Immunizing children:
Understanding the new law

Kirk Coverston, MDKirk D. Coverston, MD, FAAP

The largest and most notable advancement in medicine was the introduction of vaccines.  Most providers strongly endorse and believe in the benefits of vaccinations.  It is our duty as pediatricians and medical providers to protect and care for the children and families in the community, and part of that oath is to consider each child’s status on an individual basis. 

In the early 1950s polio was considered the most feared disease.  It was responsible for approximately 15,000 cases of paralysis per year in the United States.  After the introduction of the polio vaccine, the number of cases fell dramatically, to fewer than 10 per year.  The most common cause of death in school-aged children in 1950 was diphtheria. Approximately 500,000 people contracted measles each year, causing severe consequences in the people that survived and accounting for nearly 500 deaths.  Haemophilus influenza meningitis was responsible for 5,000 deaths per year.  Decades later, after the adoption of vaccinations, a majority of these diseases has essentially been eradicated.  To provide some insight, the most common reason for death in a school-aged child today is unintentional accidents. 

As a pediatrician practicing for 13 years, I have never seen haemophilus meningitis or epiglottitis from this terrible disease, thanks to the success of the vaccine. However, many of my partners older than I am recall that it caused significant morbidity and death in babies, which we do not see today. I rarely see chickenpox, either, due to the vaccine.

What the medical community is trying to achieve is “herd immunity.” When the greater numbers are vaccinated, it protects us all.  It protects those who cannot receive the vaccinations – those with medical conditions who cannot receive immunizations, and infants under the age of 1. 

The goal of the new law, Senate Bill 277, is an eventual achievement of total immunization of appropriate age groups for these diseases: diphtheria, hepatitis B, haemophilus influenza type B, measles, mumps, rubella, pertussis (whooping cough), polio, tetanus and varicella (chicken pox). There is no longer a personal beliefs exemption if attending public or private schools, a childcare center, day nursery, or developmental center, and parents must start the process of vaccines and follow appropriate vaccination schedules.

What this means is that if you have obtained a waiver in the past that was signed before Jan. 1, 2016, it will be honored until your child reaches the next checkpoint:  kindergarten and seventh grade.  These students may attend school until they reach a checkpoint and at the next checkpoint, the student must then obtain the immunizations or medical exemption to remain in school. 

There are also conditional admissions, which mean that a student must be as up-to-date as possible on all shots, but may attend school if waiting for the next dose in a series of vaccines. The next dose must be administered when it becomes due, or the student is excluded until the vaccine is obtained.  This most commonly applies to seventh graders, who had waivers in kindergarten but have reached the seventh grade checkpoint and do not have need of a medical exemption.  


When school starts, these students must be in the process of obtaining full immunization status.  This is a process for you to undertake with your primary pediatrician/physician, setting appointments to obtain these immunizations on a catch-up schedule. 

There are certain students who do qualify for a medical exemption.  This is determined between you and your primary physician, and the exemptions can only be completed by a licensed physician (MD or DO only). 

These exemptions must state the following:


  • The physical or medical condition of the child are such that child does not need the vaccine.
  • Name of each immunization that the child is exempt from having.
  • If the exemption is permanent or temporary - if temporary the expiration date of exemption.
  • Schools will not be contacting doctors for medical exemptions – it is up to the parent to discuss this with the child’s primary physician

As a pediatrician, our goals are to help keep your children safe and immunized, but we also acknowledge that there are certain children who shouldn’t receive the vaccines.  The new law is a great step toward making sure that ALL children are safe and immunized in their learning environments and obtaining healthy futures.  Let’s open the door for talk and discussion for the benefit of your child.

(Dr. Coverston is a Board-certified pediatrician who practices at Visalia Medical Clinic. He is a Fellow of the American Academy of Pediatrics and has been in practice in Tulare County since 2012.)