School Vaccination Requirements Claire Hannan, MPH Executive Director, AIM National Immunization Conference March 8, 2007

School Vaccination Requirements Background AIM Position Statement (www.immunizationmanagers.org) Status of HPV school requirements HPV school requirement implications

Background School immunization requirements (“school laws”) are critically important to assure protection of children from vaccine preventable diseases. Strong evidence for their effectiveness exists. School immunization requirements are established at the state level either through legislation or regulation.

AIM POSITION STATEMENT School and Child Care Immunization Requirements Allow adequate implementation period Consider risks and benefits Utilize existing state processes Coordinate “exemptions” with existing state policy

Allow adequate implementation period Coverage for the vaccine in private health insurance plans Sufficient funding to purchase the vaccine for underinsured Physician/provider support for the vaccine Public acceptance of the vaccine

Allow adequate implementation period Stable and adequate vaccine supply Addition of vaccine to immunization information systems (registries) Adequate data to assure vaccine safety Significant uptake in the recommended population to reduce the compliance burden on the school/child care system

Consider risks and benefits Vaccine mandates must be evaluated carefully, including their epidemiologic, economic, and ethical concerns.[1] Inappropriate application of mandates risks loss of support for immunization programs and reversal of policy and program gains. [1] Feudtner C, Marcuse EK. Ethics and Immunization Policy: Promoting dialogue to sustain consensus. Pediatrics 2001;107:1158-1164.

Utilize existing state processes 39 states have rulemaking process 11 states require legislative approval Most states have immunization advisory committee Process allows for data review and public input

Coordinate “exemptions” with existing state policy 48 allow religious exemptions from childhood immunization requirements, and all states allow medical exemptions. Only a minority of states allow philosophic or personal exemptions. Opening existing law or regulations for this purpose risks having an effective mandate weakened, altered in an undesirable way, or even revoked entirely.

Status of HPV school entry requirements HPV mandate legislation proposed in 22 states Under discussion in another 10 states Pursued via rules change in another 4 states Passed legislature in 1 state (VA) Executive Order in 1 state (TX)

HPV School Requirement Implications Implementation date Funding Exemptions

Mandate implications: Implementation Date Complete series requires 3 doses 3 visits to provider In Maryland: 7,000 provider visits a month to give 3 doses in 15 month time period

Mandate implications: Funding 17 states required to make vaccine available if school mandate passes Enormous funding implications

Mandate implications: Exemptions 16 mandate proposals allow exemptions What message does this send to parents? Will these opt-outs be permanently lost?

Universal Goal: protect ALL young girls from cervical cancer!

Acknowledgements Leah Sirkus, ASTHO Missouri Immunization Program Greg Reed, Maryland Immunization Program AIM HPV Implementation Survey, February 2007, N=51