State Legislatures Continue to Focus on Vaccinations in 2017
Vaccines remain a vital and cost-effective public health intervention to prevent and control diseases, and state legislatures play an active role in developing vaccination laws that balance public health benefits with individual autonomy. As a result, vaccine policies are perennially considered during legislative sessions. Only one month into 2017, and ASTHO is tracking 61 bills from 22 states. Four of the tracked bills have already passed one legislative chamber. This year, legislative efforts are primarily focused on vaccine exemptions (21 bills), modifying mandatory vaccinations (15 bills), and changing scopes of practice for vaccine administration (13 bills).
Eight of the bills introduced bolster mandatory vaccine requirements by repealing or restricting nonmedical exemptions and strengthening the processes to claim an exemption. Six bills weaken vaccine requirements by adding nonmedical exemptions and by requiring healthcare providers to inform parents of exemptions. The remaining seven bills cover a range of administrative issues, such as requiring the state health agency to create standardized forms and processes to seek exemptions and disclosing vaccination rates in schools. Finally, a bill introduced in New York would disallow parents who receive a nonmedical vaccine exemption for their children from claiming a state child tax credit. The credit would instead fund health department vaccine programs and activities.
States are pursuing mandatory vaccination laws as a key strategy to increase vaccination rates and protect the public from a range of infectious diseases. In most states, students who are home-schooled are not required to be vaccinated. One bill this session allows home-schooled students to participate in interscholastic extracurricular activities at public schools if they have the vaccinations required to attend school. To prevent cervical and other cancers, two bills require middle school students to be vaccinated against human papillomavirus. Another bill requires children enrolled in day care centers to receive influenza vaccines. Additionally, two bills would require meningococcal meningitis vaccinations for students entering sixth grade.
Legislatures are also considering bills to improve vaccination rates and reduce the risk for students living in dorms or campus residences. Most of the bills targeting this population require or encourage meningococcal meningitis vaccinations for college students. However, two bills would either encourage or require proof of vaccination against additional diseases before enrollment. With the recent mumps outbreaks at colleges across the United States, states are likely to pursue efforts to improve vaccination rates in this population.
Two bills being considered this session would restrict mandatory vaccinations. First, one bill prohibits hospitals from vaccinating newborns against hepatitis B unless the parents specifically request the vaccination. The second bill prohibits the state health commissioner from adding new vaccinations to the list of required childhood vaccines and from adopting rules or protocols for partial vaccinations.
Fifteen bills cover topics surrounding vaccine administration. Although the scope of bills varies, states continue to look to non-physician providers as a means to improve access to vaccinations. The majority of the bills allow non-physician providers, such as pharmacists and nurse practitioners (NPs) to administer vaccinations. Another bill allows licensed practical nurses to administer vaccinations with a lower level of supervision. Finally, to address concerns about continuity of patient care, one bill expressly requires that pharmacists who administer a vaccine provide documentation to the patient’s primary care physician within a set amount of time. The final scope of practice bill allows NPs and physician assistants to certify that a patient is eligible for a medical exemption from a required vaccine.
As state legislatures continue to consider vaccination policies in 2017, ASTHO will track the activity and provide the latest information for state health departments.
KT Kramer, JD, MHA is ASTHO’s director of state health policy. She supports state and territorial health agencies to advance and strengthen public health
through laws and policies.