Vaccine legislation in the USA – a state by state analysis

One of the most successful pieces of vaccine legislation in recent years has been SB277 in California, which eliminated personal belief exemptions (PBE), that allowed a parent to exclude a child from immunization requirements for school based on the parent’s personal beliefs, including religious objections.  These PBEs had been used and abused by anti-vaccine parents to exempt their school-aged children from most, if not all, vaccines.

Other than California, only West Virginia and Mississippi have such strict prohibitions on these PBEs that they are effectively not allowed as a method to refuse vaccines before a child enters school. But many other states are considering vaccine legislation that could improve vaccine uptake. Unfortunately, there are also states on the other side of the equation that are considering laws that reduce restrictions on personal belief exemptions.

The National Vaccine Information Center (NVIC), which seems to conflate “information” with misinformation about vaccines, claims that there are 134 vaccine bills being considered in 35 states. I wish!

I thought we would could take a look at current vaccine legislation being considered by various states that could potentially increase vaccine uptake in those states. Then we’ll take a look at those states pushing legislation that might decrease vaccine uptake. This should provide real information about what’s going on with these laws, instead of the alternative facts from the vaccine deniers at NVIC.

Vaccine legislation signed into law

Utah –  HB308 was signed into law by the Utah Governor on 24 March 2017. The law would require that the parent or guardian of a student requesting a non-medical exemption to either complete an online educational module or receive in-person consultaton from a local health department official. The Utah Department of Health is charged with developing the educational module and the exemption form.

Although this law does not eliminate personal belief exemptions, it does make those non-medical exemptions a bit more complicated to get. Many people request PBEs when they forget to have their children vaccinated, or other circumstances that don’t necessarily indicate true anti-vaccine attitudes of parents. Maybe further education about the incredible benefits of vaccines will convince many vaccine hesitant parents to forgo PBEs. In any case, this should increase the vaccine uptake in the state of Utah.

 

Pro-vaccine legislation under active consideration

ArizonaSB1509 would require public schools to post immunization rates on the school’s website.

Although it does not remove exemptions, it might help parents make decisions about where to send their kids for education, especially if the parents prefer schools with higher vaccination rates.

Connecticut – There are three different pro-vaccine bills under consideration in the state legislature. SB840 would require posting of immunization rates at every public and private school in the state. HB7059 would require the parents or guardian of a child claiming a religious exemption from immunization to affirm that such parents or guardian participated in an immunization education program administered by the Department of Public Health. Finally, HB6971 would require a science-based educational session regarding the efficacy and safety of vaccines for those seeking an exemption from immunization requirements for religious reasons.

These three laws would go a long ways toward reducing the exemption rate for vaccines in Connecticut.

New JerseyS801  requires the parent/guardian seeking a religious exemption to include a written explanation of “how the administration of the vaccine conflicts with the bona fide religious tenets or practices of the student.” It also states that a general philosophical or moral objection is not sufficient.

Since very few mainstream religions actually oppose vaccinations (and most highly encourage vaccinations of children), this could be a method to reduce the abuse of so-called “religious exemptions” to vaccines.

New York – The state has five different pro-vaccine bills under consideration, some of them would be quite powerful in reducing personal belief exemptions. S52 repeals those provisions in the health care code relating to exemption from vaccination due to religious beliefs. S163 allows the protections of the medical exemption from mandatory immunizations for students to include professional assessments of physicians, nurse practitioners and physician assistants in the care of their individual patients. S601 establishes a protocol with specific criteria regarding religious exemptions to immunizations in schools prior to an individual being able to submit a request for a religious exemption to immunization form. S2955 requires school districts to report to the department of education data regarding exemptions to vaccinations. S3546 would require parents seeking a religious exemption for their child to file an affidavit from a physician that the parent or guardian has received information about the risks to the unvaccinated child and other individuals.

Each of these laws would go a long way to reducing PBEs in the state of New York. S52 would be particularly interesting to increasing vaccination uptake, since there seems to be a significant effort by some New York residents to abuse religious exemptions to vaccines. Several cases have been adjudicated in courts regarding New York and religious exemptions (see New York section).

Oklahoma – SB725 would require schools to report immunization and exemption data to the state Department of Health.

PennsylvaniaSB217 would eliminate exemptions for strong moral and ethical convictions. This law would eliminate some aspects of personal belief exemptions, although it seems to still allow religious exemptions.

Texas – Texas has five pieces of vaccine legislation at various stages of consideration in the Texas legislature. HB241 would require a healthcare practioner to provide counseling before conscientious or religious exemption to vaccines can be granted. HB120 would remove conscientious and religious belief exemption and replace it with “non-medical” exemption. HB126 would require recipients of conscientious and religious exemptions to complete an educational module relating to vaccines. HB1124 mandates the development of blank affidavit of exemption form by the state Department of Health Services, which would state that the person understands the risks and benefits of their child not being vaccinated. SB1010 would require each school to report immunization and exemption data to the stated Department of Health Services. Furthermore, the department would be required to post the data in electronic form and on the department’s website.

Each of these bills would help increase immunization uptake in Texas. Some of them, like HB241, would probably make a big difference in vaccination rates.

Although this is not a massive number of states looking at improving vaccination uptake, there are several large states, like New York, Pennsylvania and Texas. And there seems to be a lot of bipartisan activity in these legislatures with both Republicans and Democrats sponsoring critical vaccine legislation in their respective states.

