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**http://www.immunize.org/laws/exemptions.asp (exemptions)
**http://www.immunize.org/laws/exemptions.asp (exemptions)


*[<!-- unlinked to help with abuse monitoring><nowiki>http://www.nvic.org/Vaccine-Laws/state-vaccine-requirements.aspx</nowiki> State Law & Vaccine Requirements] (links to a state page including statutes and exemptions)
*[http://www.nvic.org/Vaccine-Laws/state-vaccine-requirements.aspx State Law & Vaccine Requirements] (links to a state page including statutes and exemptions)
**[<!-- unlinked to help with abuse monitoring><nowiki>http://www.nvic.org/Vaccine-Laws/state-vaccine-requirements/alabama.aspx</nowiki> NVIC Alabama State Vaccine Requirements]
**[http://www.nvic.org/Vaccine-Laws/state-vaccine-requirements/alabama.aspx NVIC Alabama State Vaccine Requirements]


*[https://www.cdc.gov/vaccines/imz-managers/laws/state-reqs.html CDC - State Vaccination Requirements] (links to various databases, including [https://www2a.cdc.gov/vaccines/statevaccsApp/default.asp self-generating lists for healthcare workers and patients], and the above immunize.org charts
*[https://www.cdc.gov/vaccines/imz-managers/laws/state-reqs.html CDC - State Vaccination Requirements] (links to various databases, including [https://www2a.cdc.gov/vaccines/statevaccsApp/default.asp self-generating lists for healthcare workers and patients], and the above immunize.org charts
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*[http://vaccines.procon.org/view.resource.php?resourceID=003597 Procon - State Vaccination Exemptions for Children Entering Public Schools]
*[http://vaccines.procon.org/view.resource.php?resourceID=003597 Procon - State Vaccination Exemptions for Children Entering Public Schools]


<!-- unlinked to help with abuse monitoring><nowiki>http://www.nvic.org/vaccine-laws.aspx</nowiki>
http://www.nvic.org/vaccine-laws.aspx


[http://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx STATES WITH RELIGIOUS AND PHILOSOPHICAL EXEMPTIONS FROM SCHOOL IMMUNIZATION REQUIREMENTS], NCSL, 8/23/2016
[http://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx STATES WITH RELIGIOUS AND PHILOSOPHICAL EXEMPTIONS FROM SCHOOL IMMUNIZATION REQUIREMENTS], NCSL, 8/23/2016

Revision as of 05:15, 5 December 2017

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Vaccine mandates and promotion

History of Vaccines: Vaccination Exemptions

Healthcare.gov: Preventive health services (incl. vaccination)

http://www.nvic.org/vaccine-laws.aspx

STATES WITH RELIGIOUS AND PHILOSOPHICAL EXEMPTIONS FROM SCHOOL IMMUNIZATION REQUIREMENTS, NCSL, 8/23/2016

Research: Anti-vax rumors in Afghanistan, Pakistan

Liability for viral outbreak on common carriers.


As readers of the HR Defense blog know, the EEOC filed suit last year on behalf of six former employees of a hospital who were fired after refusing the flu vaccine on religious grounds. The employer allowed for an exemption, but required employees to obtain a certification by a clergy member or other third party that the employee “practices a religion where influenza vaccination is contraindicated according to doctrine or accepted religious practices.”

Requiring A Flu Shot Over Religious Objections: Risky Business, Laurie M. Weinstein on October 24, 2016

13. May an employer covered by the ADA and Title VII of the Civil Rights Act of 1964 compel all of its employees to take the influenza vaccine regardless of their medical conditions or their religious beliefs during a pandemic?

No. An employee may be entitled to an exemption from a mandatory vaccination requirement based on an ADA disability that prevents him from taking the influenza vaccine. This would be a reasonable accommodation barring undue hardship (significant difficulty or expense). Similarly, under Title VII of the Civil Rights Act of 1964, once an employer receives notice that an employee's sincerely held religious belief, practice, or observance prevents him from taking the influenza vaccine, the employer must provide a reasonable accommodation unless it would pose an undue hardship as defined by Title VII ("more than de minimis cost" to the operation of the employer's business, which is a lower standard than under the ADA).

Generally, ADA-covered employers should consider simply encouraging employees to get the influenza vaccine rather than requiring them to take it.

