BILL ANALYSIS Ó
AB 2009
Page 1
Date of Hearing: April 10, 2012
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 2009 (Galgiani) - As Amended: March 29, 2012
SUBJECT : Communicable disease: influenza vaccinations.
SUMMARY : Includes persons who are under 18 years of age among
those who have priority to receive flu vaccine. Specifically,
this bill :
1)Includes persons who are not more than 18 years of age among
those who have priority to receive flu vaccine under a flu
vaccine program administered by the Department of Public
Health (DPH) for older adults (60 years or older).
2)Finds and declares the importance of preventing influenza
infection among school-aged children and, that current law
related to prioritization for influenza vaccines is outdated
and needs to be updated to reflect current recommendations by
the federal Centers for Disease Control and Prevention (CDC).
EXISTING LAW :
1)Establishes the Immunization Branch within DPH to protect
Californians against vaccine preventable diseases.
2)Requires DPH to provide appropriate flu vaccine to local
governmental or private, nonprofit agencies at no charge in
order that the agencies may provide the vaccine, at a minimal
cost, at accessible locations in the order of priority first,
for all persons 60 years of age or older in this state and
then to any other high-risk groups identified by the United
State Public Health Service. Requires DPH and the State
Department of Aging to prepare, publish, and disseminate
information regarding the availability of the vaccine and the
effectiveness of the vaccine in protecting the health of older
persons.
3)Establishes the federal Vaccine for Children Program that
offers vaccines at no cost for eligible children.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
AB 2009
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COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, "while
children are the most vulnerable to catching the flu, they are
also the ones who suffer the most from it. Catching the flu
often leads to many unnecessary school absences, missed work
days for parents/caregivers and related medical expenses."
This bill is necessary to ensure flu vaccination of children
becomes a priority. To illustrate the importance of flu
vaccination, the author cites a Japanese influenza vaccination
program aimed at protecting school children and reducing the
rate of transmission of infection within the community,
particularly to the elderly and those with chronic, high-risk
conditions. In this program, the vaccination of Japanese
children prevented about 37,000 to 49,000 deaths per year, or
about one death for every 420 children vaccinated. As the
vaccination of school children was discontinued, mortality
rates in Japan increased.
2)BACKGROUND .
a) Influenza . According to DPH's Website, influenza is a
contagious respiratory illness caused by influenza viruses,
and can cause mild to severe illness, and at times can lead
to death. The best way to prevent influenza is by getting a
flu vaccination each year. The CDC recommends a yearly
flu vaccine for everyone six months of age and older as the
first and most important step in protecting against this
serious disease. While there are many different flu
viruses, the flu vaccine is designed to protect against the
three main flu strains that research indicates will cause
the most illness during the flu season. The importance of
obtaining a flu vaccine was highlighted in 2009 with the
H1N1 outbreak in the United States. H1N1 is a new strain
of the influenza virus that first appeared in April 2009 in
the United States and spread worldwide. The symptoms of
H1N1 are similar to the regular human seasonal flu
infection. According to DPH's Website, by December 2009,
8,003 people in California were hospitalized, and 449
people died from H1N1.
Driven by the H1N1 pandemic, in February 2010, the Advisory
Committee on Immunization Practices, which advises the CDC
on vaccine issues, voted to recommend that all people aged
six months and older must obtain a flu vaccine (universal
recommendation for vaccination). However, the CDC also
points out that while everyone should get flu vaccine each
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flu season, it is especially important that the following
groups get vaccinated either because they are high risk of
having serious flu-related complications or because they
live with or care for people at high risk for developing
flu-related complications: pregnant women; children younger
than five; but especially children younger than two years
old, people 50 years of age and older; people of any age
with certain chronic medical conditions; people who live in
nursing homes and other long-term care facilities; and,
people who live with or care for those at high risk for
complications from flu, as specified.
b) Hospitalizations and Deaths Due to Influenza.
Protection against influenza virus is important because of
serious complications, including death, which may arise.
