States Maintain and Increase Vaccine Coverage Through Legislative Action

November 07, 2019|11:35 a.m.| ASTHO Staff

Increasing and maintaining vaccine coverage is an important way to prevent the spread of disease and keep communities healthy. Vaccines have greatly reduced or eliminated many infectious diseases that once killed or harmed infants, children, and adults. Not only can vaccines prevent certain diseases in vaccinated individuals, they can also lower the chance of spreading disease to vulnerable populations such as infants, older adults, and people with weakened immune systems who are especially vulnerable to infectious diseases and may not be able to be vaccinated. Each year, thousands of adults in the U.S. become seriously ill and are hospitalized because of diseases that vaccines help prevent.

Health departments monitor vaccine coverage to understand how well communities are protected from vaccine-preventable diseases and identify areas and groups with lower vaccination coverage for targeted public health interventions. States can also increase vaccine coverage through policy interventions. Due to the extremely high number of measles outbreaks in 2019, states paid significant attention to legislation limiting vaccine exemptions. In addition to limiting exemptions, states can increase vaccine coverage rates by targeting adult vaccination requirements, expanding the number and types of individuals who can administer vaccines, and establishing or improving immunization reporting systems. Below is an overview of 2019 state vaccine legislative activities.

Adult Vaccination
The Oregon governor enacted a bill requiring the department of corrections to offer immunizations against the influenza virus to each inmate in physical custody. The bill also requires the department to schedule appointments for each inmate to receive immunizations if he or she does not decline in writing.

In Rhode Island, the governor signed companion bills (SB 676 and HB 5541) that require the department of health to include routine adult immunization in its immunization program and expand the provisions requiring reporting immunization status and other relevant information by entities mandated to report such information to adults as well as children.

Vaccine Administration
Some individuals may not be reliably linked to healthcare providers and may therefore not receive timely and consistent preventive services, such as immunizations. Legislation that authorizes alternative providers within the immunization neighborhood (e.g., pharmacies, schools, workplace, and other clinical sites) can expand the venues where vaccines are available and thereby increase access to vaccinations.

The Indiana General Assembly passed a bill allowing the state health commissioner (or designated public health authority who is a licensed prescriber) to issue a standing order, prescription, or protocol that allows an individual who is licensed, certified, or registered by a board to administer or dispense an immunization recommended by CDC’s Advisory Committee on Immunization Practices for individuals eleven years or older, if this is within the individual’s scope of practice.

Several states authorized pharmacists and dentists to administer vaccines. Arkansas amended the definition of “practice of pharmacy” to allow vaccine administration to people ages 7 to 18 under a written protocol. A new Montana law allows immunization-certified pharmacists to prescribe the following immunizations: influenza to individuals 12 years of age or older; pneumococcal and tetanus, diphtheria, and pertussis to individuals who are 18 years of age or older; and herpes zoster to individuals identified in CDC’s guidelines. Under this law, the certified pharmacists may also administer immunizations to individuals 7 or older, as provided by CDC’s most recent guidelines by vaccine and age group.

A New Jersey bill authorizes pharmacy interns to administer immunizations if they are under direct supervision of a licensed pharmacist pre-approved by the state board of pharmacy. Per the bill, immunizations administered by a pharmacist or pharmacist intern shall be reported to the state immunization information system.

A new North Carolina law allows immunizing pharmacists to administer the influenza vaccine to people 10 or older (decreased from age 14) or people 6 or older pursuant to a prescription following a physical examination. The bill also allows immunizing pharmacists to administer CDC-recommended vaccines to people 18 and older. Oregon’s governor signed a bill authorizing dentists to prescribe and administer vaccines to any established patient.

Vaccination and Exemption Reporting
Developing, effectively using, and improving immunization information systems can strengthen vaccine management, accountability, quality assurance and delivery, consumer information, surveillance, adverse events tracking, and assessment. In addition, these systems can help identify the people and communities most at risk in the event of disease outbreaks or public health emergencies.

Maryland’s governor signed into law a bill requiring healthcare providers who administer vaccines to report all administered vaccines to ImmuNet, the state’s immunization registry. (This requirement does not apply to healthcare providers who administer vaccines in a nursing facility, an assisted living program, a continuing care retirement community, or a medical day care program.) The Arkansas State Legislature passed legislation requiring public and private schools to create and maintain the number and percentage of students granted exemptions from the requirement to obtain vaccinations by the department of health.

The governor of Texas signed two bills related to immunization reporting for emergency medical personnel and first responders. HB 1418 requires the health and human services commission to tell emergency medical services personnel applying for certification or recertification if their immunization history is included in the immunization registry. If their information is not included, the commission must provide information about the risks of exposure to and infection by a potentially serious but vaccine-preventable communicable disease when responding to an emergency. HB 1256 requires the department of health to provide employers of first responders with direct access to employees’ immunization information in the registry for verification. The first responder must provide electronic or written consent and may withdraw consent at any time.

Immunization is one of the most cost-effective means of public health promotion and disease prevention. Increasing coverage rates in adults, monitoring vaccine coverage levels, and increasing access to vaccines by expanding the institutions and providers authorized to administer them requires cross-sector partnerships, resources, surveillance, and enforcement. State and territorial health agencies are well positioned to utilize their expertise, staff, funding, and partnerships to educate stakeholders and pursue appropriate policies and legislation that will increase or maintain vaccine coverage rates. ASTHO will continue to monitor legislative activity and trends on this important public health issue.