June 9, 2023

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SB 212: who determines which vaccines are mandatory?

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Lawmakers wrestled with who decides which vaccines are mandatory for school children during a hearing on Tuesday — KDHE Secretary Lee Norman or the legislature, as proposed in SB 212. This KDHE immunization memo lists 14 immunizations, some of which require multiple shots, in order to enroll in school or frequent a licensed daycare.  Senate Bill 212 freezes the current list and changes how future immunizations are added to it.

Proponents of the proposal say the authority to add immunization requirements belongs to the legislature and not in the hands of a single, unelected bureaucrat. Opponents worry the legislation politicizes the process.

Since 1978, the KDHE Secretary is responsible for determining which immunizations are required. Individuals can request medical and religious exemptions. KDHE Secretary Lee Norman told the Kansas Senate Public Health and Welfare Committee that he is advised by content experts on the annual list of required vaccines and the recommendations are based on advice from the Center for Disease Control’s Advisory Committee on Immunization Practices (ACIP).

“The ACIP is regarded as the premier resource for guidance on vaccine best practices,” Norman said.

Dr. Kevin Ault, the sole Kansans to sit on the CDC vaccination recommendation panel, offered neutral testimony on the proposal. Ault, who is a doctor and professor at the University of Kansas Medical Center, explained how ACIP reaches decisions on vaccine recommendations.

KDHE bases recommendations from CDC vaccine panel

The ACIP’s 15 members are selected based on expertise in vaccinology, immunology, pediatrics, internal medicine, nursing, virology, public health, infectious disease, and preventative medicine. To be placed on the committee, members must be nominated and then selected by the Secretary of the U.S. Department of Health and Human Services. They review scientific research as it relates to vaccine safety and review outbreaks of vaccine-preventable diseases. In a normal year, the committee meets three times. However, panelists met frequently during the pandemic.

For instance, during a Dec. 1, 2020 meeting, the panel crafted recommendations for phasing COVID-19 vaccinations. They say they based their recommendations on science. However, they also considered ethical principles such as maximizing benefits, reducing harm, promoting justice, and mitigating health inequities to determine vaccine phasing.

Kansas eventually adopted most of the CDC’s recommendations for vaccine phasing, including parroting the panel’s concerns for social justice.

“Through this framework, my administration upholds our commitment to maximizing benefits, minimizing harm and striving for equity, justice and fairness when it comes to when the vaccine will be made available to which Kansans,” Gov. Laura Kelly said upon rolling out the Kansas Vaccination Plan.

‘Equity, justice, and fairness’ in this case means proportionately giving vaccines based on things like race, rather than based on who is the most vulnerable.

KDHE added two more vaccines under Norman

Proponents and opponents of the legislation testified heavily on the efficacy and safety of existing vaccines and of COVID-19 vaccines. However, the proposal would not change the current list of mandatory vaccines. It would change the process for adding new ones to the mandatory vaccine schedule.

Norman told the committee that legislative input and public comment play an important role in the current vaccine recommendation process. However, people testifying yesterday in support of SB 212 said KDHE side-stepped legislative oversight when it added an immunization for meningitis to Kansas’s vaccine schedule.

In 2017, vaccine proponents asked the KDHE secretary to add the meningitis vaccine to the mandatory list. The secretary denied the request. Proponents then sought legislation to add the meningitis vaccine to the list. 

“This senate committee considered the bill and refused to pass it,” William Mize, an attorney who testified on behalf of Kansans for Health Freedom, said. “Thereafter in 2019, after the legislature adjourned for the session, the secretary added the meningitis vaccine to the list of mandatory vaccines. He also added the Hepatitis A vaccine. What changed? A new Secretary of Health.”

Opponents worry a process hampers public health efforts

Rep. John Eplee, an Atchison doctor, said all 50 states allow their health departments or a commission to determine mandatory vaccines.

“Kansas would be the first to go against the grain on that,” Eplee said. 

He said the Secretary of KDHE is fully capable of making the right recommendations for public health and safety.

However, Sen. Mark Steffen, a Hutchinson doctor, disagreed.

“The stark reality is that our current Secretary of Health and Environment has conducted himself in a manner that has lost the trust of the people of Kansas,” Steffen supplied in written testimony.

Examples of Steffen’s concern can be found here, here, here, and here.  Even the Wall Street Journal said Norman ‘fudged the data.’

Under the bill, adding an immunization to the list would require going through the legislative process rather than an administrative one. New additions would be placed into legislation, adopted by both legislative chambers, and signed by the Governor. The KDHE Secretary and medical professionals would weigh in on potential vaccination additions through testimony in legislative committee hearings.

SB 212 opponents have timing concerns

Norman said that vaccine decisions must be made annually by February so kids are vaccinated by August when school starts. However, school officials typically offer a grace period for unvaccinated students, allowing them to attend school for several months as their immunizations are updated.

Senate Bill 212 would place into state statute the mandatory list of vaccines, potentially slowing the process according to opponents. Dr. Dena Hubbard, the legislative coordinator for the Kansas Chapter of the American Academy of Pediatrics, said timely response to medical advances is critical to managing vaccine requirements.

“Should vaccine recommendations change, including change in dosing or schedule, (the) addition of new vaccine against pandemic infections disease, etc., it is essential to our state to be able to adapt and respond to these issues in a timely and effective manner,” Hubbard said. “The public health experts at KDHE should maintain the ability to determine and address critical public health-related issues without political undermining.”

The timing concern would likely be negligible, however, given that most vaccines take years to get approval and there is considerable advance notice of pending approvals.

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