-effects from vaccines, which are injected into the bloodstream, especially when drugs have known side-effects. Why wouldn’t vaccines have side-effects?????

    I know the answers…It’s all about money.

    • Sally, I’m just going to deal with point #3. No doubt someone will be along presently to address your first two queries.

      These succubus-like pharmaceutical reps must be quite something. The only pharmaceutical rep I’ve ever met who came even close to your description hawked ADHD medications, not vaccines. I don’t remember how big her breasts were, since I’m not the kind of fellah to notice such things. (You’re probably not a regular reader, so you may have to figure out what that means.) Buxom or not, I hated her, and refused to speak with her when she visited. (This was at my last job; I haven’t spoken two words to a drug rep in my new job). In any case, I don’t think I remember ever having met a pharmaceutic representative to discuss a vaccine except once to learn about Gardasil. (IIRC, he was a somewhat disheveled middle-aged gentleman.) The vast majority of the information I have learned about that particular vaccine has come from conferences sponsored either by professional societies I belong to or the medical school where I am on faculty.

      Oh, and you’re simply wrong about where vaccines are injected. They go into muscles or subcutaneous tissue, not into the bloodstream.

      Whoops. One more thing — nobody said vaccines don’t have side effects. They do. (Localized redness, swelling, fever, sometimes a rash. Rarely an allergic reaction.) They don’t cause autism, however, or any of the other more dire afflictions falsely attributed to them by your crowd.


    • 1: Nothing on this earth is ‘totally safe’. If you expect everything to be 100% safe, I have two words for you: Nirvana Fallacy.

      VAERS was set up so that everyday people can report what they feel MIGHT be an adverse reaction to a vaccination. Those reports are followed up and verified, and it allows for tracking adverse reactions to ensure vaccine safety.

      The compensation fund was set up indeed to protect vaccine manufactures from being bombarded by spurious litigation – something our society has perfected – the art of suing anyone you can for anything. I see it as a good thing; people have to PROVE their child was injured – they cannot just say their child is and be handed money for it. Granted, the vaccine court is more ‘lax’ in their science standards than I’d prefer, but it’s better than frivolous lawsuits clogging up the regular court system.

      2: Please provide a source for your claim that the CDC is ‘full of people who have direct and indirect financial ties to the pharmaceutical companies’. To be honest, claiming this reeks of a conspiracy theorist.

      3: Russell’s covered this one – biased much against big breasted blondes much?

      Furthermore, there is NO vaccine – not a SINGLE ONE – which is ‘injected into the bloodstream’. There are PLENTY of safety (and efficacy) studies regarding vaccines. You just need to pull your head out from Whale.to and NVIC and smell the roses instead of the bullshit you’ve had your head dipped into.

    • Dear Sally,

      A modest amount of research would have told you the answer to #1.


      The Vaccine Adverse Event Reporting System (VAERS) is a national vaccine safety surveillance program co-sponsored by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). VAERS is a post-marketing safety surveillance program that collects information about adverse events (possible side effects) that occur after the administration of vaccines licensed for use in the United States.

      The National Childhood Vaccine Injury Act (NCVIA) of 1986 requires health professionals and vaccine manufacturers to report to the U.S. Department of Health and Human Services (HHS) specific adverse events that occur after the administration of routinely recommended vaccines. In response to NCVIA, CDC and FDA established VAERS in 1990 (Chen, Vaccine, 1994).

      VAERS has demonstrated its public health importance by providing health scientists with signals about possible adverse events following immunization. In one instance, VAERS detected reports for intussusception over that what would be expected to occur by chance alone after the RotaShield rotavirus vaccine in 1999. Epidemiologic studies confirmed an increased risk, and these data contributed to the product’s removal from the US market. In another example, VAERS determined that there may be a potential for a small increase in risk for Guillain-Barre’ syndrome (GBS) after the meningococcal conjugate vaccine, Menactra. As a result of this finding, a history of GBS became a contraindication to the vaccine and further controlled studies are currently underway to research this issue.

      You are falling for the nirvana fallacy.. Nothing in life is perfectly safe, but you or your child faces a bigger risk from driving to the pediatrician’s office that that posed by all the immunizations on the CDC schedule.

      I actually did the calculations from the Vaccine Injury Compensation Program through 2011. The average ratio of vaccine awards per million doses of vaccines is…1.3.

      • See, this is why I didn’t bother with questions 1 and 2. I knew you’d both come along and do it so much better than me.

        • I got a little snarkier than normal, but I’ve had my fill of anti-vaccine folks who either parrot what some other imbecile has written somewhere on the internet regarding vaccines and the “TROOF” or folks who pull out studies from Shaw & Tomljenovic (who are the equivalent of Tweedledumb and Tweedledumber in the science world), and insist they understand critical thinking.

  12. Darwy, did you know that the spate of papers by Shaw & Tomljenovic were funded by two anti-vaccine organizations?

    The Dwoskin Family Foundation funded the anti-vax propaganda film The Greater Good AND S&T’s “research” AND the notorious anti-vaccine conference in the Jamaica, the one where Anderson Cooper interviewed Andy Wakefield via Skype. Claire Dwoskin wrote in an email to John Stossel of Fox: “Vaccines are a holocaust of poison on our children’s brains and immune systems.”

    There were two other funders, the Lotus Foundation and the Katlyn Fox Family Foundation. I was unable to ascertain which of the many “Lotus Foundations” were L&S’s funders, but the Katlyn Fox Foundation funds vaccine “safety” studies, and is named for the Foxes’ daughter who died of SIDS, which they call “complications of vaccines”.

    • Yes, I did Liz.

      I just find it reprehensible how they abuse science to suit their own ends. They make erroneous assumptions, baseless assumptions and such and try to intimate that it’s ‘sound science’.

  13. Thanks for sharing article with outstanding video and to give me a chance to comment on it. Vaccine-injuries are injury caused by vaccination. I know that deaths from vaccine-injuries are much more common than deaths from infections those vaccines are designed to prevent. If I have a child someday, I’d choose not to vaccinate as well.

    • ” I know that deaths from vaccine-injuries are much more common than deaths from infections those vaccines are designed to prevent”

      Just shows that you don’t know much of anything.

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