Ending Exemptions – The Importance of Strong Vaccine

LawsAmerican Academy of Family Physicians

State Legislative ConferenceOctober 29, 2016

Diane C PetersonImmunization Action Coalition

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Status of exemptions to state-mandated vaccinations

Overview of legislative efforts Lessons learned in advocating on policy issues Available resources

Today’s Presentation

Exemptions Permitted to School and ChildcareImmunization Requirements

October 2016WA

OR

NV

MT

ID

AK

UT

AZ1

WY

ND

KS

NM

CO

LA

AR

IN

MI

OH

GAAL

VA3

NC

SC

WV

ME

NY

PA

NHVT

HI

MO2

NE

IL

WI

IA

KY

CT

MDDE

FL

DC

RI

CA

OK

TX

SD

TN

MS

NJ

MAMN

Medical, Religious, Personal Belief

Medical, Religious

Type of Exemptions Permitted

Medical Only

1 Arizona: Personal belief exemption permitted for school only2 Missouri: Personal belief exemption permitted for childcare only3 Virginia: Personal belief exemption permitted for HPV only

Medical, Personal Belief

State Non-Med 2009-10 2015-16

Alaska Religious 3.8 (4-5) 4.7 (3)Arizona Rel/PBE 2.8 (12) 4.5 (4)Colorado (eff 7/16*) Rel/PBE NA 4.3 (7)Hawaii Religious 3.5 (7-8) 2.5 (13)Idaho Rel/PBE 3.5 (7-8) 5.8 (2)Illinois (eff 9/17*) Religious 3.4 (9) NAMaine Rel/PBE 3.0 (11) 4.0 (8)Michigan (eff 1/15*) Rel/PBE 3.8 (4-5) 3.4 (10)North Dakota Rel/PBE 0.9 (21) 3.0 (11)Oregon (eff 3/14* & 9/15*) Rel/PBE 5.2 (3) 6.2 (1)Utah Rel/PBE 3.6 (6) 4.4 (5-6)Vermont (eff 1/13* & 7/16*) Rel/PBE 5.3 (2) 4.4 (5-6)Washington (eff 7/11*) Rel/PBE 5.7 (1) 3.6 (9)Wisconsin Rel/PBE 3.1 (10) 2.9 (12)

Percentage of Kg Children with Non-Medical Exemption to Vaccination and State Rank, U.S.,

Selected School Years

CDC. Vaccination Coverage Among Children in Kindergarten—U.S., as published in MMWR.

*Indicates the date when stronger exemption policies became effective.

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States with legislation pertaining to non-medical exemptions in 2009-14

WA

OR

NV

MT

ID

AK

UT

AZ

WY

ND

KS

NM

CO

LA

AR

IN

MI

OH

GAAL

VA

NC

SC

WV

ME

NY

PA

NHVT

HI

MO

NE

IL

WI

IA

KY

CT

MDDE

FL

DC

RI

CA

OK

TX

SD

TN

MS

NJ

MAMN

CA

WA

AZ

VT

MS

Relax /Add PBEStrengthen PBEBoth

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States that enacted bills/regulations pertaining to non-medical exemptions in 2009-14

WA

OR

NV

MT

ID

AK

UT

AZ

WY

ND

KS

NM

CO

LA

AR

IN

MI

OH

GAAL

VA

NC

SC

WV

ME

NY

PA

NHVT

HI

MO

NE

IL

WI

IA

KY

CT

MDDE

FL

DC

RI

CA

OK

TX

SD

TN

MS

NJ

MAMN

CA

WA

AZ

VT

MS

Strengthen PBE

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Washington: stmnt from HCP; risk/benefit info given (effective July 2011)

Vermont: must review evidence-based ed materials provided by SHD; annual renewal (effective Jan 2013)

California: stmnt from HCP; risk/benefit info given (effective Jan 2014)

Oregon: stmnt from HCP or certificate of completion of an on-line vaccine educational module (effective March 2014)

Michigan: must meet with a hlth educator at LHD and receive a certified waiver form (effective Jan 2015)

States that Enacted Exemption-Related Requirements 2011—2014

The outbreak . . . . . . .

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States with legislation pertaining to non-medical exemptions in 2015

WA

OR

NV

MT

ID

AK

UT

AZ

WY

ND

KS

NM

CO

LA

AR

IN

MI

OH

GAAL

VA

NC

SC

WV

ME

NY

PA

NHVT

HI

MO

NE

IL

WI

IA

KY

CT

MDDE

FL

DC

RI

CA

OK

TX

SD

TN

MS

NJ

MAMN

CA

WA

AZ

VT

MS

Relax /Add PBEStrengthen/Eliminate non-medical exemption

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States that enacted legislation pertaining to non-medical exemptions in 2015

WA

OR

NV

MT

ID

AK

UT

AZ

WY

ND

KS

NM

CO

LA

AR

IN

MI

OH

GAAL

VA

NC

SC

WV

ME

NY

PA

NHVT

HI

MO

NE

IL

WI

IA

KY

CT

MDDE

FL

DC

RI

CA

OK

TX

SD

TN

MS

NJ

MAMN

CA

WA

AZ

VT

MS

Relax /Add PBEStrengthen/Eliminate non-medical exemption

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California: Eliminated all non-medical exemptions (effective July 2016)

Colorado: For pre-Kg, exemption request due at each age when vax are due; for Kg—Gr 12, due annually; exemption data posted and on-line learning module on CDPHE website. (effective July 2016).

