State Legislative Conference 2016

1. 1

2.  Status of exemptions to state-mandated vaccinations
 Overview of legislative efforts
 Lessons learned in advocating on policy issues
 Available resources

3. Exemptions Permitted to School and Childcare
Immunization Requirements
October 2016
WA
OR
NV
MT
ID
AK
UT
AZ1
WY
ND
KS
NM
CO
LA
AR
IN
MI
OH
GAAL
VA3
NC
SC
WV
ME
NY
PA
NH
VT
HI
MO2
NE
IL
WI
IA
KY
CT
MD
DE
FL
DC
RI
CA
OK
TX
SD
TN
MS
NJ
MA
MN
Medical, Religious, Personal Belief
Medical, Religious
Type of Exemptions Permitted
Medical Only
1 Arizona: Personal belief exemption permitted for school only
2 Missouri: Personal belief exemption permitted for childcare only
3 Virginia: Personal belief exemption permitted for HPV only
Medical, Personal Belief

4. State Non-Med 2009-10 2015-16
Alaska Religious 3.8 (4-5) 4.7 (3)
Arizona Rel/PBE 2.8 (12) 4.5 (4)
Colorado (eff 7/16*) Rel/PBE NA 4.3 (7)
Hawaii Religious 3.5 (7-8) 2.5 (13)
Idaho Rel/PBE 3.5 (7-8) 5.8 (2)
Illinois (eff 9/17*) Religious 3.4 (9) NA
Maine Rel/PBE 3.0 (11) 4.0 (8)
Michigan (eff 1/15*) Rel/PBE 3.8 (4-5) 3.4 (10)
North Dakota Rel/PBE 0.9 (21) 3.0 (11)
Oregon (eff 3/14* & 9/15*) Rel/PBE 5.2 (3) 6.2 (1)
Utah Rel/PBE 3.6 (6) 4.4 (5-6)
Vermont (eff 1/13* & 7/16*) Rel/PBE 5.3 (2) 4.4 (5-6)
Washington (eff 7/11*) Rel/PBE 5.7 (1) 3.6 (9)
Wisconsin Rel/PBE 3.1 (10) 2.9 (12)
CDC. Vaccination Coverage Among Children in Kindergarten—U.S.,
as published in MMWR.
*Indicates the date when stronger exemption policies became effective.

5. States with legislation pertaining to
non-medical exemptions in 2009-14
WA
OR
NV
MT
ID
AK
UT
AZ
WY
ND
KS
NM
CO
LA
AR
IN
MI
OH
GAAL
VA
NC
SC
WV
ME
NY
PA
NH
VT
HI
MO
NE
IL
WI
IA
KY
CT
MD
DE
FL
DC
RI
CA
OK
TX
SD
TN
MS
NJ
MA
MN
CA
WA
AZ
VT
MS
5
Relax /Add PBE
Strengthen PBE
Both

6. States that enacted bills/regulations pertaining
to non-medical exemptions in 2009-14
WA
OR
NV
MT
ID
AK
UT
AZ
WY
ND
KS
NM
CO
LA
AR
IN
MI
OH
GAAL
VA
NC
SC
WV
ME
NY
PA
NH
VT
HI
MO
NE
IL
WI
IA
KY
CT
MD
DE
FL
DC
RI
CA
OK
TX
SD
TN
MS
NJ
MA
MN
CA
WA
AZ
VT
MS
6
Strengthen PBE

7.  Washington: stmnt from HCP; risk/benefit info given
(effective July 2011)
 Vermont: must review evidence-based ed materials provided
by SHD; annual renewal (effective Jan 2013)
 California: stmnt from HCP; risk/benefit info given
(effective Jan 2014)
 Oregon: stmnt from HCP or certificate of completion of an
on-line vaccine educational module (effective March 2014)
 Michigan: must meet with a hlth educator at LHD and
receive a certified waiver form (effective Jan 2015)
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8. The outbreak . . . . . . .

9. States with legislation pertaining to
non-medical exemptions in 2015
WA
OR
NV
MT
ID
AK
UT
AZ
WY
ND
KS
NM
CO
LA
AR
IN
MI
OH
GAAL
VA
NC
SC
WV
ME
NY
PA
NH
VT
HI
MO
NE
IL
WI
IA
KY
CT
MD
DE
FL
DC
RI
CA
OK
TX
SD
TN
MS
NJ
MA
MN
CA
WA
AZ
VT
MS
9
Relax /Add PBE
Strengthen/Eliminate non-medical exemption