EEOC, EEOC Sues Baystate Medical Center for Religious Discrimination & Retaliation, 6-2-16

EEOC, Saint Vincent Health Center To Pay $300,000 To Settle EEOC Religious Accommodation Lawsuit, 12-23-16

Workplace

In 1827, Boston enacted the first mandate. Students were required to be inoculated against smallpox.112 By 1963, 20 states and the District of Columbia required various vaccines for school entry.113 By the early 1980s, every state required students to demonstrate that they had received certain immunizations as a prerequisite for school attendance.114

112 Hodge JG, Gostin LO. School vaccination requirements: historical, social, and legal perspectives: A state of the art assessment of law and policy. Center for Law and the Public’s Health. February 15, 2002. 113 James Colgrove. State of Immunity: The Politics of Vaccination in Twentieth-Century America 176-77 (2006).

114 Id.

In September 2004, Virginia Mason Hospital, an acute care hospital in Seattle, Washington became the first facility to implement a mandatory influenza vaccination program. All employees were required to receive seasonal influenza vaccine as a condition of employment. Only those who had a religious objection or a documented vaccine allergy were exempted from the new policy.131

Following Virginia Mason, 87 facilities in 30 states and the District of Columbia have implemented similar vaccination policies. Currently, three local health departments, Cook County Health & Hospitals System in Illinois, Garland Health Department in Texas, and RiverStone Health in Montana have HCW influenza vaccination mandates. 132 131 Rosenbaum S. When Worlds Collide: Public Health and Union Rights in Virginia Mason Hospital vs. Washington State Nurses Association. Public Health Reports. September-October 2008.

132 Immunization Action Coalition. IAC’s Honor Roll for Patient Safety: Institutional Mandates. Available at: http://www.immunize.org/honor-roll/. Accessed February 17, 2011. 1

Other

California Senate bill (SB) 277 eliminated the personal belief exemption (PBE) provision from the state’s school-entry vaccine mandates prior to the 2016-2017 school year. Previously, vaccine-hesitant parents could acquire a PBE for their child based on philosophical or religious beliefs. Now, the only pathway for an unvaccinated kindergartener to enter a public or private school in California is with a medical exemption (ME), which requires a written statement from a licensed physician describing the medical reasons that immunization is unsafe.1 Previously, MEs were only granted to children with a contraindication to vaccination; however, SB 277 gave physicians broader discretion to grant MEs for reasons other than a contraindication, including family medical history.2,3[1]

Standing orders implicates highly complex state scope of practice laws: Alexandra M. Stewart, Megan C. Lindley, Marisa A. Cox, State Law and Standing Orders for Immunization Services, American Journal of Preventive Medicine (2015)

Medicaid policy impacts provider willingness to vaccinate: Alexandra M. Stewart, Megan C. Lindley, Marisa A. Cox, Medicaid Provider Reimbursement Policy for Adult Immunizations, Vaccine 33 (2015) 5801-5808

Alexandra M. Stewart, Megan C. Lindley, Kristen H.M. Chang, Marisa A. Cox, Vaccination Benefits and Cost-sharing Policy for Non-institutionalized Adult Medicaid Enrollees, Vaccine 32 (2014)

As a companion: Alexandra M. Stewart, Arthur Caplan, Marisa A. Cox, Kristen H.M. Chang, Mandatory Vaccination of Health Care Personnel: Good Policy, Law, and Outcomes, 53 Jurimetrics, The Journal of Law, Science, and Technology (2013)

Also helpful: Alexandra M. Stewart, Cox MA. State Law and Influenza Vaccination of Health Care Personnel. Vaccine 31 (2013) Abstract

U.S. Vaccine Policy course piece: Dalrymple, D.W. and Grabenstein, J.D. “Interwoven support: An historical survey of US federal programs enabling immunization.” Vaccine 32 (2014) Abstract

Procon - Polio Cases, Deaths, and Vaccination Rates

References

  1. ^ Paul L. Delamater, PhD1; Timothy F. Leslie, PhD2; Y. Tony Yang, ScD, LLM, MPH3, Change in Medical Exemptions From Immunization in California After Elimination of Personal Belief Exemptions, September 5, 2017, JAMA. 2017;318(9):863-864. doi:10.1001/jama.2017.9242