A Dose of Reality: Texans Stand Up for Immunizations

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1 A Dose of Reality: Texans Stand Up for Immunizations Nidhi M. Nakra, M.P.H. Director of Education and Advocacy The Immunization Partnership Texas Vaccines for Children Conference May 29, 2013 ~ Odessa, Texas

2 The Immunization Partnership Who are we? Statewide partnership committed to the eradication of VPDs through education, advocacy, and the promotion of immunization best practices. Advocacy and Stakeholder Engagement Building Coalitions across Texas (BCaT) Immunization Champions Community Immunity Provider Education

3 Community Immunity Activity

4 Background Benefit of Stakeholder Engagement Exchange informational need through informal dialogue Communicate through legislative/grassroots efforts Identify opportunities and evaluate policy options

5 Background Stakeholder Assessments Town Hall Meetings 8 meetings 125 participants 10 meetings 412 participants 4 meeting 169 participants Web-based Survey 129 respondents 536 respondents 217 respondents Publication Texans Speak Out: How to Improve Immunization Rates An Ounce of Prevention: Texans Speak Up for Immunizations A Dose of Reality: Texans Stand Up for Immunizations

6 Legislative Reforms 2009 ImmTrac and Adults (SB 346) Sen. Jane Nelson and Rep. Lois Kolkhorst Adults may now enter their information into the state immunization registry, ImmTrac. ImmTrac and Interstate Data Sharing (SB 347) Sen. Jane Nelson and Rep. Lois Kolkhorst Allows Texas to share information with other state if there is an emergency in Texas that forces Texans to surrounding states. Meningitis Vaccination for College Students (HB 4189) Rep. Patrick Rose and Sen. Kirk Watson Effective January 2010, any student entering a dormitory for the first time must have the meningitis vaccine.

7 Legislative Reforms 2011 Meningitis Vaccination for College Students (SB 1107) Sen. Wendy Davis and Rep. Charlie Howard The Jamie Schanbaum and Nicolis Williams Act requires all college students to be vaccinated against meningitis prior to school entry. Pertussis Education for New Parents (HB 3336) Rep. Garnet Coleman and Sen. Bob Deuell Parents of newborn children will receive information about the dangers of pertussis and about the importance of vaccinations. Healthcare Worker Vaccination (SB 7) Sen. Jane Nelson and Rep. John Zerwas Ensures that all Texas healthcare facilities have a policy in place regarding healthcare worker vaccination.

8 2012 Stakeholder Assessment Town Hall Meetings Location of Immunization Stakeholder Meetings, 2012

9 2012 Stakeholder Assessment Town Hall Meetings Review immunization topics on the national and state front Discuss immunization challenges and identify priorities Share advocacy strategies and techniques

10 2012 Stakeholder Assessment Web-Based Survey Respondents 217 respondents 46 towns and cities across Texas 37% attended at least one stakeholder meeting Survey Topics Barriers to increasing immunization rates in Texas Potential enhancements to the immunization registry Meningitis and human papilloma virus (HPV) vaccines Immunization funding Level of support for potential legislation

12 Summary of Recommendations 1. Restore funding for immunizations and safety net programs. 2. Enhance the state immunization registry, ImmTrac, with specific features. 3. Provide outreach and education to people who are vaccine hesitant. 4. Reduce the number of vaccine exemptions that are claimed due to reasons of conscience. 5. Improve immunization uptake among childcare providers through education and facility-based vaccination policies. 6. Decrease incidence of bacterial meningitis by improving access to meningitis vaccine for college students. 7. Promote strategies to reduce pertussis (whooping cough) incidence.

13 Stakeholder Assessment Findings Immunization Funding and Policies

14 We turn away approximately clients/month due to the eligibility changes. Many people regard us as the experts in immunizations and prefer to receive their vaccines from us. - TVFC Coordinator Many parents say their primary care providers don t carry the vaccines and they can t afford to pay the private vaccine prices. So, I don t know if they are finding physicians who do carry the vaccines or if they are just delaying getting vaccinated. - Stakeholder, Wichita Falls The new, more restrictive eligibility requirements have increased staff time necessary to screen patients and especially to explain to former patients why we can t serve them anymore. - Employee, public health dept

15 Health Science applicants are having a difficult time trying to find low cost vaccines, and financial aid doesn t pay for them. -Employee, Community College, Houston We live in a very rural area of south Texas. Adults are not receiving the vaccinations they need because of the distance they have to drive to receive them. -Employee, public health department Most adults we hear from say that they will just give up on fighting or chasing their insurance company. Many tell us that they will not bother with immunizations anymore. This is especially true of our minority and high-risk populations. -Director, public health department

16 Stakeholder Assessment Findings Enhancements to ImmTrac

17 Stakeholder Assessment Findings Enhancements to ImmTrac Extent to which Current Process of Obtaining Consent for ImmTrac Contributes to the Following Issues, 2012