10. States that enacted legislation pertaining
to non-medical exemptions in 2015
WA
OR
NV
MT
ID
AK
UT
AZ
WY
ND
KS
NM
CO
LA
AR
IN
MI
OH
GAAL
VA
NC
SC
WV
ME
NY
PA
NH
VT
HI
MO
NE
IL
WI
IA
KY
CT
MD
DE
FL
DC
RI
CA
OK
TX
SD
TN
MS
NJ
MA
MN
CA
WA
AZ
VT
MS
10
Relax /Add PBE
Strengthen/Eliminate non-medical exemption

11.  California: Eliminated all non-medical exemptions (effective
July 2016)
 Colorado: For pre-Kg, exemption request due at each age
when vax are due; for Kg—Gr 12, due annually; exemption data
posted and on-line learning module on CDPHE website. (effective
July 2016).
 Connecticut: Religious exemption review process and
submission due annually (effective July 2015)
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12.  Illinois: Parent must state specific religious belief that
conflicts with imms; stmnt must be submitted at Kg, gr 6 & 9
and include stmnt from HCP that risk/benefit info given.
“General philosophical or moral reluctance not sufficient basis
for exemption.” (effective 10/16/2015; full implementation
SY 2016)
 Vermont: School and child care imm rates must be provided to
parents/guardians annually (eff 7/1/2015). Philosophical
exemption eliminated (eff 7/1/2016).
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13.  Educational component (e.g., physician, LHD, on-line
educational module)
 Religious exemption strengthened (e.g., review
process, specifics of conflict stated)
 Renewal (e.g., annually, grade 7)
 Publication of exemption rates (e.g., by county, school
district, school)

15. States posting local-level exemption data
to school immunization requirements
WA
OR
NV
MT
ID
AK
UT
AZ
WY
ND
KS
NM
CO
LA
AR
IN
MI
OH
GAAL
VA
NC
SC
WV
ME
NY
PA
NH
VT
HI
MO
NE
IL
WI
IA
KY
CT
MD
DE
FL
DC
RI
CA
OK
TX
SD
TN
MS
NJ
MA
MNMN
CA*
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October 2016
www.cdc.gov/vaccines/imz-managers/coverage/schoolvaxview/pubs-resources.html

19.  Difficult communication issues
 Complex science that cannot prove the negative
 Very intense advocacy
 Reality of many unanswered questions about autism
and unmet needs of affected families

20. Lesson learned: Legislators frequently
comment that they have only heard from
persons supporting just one side of the issue.
What can you do?
 Make certain that legislators hear from you.
 Schedule a “Day on the Hill.”
 Involve ordinary parents.

23. Lesson learned: Stories that are of a strong personal
and emotional nature can be more influential than
scientific and statistical arguments.
What can you do?
 Include personal stories by arranging for advocacy by
- parents of children affected by vaccine-
preventable diseases (VPDs)
- parent of children with autism
- parents of vulnerable and fragile children
- frontline healthcare providers

24. Resources to Find Parent Advocates
Every Child by Two: www.ecbt.org
Meningitis Angels: http://meningitis-angels.org
National Meningitis Association: www.nmaus.org
Parents of Kids with Infection Diseases: www.pkids.org
State/Local Immunization Coalitions: www.immunizationcoalitions.org
Voices for Vaccine: www.voicesforvaccines.org

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Policy Statements on Non-medical Exemptions
See www.immunize.org/laws/#exempt

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See www.immunize.org/laws/#exempt
Policy Statements on Non-medical Exemptions

27.  H-440.970 Religious Exemptions from Immunizations: ... The
American Medical Association .. encourages state medical
associations to seek removal of such exemptions in statutes ...
(June 2015)
 With the exception of policies which allow for refusal due to a
documented allergy or medical contraindication, the AAFP does
not support immunization exemption policies. (September 2015)
 The AAP views nonmedical exemptions to school-required
immunizations as inappropriate for individual, public health, and
ethical reasons and advocates for their elimination. (August
2016)
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28.  The American College of Physicians supports (the idea that)
“states should only grant exemptions to . . . mandated vaccines
for medical reasons.” (July 2015)
 The Infectious Diseases Society of America urges states to “. . .
eliminate exemptions to immunization mandates based on non-
medical indications, because intentionally unvaccinated
individuals pose an unacceptable danger to the public” and “track
exemption rates and assess the impact that exemptions may
have on disease rates”
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29. www.immunize.org/concerns/
See www.immunize.org/concerns

30. See www.immunize.org/talking-about-vaccines/religious-concerns.asp

31. www.immunize.org/catg.d/p4028.pdf
www.immunize.org/catg.d/p2069.pdf

32. www.immunize.org/catg.d/p4059.pdf

33.  Diane Peterson, diane@immunize.org
 Immunization Action Coalition
◦ www.immunize.org
◦ www.vaccineinformation.org
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