 

Anti-vaccine legislation under active consideration

Colorado – SB250 would allow for parents to submit a letter expressing their opposition to immunization requirement. Furthermore, it states that these parents will not be required to submit a specific form. This law would make it easier for parents to utilize personal belief exemptions to vaccination of their children.

HawaiiSB779 allows parents to use philosophical exemptions to immunization requirements for their children

MichiganHB4425 and HB4426 prohibits promulgation of rules that are more stringent than the vaccine exemptions currently in statute.

Missouri – Two bills are under consideration in the state. HB332 blocks the use of varicella (chickenpox) and zoster (shingles) vaccines containing “foreign human DNA contaminates” to patients in public health clinics.

Several vaccines, including the two blocked by this law, utilize human cells in the production of the vaccine, so there is a possibility that “human DNA” could be found in some vaccines. However, there are two major issues:

  1. The amount of human DNA in a vaccine dose is vanishingly small, measured in trillionths of a gram, almost unmeasurable with modern diagnostic equipment. And much of that is destroyed by the manufacturing process.
  2. There is almost a 0% chance of any of this DNA in the vaccine to be incorporated into any cells of the recipient – if it were so easy, we’d turn into corn after eating an ear of corn. This isn’t how gene transfer works.

New Jersey – Two anti-vaccine bills are under consideration in the state (along with one pro-vaccine bill mentioned above). A169 permits exemption from mandatory immunization for students in writing for any reason. A2727 provides for conscientious exemption to mandatory immunizations.

Oklahoma – In addition to the pro-vaccine legislation introduced in the state mentioned above, HB1386 states that the parent or guardian must give informed consent prior to vaccinating a child which should include receipt of the Vaccine Information Statement for each vaccine given, information on the National Vaccine Child Injury Act (which established the National Vaccine Injury Compensation Program or Vaccine Court), and other information.

Oregon – There are three bills that have been introduced into this years legislative session. SB579 requires health care practitioner, before administering vaccination to child, to obtain informed consent from parent of child or, if child is emancipated or has reached age of majority, from child. The bill has the same requirements for information as Oklahoma’s HB1386 mentioned above prior to gaining informed consent. SB580 would require health care practitioners, before administering vaccination to child, to provide written notice of each vaccination that child is required to receive as condition of attending school or children’s facility in this state. It would also inform the parent of each exemption to that requirement. SB869 has nearly the same requirements as SB579, and appears to be further along in the legislative process.

Rhode Island – There are two anti-vaccine bills introduced this year. SB47 makes changes to department of health’s authority to mandate certain vaccinations, reinstates philosophical exemption to vaccinations, and requires public hearings when changes to required vaccinations are proposed. H5681 provides an exception to required school immunizations for pupils whose personal beliefs are contrary to immunization and/or testing – in other words, this would open up exemptions to include personal belief.

Texas – Despite five bills in the Texas legislature that could be consider pro-vaccine, there are two bills that are definitely anti-vaccine. HB1029 and SB479 are similar bills that would require informed consent to immunizations for children, with similar information requirements as seen in Oregon’s SB579 and Oklahoma’s HB1386.

Informed consent is not necessarily anti-vaccine, all patients (and parents) should be aware of all of the benefits and risks of medical procedures. Although the information that is required by these “informed consent” bills is freely available, and by itself, are not necessarily anti-vaccine. However, they have been used by anti-vaccine activists as methods to scare parents away from vaccines. The Vaccine Information Statement, for example, shows risk that can appear to show that vaccines are dangerous, even though the statement makes clear that these events are extremely rare. In fact, anti-vaccine groups tend to only focus on the potential adverse events rather than the overall benefit described. Furthermore, the adverse events listed in these statements are often not causal.

 

Vaccine legislation that died in session

In addition to the vaccine legislation discussed above (both pro and anti), vaccine related bills in Arkansas, Idaho, Iowa, Minnesota, Mississippi, Virginia and West Virginia failed to be passed before the end of the legislative session for their respective states. Interestingly, Mississippi considered a bill, which died in Committee, which would have instituted religious and personal belief exemptions to vaccines – if this bill would have passed, Mississippi would have lost its place as one of the strictest states with the highest vaccination rates in the country.

 

Summary

As you can see, there’s nowhere near the 134 bills being considered that the NVIC claims. But they’re not exactly known for their veracity in discussing vaccines.

There are a lot of bills that will improve vaccine uptake, and a lot of bills that could make more parents reject vaccines to protect their children from terrible diseases. Although we are focused on national issues, including Donald Trump’s own words about vaccines, which he appears to dislike intensely, we need to also focus on the state level activities regarding vaccines. Almost all vaccine requirements and rules are established by state laws and regulations, not by Federal Agencies such as the CDC (which produces the vaccine schedules for children and adults, but has not legal power to enforce it across the USA).

Vaccines are extremely safe, extremely effective. Let’s hope that more states follow California’s lead and remove personal belief exemptions that will result in higher vaccination rates.

 

Editor’s note – thanks to Dorit Rubinstein Reiss with valuable assistance in completing this article.  

The Original Skeptical Raptor
Chief Executive Officer at SkepticalRaptor
Lifetime lover of science, especially biomedical research. Spent years in academics, business development, research, and traveling the world shilling for Big Pharma. I love sports, mostly college basketball and football, hockey, and baseball. I enjoy great food and intelligent conversation. And a delicious morning coffee!