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

2. School Vaccination Requirements
Background
AIM Position Statement (
Status of HPV school requirements
HPV school requirement implications

3. 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.

4. 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

5. 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

6. 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

7. 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:

8. 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

9. 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.

10. 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)

12. HPV School Requirement Implications
Implementation date
Funding
Exemptions

13. 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

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

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

16. Universal Goal: protect ALL young girls from cervical cancer!

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