Connecticut: Religious exemption review process and submission due annually (effective July 2015)

States that Enacted Exemption-Related Legislation in 2015

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Illinois: Parent must state specific religious belief that conflicts with imms; stmnt must be submitted at Kg, gr 6 & 9 and include stmnt from HCP that risk/benefit info given. “General philosophical or moral reluctance not sufficient basis for exemption.” (effective 10/16/2015; full implementation SY 2016)

Vermont: School and child care imm rates must be provided to parents/guardians annually (eff 7/1/2015). Philosophical exemption eliminated (eff 7/1/2016).

States that Enacted Exemption-Related Legislation in 2015

Educational component (e.g., physician, LHD, on-line educational module)

Religious exemption strengthened (e.g., review process, specifics of conflict stated)

Renewal (e.g., annually, grade 7) Publication of exemption rates (e.g., by county,

school district, school)

Components of Recent Legislation

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States posting local-level exemption datato school immunization requirements

WA

OR

NV

MT

ID

AK

UT

AZ

WY

ND

KS

NM

CO

LA

AR

IN

MI

OH

GAAL

VA

NC

SC

WV

ME

NY

PA

NHVT

HI

MO

NE

IL

WI

IA

KY

CT

MDDE

FL

DC

RI

CA

OK

TX

SD

TN

MS

NJ

MAMNMN

CA*

October 2016

www.cdc.gov/vaccines/imz-managers/coverage/schoolvaxview/pubs-resources.html

Issues for State Legislators

Difficult communication issues Complex science that cannot prove the negative Very intense advocacy Reality of many unanswered questions about

autism and unmet needs of affected families

Lesson learned: Legislators frequently comment that they have only heard from persons supporting just one side of the issue.

What can you do? Make certain that legislators hear from

you. Schedule a “Day on the Hill.” Involve ordinary parents.

We, the undersigned, jointly affirm the value, safety, and effectiveness of vaccines in preventing serious illness and saving lives. . . . In order to advance the many success that have been achieved through immunization, we believe that public policy decisions about vaccination should be based on criteria that will:

Reduce barriers to giving safe and effective vaccines

Encourage adherence to evidence-based vaccine recommendations

Support giving the public science-based immunization information

Lesson learned: Stories that are of a strong personal and emotional nature can be more influential than scientific and statistical arguments.

What can you do? Include personal stories by arranging for

advocacy by - parents of children affected by vaccine-

preventable diseases (VPDs)- parent of children with autism- parents of vulnerable and fragile children- frontline healthcare providers

Resources to Find Parent Advocates

Every Child by Two: www.ecbt.org

Meningitis Angels: http://meningitis-angels.org

National Meningitis Association: www.nmaus.org

Parents of Kids with Infection Diseases: www.pkids.org

State/Local Immunization Coalitions:

www.immunizationcoalitions.org

Voices for Vaccine: www.voicesforvaccines.org

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Policy Statements on Non-medical Exemptions

See www.immunize.org/laws/#exempt

26See www.immunize.org/laws/#exempt

Policy Statements on Non-medical Exemptions

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H-440.970 Religious Exemptions from Immunizations: ... The American Medical Association .. encourages state medical associations to seek removal of such exemptions in statutes ... (June 2015)

With the exception of policies which allow for refusal due to a documented allergy or medical contraindication, the AAFP does not support immunization exemption policies. (September 2015)

The AAP views nonmedical exemptions to school-required immunizations as inappropriate for individual, public health, and ethical reasons and advocates for their elimination. (August 2016)

Medical Groups that Have Adopted Policies Related to Non-Medical Exemptions to

Immunizations

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The American College of Physicians supports (the idea that) “states should only grant exemptions to . . . mandated vaccines for medical reasons.” (July 2015)

The Infectious Diseases Society of America urges states to “. . . eliminate exemptions to immunization mandates based on non-medical indications, because intentionally unvaccinated individuals pose an unacceptable danger to the public” and “track exemption rates and assess the impact that exemptions may have on disease rates”

Medical Groups that Have Adopted Policies Related to Non-Medical Exemptions to

Immunizations

www.immunize.org/concerns/

See www.immunize.org/concerns

See www.immunize.org/talking-about-vaccines/religious-concerns.asp

www.immunize.org/catg.d/p4028.pdf

www.immunize.org/catg.d/p2069.pdf

www.immunize.org/catg.d/p4059.pdf

Diane Peterson, diane@immunize.org

Immunization Action Coalition◦ www.immunize.org◦ www.vaccineinformation.org

Thank you!!!

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