According to CDC, during the 2010-11 influenza season,
influenza activity first began to increase in the
southeastern United States in November and peaked
nationally in early February. During this season, a higher
rate of hospitalization was observed for persons aged e 65
years, and lower hospitalization rates were observed in
younger populations than during the pandemic year. There
were 115 deaths associated withc) laboratory-confirmed
influenza virus infections occurring from October 3,
2010-May 21, 2011 among children aged <18 years during the
2010-11 influenza season that were reported to CDC. These
deaths were reported from 34 states, Chicago, and New York
City. The mean and median ages of children who died were
6.8 years and 5.7 years, respectively; 16 children were
aged <6 months, 17 were aged 6-23 months, 21 were aged 2-4
years, 32 were aged 5-11 years, and 29 were aged 12-17
years. For comparison, during the 2009 pandemic, 348
pediatric deaths were reported to CDC during April 15, 2009
- October 2, 2010. Before the pandemic, 67
influenza-associated pediatric deaths were reported for the
2008-09 season, and 88 deaths were reported for the 2007 -
08 season. Furthermore, the CDC also included cumulative
hospitalization rates (per 100,000 population) because of
influenza. For example, the cumulative hospitalization
rate for October 1, 2010-April 30, 2011, was 43.8 among
children aged 0-4 years, 8.9 among children aged 5-17
years, 11.1 among adults aged 18-49 years, 22.5 among
adults aged 50-64 years, and 65.0 among adults aged e65
years.
d) Flu Vaccine Program for Older Adults . This program was
designed to utilize voluntary assistance from public or
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private sectors in administering the vaccines.
Participating entities may charge and retain a fee not
exceeding $2 per person to offset administrative operating
costs. Additionally, DPH is allowed to seek and utilize
available funds for the cost of the vaccine and its
administration, including reimbursement under the Medi-Cal
program to the extent permitted by federal law.
Participating entities are also immune from liability for
any injury caused by an act or omission in the
administration of the vaccine or other immunizing agent to
a person 60 years or older or to members of high-risk
groups, as specified.
Each year a request for bids is open to all manufacturers and
distributors of influenza vaccine and the amount of vaccine
that is purchased by DPH depends on the prices contained in
the winning bids compared to the amount of state funds
available for this purpose. DPH allocates state-purchased
influenza vaccine to local health departments based on
their population distribution and historical vaccine usage.
Local health departments then use or distribute their
vaccine allocations at the local level. According to DPH,
the following are the number of vaccines ordered for
distribution to local health departments for the most
recent flu seasons: 2011-12: 285,950 doses, 2010-11:
790,000 doses, and in 2010-09, 684,000 doses. Since DPH
anticipates the number of doses that local health
departments will want to administer every flu season, DPH
orders more vaccine that actually distributed. The table
below shows vaccines that are ordered and distributed to
local health departments. It should be noted that from
year to year, thousands of flu vaccines remain unused.
Administration by Age Group, 2000-2011 Influenza Seasons
-------------------------------------------------------------
|Season | <18 | 19-59 | >60 | Total | * Total | ** |
| |years | years | years | doses | doses |Approx. |
| | | | |Ordered |administer| Unused |
| | | | | | ed | Doses |
|-------+------+--------+--------+--------+----------+--------|
|2000-20|15,456|146,722 |546,047 |749,226 | 709,292 | 39,934 |
|01 | | | | | | |
|-------+------+--------+--------+--------+----------+--------|
|2001-20|16,980|159,128 |536,782 |741,828 | 714,790 | 27,038 |
|02 | | | | | | |
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|-------+------+--------+--------+--------+----------+--------|
|2002-20|25,807|174,639 |404,919 |687,879 | 605,407 | 82,472 |
|03 | | | | | | |
|-------+------+--------+--------+--------+----------+--------|
|2003-20|69,058|196,598 |361,291 |668,715 | 626,947 | 41,768 |
|04 | | | | | | |
|-------+------+--------+--------+--------+----------+--------|
|2004-20|61,654|149,069 |380,072 |706,480 | 628,442 | 78,038 |
|05 | | | | | | |
|-------+------+--------+--------+--------+----------+--------|
|2005-20|90,149|199,979 |368,593 |767,690 | 659,727 |107,963 |
|06 | | | | | | |
|-------+------+--------+--------+--------+----------+--------|
|2006-20|118,72|213,034 |286,066 |688,318 | 624,576 | 63,742 |
|07 | 6 | | | | | |
|-------+------+--------+--------+--------+----------+--------|
|2007-20|121,34|232,591 |245,663 |659,042 | 599,598 | 59,444 |
|08 | 4 | | | | | |
|-------+------+--------+--------+--------+----------+--------|
|2008-20|75,828|231,640 |204,077 |589,205 | 511,709 | 77,496 |
|09 | | | | | | |
|-------+------+--------+--------+--------+----------+--------|
|2009-20|126,79|219,233 |160,887 |572,681 | 512,305 | 60,376 |
|10 | 4 | | | | | |
|-------+------+--------+--------+--------+----------+--------|
|2010-20|121,67|315,512 |165,243 |701,182 | 604,667 |96,515 |
|11 | 5 | | | | | |
-------------------------------------------------------------
* Includes doses given to persons whose age was not
reported to DPH.
