1. State Thimerosal Legislation: Status Update and Program Impact
Ian Van Dinther
State Government Affairs Analyst
American Academy of Pediatrics

2. Overview
Since 2004, six states have enacted legislation restricting the use of thimerosal-containing vaccines.

3. California Iowa Delaware Illinois Missouri New York
States
California
Iowa
Delaware
Illinois
Missouri
New York

4. Overview
This legislation may impede the ability of states to implement immunization programs in accordance with current recommendations.

5. Key Provisions of Enacted Laws Iowa (2004)
Children under eight
Permits vaccines containing “trace amounts as defined by the US FDA”
Exempts flu vaccine and instances of public health emergency
Effective 1/1/2006

6. Key Provisions of Enacted Laws California (2004):
Children under 3 / pregnant women; effective 7/1/2006
0.5µg per 0.5ml dose / 1 µg per .5ml
Exemption in event of actual or potential public health emergency or shortage (if Sec. State dept. HHS so finds, and Gov. concurs)

7. Key Provisions of Enacted Laws Delaware (2005):
Children under 8 / pregnant women; effective 1/1/2006
Exempts influenza vaccines, and vaccines containing “trace amounts as defined by the US FDA” until 1/1/2007

8. Key Provisions of Enacted Laws Delaware (2005 - continued):
Exempts only vaccines containing “trace amounts as defined by the US FDA” until 1/1/2008
Exempts only declared states of emergency and epidemics beyond 1/1/2008

9. Key Provisions of Enacted Laws Illinois (2005):
No age specification
1.25µg per dose, effective 1/1/2006
Prohibits vaccines containing trace thimerosal after 1/1/2008
Dept. Health may waive requirement in event of actual or potential emergency, epidemic or shortage

10. Key Provisions of Enacted Laws Missouri (2005):
Children under 3 / pregnant women; effective 4/1/2007
1µg per 0.5ml dose
Dir. Dept. Health may waive (if Gov. concurs) requirement in event of epidemic, emergency or shortage

11. Key Provisions of Enacted Laws New York (2005):
Children under 3 / pregnant women µg per 0.5ml dose (all vaccines except flu)
Children under 3: µg per .25ml dose - flu vaccine
Pregnant women: µg per 0.50 milliliter dose – flu vaccine

12. Key Provisions of Enacted Laws New York (2005 - continued):
Limits on flu vaccine for pregnant women do not apply until and unless the Commissioner of Health makes a yearly determination that there is an adequate supply of flu vaccine

13. Key Provisions of Enacted Laws New York (2005 - continued):
Commissioner may authorize waiver of all requirements listed above in the event of an outbreak of disease, and/or vaccines are not available for distribution, in which case vaccination is permitted with informed consent
Effective 1/1/2008

14. 2006 legislative activity in:MI NE NC OH NJ NM TN VA VT WA CO FL HI
IA (expands current law) IN KS MD MA ME

16. Implications for State Immunization Programs
When implemented, restricts use of most available supplies of flu vaccine
Prohibits use of some current formulations of childhood combination vaccines in states restricting trace thimerosal
Limits access to vaccine for Japanese Encephalitis

17. How did this happen?
Childhood influenza recommendation added to schedule
Increased media/public attention to vaccine safety issues/controversies
Thimerosal replaced exemptions as the legislative vehicle for vaccine hesitant pressure groups

18. A Note on the 1999 AAP/PHS Recommendation
Often misinterpreted and misquoted by supporters of thimerosal ban legislation
Statement recommendations addressed children under 6 months; the now - recommended flu vaccine is approved for children older than months

19. A Note on the 1999 AAP/PHS Recommendation (continued)
Statement explicitly states that vaccine availability should not be interrupted because of shortage of preservative- free vaccine
When examined more carefully, the statement does not support – but rejects – the terms of the legislation

20. Options for States
Continue to reassure the public about the value and safety of immunizations
Exercise exemption language in law
Scrutinize terms during implementation
Repeal – a daunting task

21. Progress Being Made in State Legislatures
None of the 2006 bills have yet been enacted
Some state lawmakers now have seen these bills 2 or 3 sessions in a row
We may be turning a corner on thimerosal legislation at the state level

23. For More Information: Tomorrow –
Tools and Strategies for Working with State Legislatures International Ballroom F Tuesday, March 7, 2006: 2:00 PM-3:00 PM Ian Van Dinther , ext. 7092