18 Stakeholder Assessment Findings Enhancements to ImmTrac ImmTrac Users Rank Five Categories of Enhancements to ImmTrac, 2012

19 Stakeholder Assessment Findings Enhancements to ImmTrac Childhood Screening Features Desired by ImmTrac Users, 2012

20 Stakeholder Assessment Findings Provider Utilization of ImmTrac Percentage of Respondents Who Believe the Following Perceptions Among Providers are Barriers to Using ImmTrac, 2012

21 Stakeholder Assessment Findings Provider Utilization of ImmTrac Percentage of Respondents Who Believe the Following are Barriers to Physician Utilization of ImmTrac, 2012

22 Stakeholder Assessment Findings Vaccine Hesitancy

23 Stakeholder Assessment Findings Vaccine Hesitancy 89% believe that misinformation or lack of knowledge about vaccines is a somewhat or very important barrier to increasing immunization rates Everybody has car insurance getting immunized is like buying insurance to protect the body against disease. - Stakeholder, Austin

24 Stakeholder Assessment Findings Vaccine Exemptions

25 Stakeholder Assessment Findings Vaccine Exemptions

26 Stakeholder Assessment Findings Vaccine Exemptions Percentage of K-12th Grade Students Invoking the Personal Belief Exemption, Texas,

27 Stakeholder Assessment Findings Vaccine Exemptions The exemption process in Texas should also include a written verification that the person has been counseled by a healthcare provider on the risks and benefits of vaccination

28 Stakeholder Assessment Findings Immunization Uptake Among Childcare Providers

29 Stakeholder Assessment Findings Immunization Uptake Among Childcare Providers Individuals working at childcare centers should be required to show proof that they have been vaccinated against certain VPDs.

30 Stakeholder Assessment Findings Bacterial Meningitis

31 Stakeholder Assessment Findings Bacterial Meningitis Legislation The New Law Results in More College Students Receiving Preventive Health Checks

32 Stakeholder Assessment Findings Bacterial Meningitis Legislation Extent to Which the Following Issues Make It More Challenging for College Students to Get their Meningococcal Vaccination, 2012

33 Stakeholder Assessment Findings Bacterial Meningitis Legislation If proposed that the age range for meningococcal vaccination be decreased so that college students through age 21 are required to get immunized, how likely would you be to support this proposal?

34 Stakeholder Assessment Findings Bacterial Meningitis Legislation If proposed to make the booster dose a requirement in Texas, how likely would you be to support such a measure?

35 Stakeholder Assessment Findings Pertussis

37 Pertussis

38 Legislative Proposals 2013 Bill Number Intent Current Action House Bill 772 Rep. Donna Howard Senate Bill 62 Sen. Jane Nelson Rep. Jodie Laubenberg Senate Bill 63 Sen. Jane Nelson Rep. J.D. Sheffield Senate Bill 64 Sen. Jane Nelson Rep. John Zerwas Shifts the State's immunization registry, ImmTrac, from an opt-in to an opt-out system. This change will improve efficiency, enhance privacy, and reduce costs. Revises the age of the meningitis vaccine requirement and allows only DSHS to grant exemptions. This bill will decrease the incidence of bacterial meningitis among college students. Broadens the categories of individuals who can consent to immunizations to include minors with children. Requires licensed childcare facilities to develop and implement policies for their employees, in order to protect the children in its care from VPDs. Passed House (99 votes) Referred to Senate HHS Not set on agenda Passed Senate/House Signed in both chambers Sent to the Governor Passed Senate/House Signed in both chambers Sent to the Governor Passed Senate Amended in House Sent to conference Senate concurred Signed in Senate/House

39 Legislative Proposals 2013 SB 40: Shift to opt-out immunization registry HB 771: Retain registry information after age 18 years HB 1310: Allow a physician medical practice to exclude the cost paid for vaccines from its taxable revenue. HB 2711/SB 1054: Requires proof of a meningococcal vaccination or booster dose. HB 1611: Relating to the date by which students must receive a vaccination against bacterial meningitis. HB 2709: Relating to the establishment of a state plan for bacterial pneumonia education and prevention.

40 Next Steps - Become an Advocate! Building Coalition across Texas Site assessments and strategic planning Webinars, advocacy/education resources 2014 Stakeholder Meetings and Survey Biennial publication 2014 Immunization Summit (fall) 2015 Legislative Session

41 How Big is Your Sphere of Influence?

42 Thank You! Nidhi M. Nakra, MPH Director of Education and Advocacy

The Immunization Partnership. Immunization Stakeholder Meeting Austin, Texas May 30, 2012

The Immunization Partnership. Immunization Stakeholder Meeting Austin, Texas May 30, 2012 The Immunization Partnership Immunization Stakeholder Meeting Austin, Texas May 30, 2012 Overview Immunization Updates Affordable Care Act and Funding Updates National/state policy issues Legislative accomplishments