** The actual number may be somewhat lower as DPH requests
local health departments to report their vaccine inventory
each year in March, prior to the end of the current flu
season. This is required to facilitate ordering the following
season's flu vaccine which must be done prior to the end of
the current flu season.
e) Vaccines for Children Program . Vaccination of children
remains a high priority both on the state and federal
level. For example, the federal Vaccines for Children
Program (VFC Program), officially implemented in October
1994, provides vaccines at no cost to children who might
not otherwise be vaccinated because of inability to pay.
The VFC Program was created by the Omnibus Budget
Reconciliation Act of 1993 as a new entitlement program to
be a required part of each state's Medicaid plan. Funding
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for the VFC Program is approved by the Office of Management
and Budget and allocated through the Centers for Medicare
and Medicaid Services to the CDC. CDC buys vaccines at a
discount and distributes them to grantees (state health
departments and certain local and territorial public health
agencies) which in turn distribute them at no charge to
those private physician offices and public health clinics
registered as VFC providers.
In California, DPH administers the VFC Program. According to
DPH's Website, to qualify, children must be under the age
of 19 and one of the following: Medicaid eligible,
uninsured, American Indian or Alaska native, or
underinsured, as specified. There is no charge for any
vaccines given by a VFC provider to eligible children but
there can be other costs associated with a vaccination.
For example, participating doctors can charge a standard
fee of $17.55 or less to administer each shot but if a
family cannot afford the fee per shot, the fee must be
waived. A VFC-eligible child cannot be refused a
vaccination due to the parent or guardian's inability to
pay for shot administration.
3)SUPPORT . Supporters such as the California School Nurses
Organization, SEIU California and the California Senior
Legislature indicate that adding children into the flu vaccine
priority list would minimize the spread of influenza to other
high risk groups. The American Academy of Pediatrics points
out children have the highest rates of influenza infection,
more than any other age group, and this bill would help
protect them and the community from the burden of influenza.
In their support, MedImmune points out that "the current
priority given to seniors for vaccination was added in the
1970's when Medicare did not cover flu vaccines and the
vaccine was not readily accessible to seniors at their local
pharmacy or physician's office. Unfortunately, children do
not always have the same coverage options as seniors and can
benefit from free flu vaccines administered by a school nurse
or a clinic organized a local health department."
4)RELATED LEGISLATION . AB 2109 (Pan), pending in this
Committee, would specify certain requirements for parents and
guardians of school-aged children who wish to seek exemption
from immunization requirements. AB 2064 (V. Manuel Pérez),
also pending in this Committee, would require health care
service plans and health insurers that provide coverage for
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childhood and adolescent immunizations to reimburse physicians
of the costs of vaccines, as specified.
5)PREVIOUS LEGISLATION .
a) SB 1711 (Ortiz) of 2006, would have required the
Department of Health Services (DHS now DPH) or its
contractor to evaluate the effectiveness of the current
system of distributing vaccines to local governmental and
private nonprofit agencies and provide a report to the
Legislature by January 1, 2008. SB 1711 died in the
Assembly Appropriations Committee.
b) SB 1220 (Migden) of 2006 would have created an influenza
vaccine purchasing and distribution program for smaller
physician practices within DHS, and would have authorized
DHS to recover all costs from the sale of the vaccine. SB
1220 was vetoed by then Governor Schwarzenegger who
indicated that "SB 1220 would require new, unnecessary
bureaucracy within state government, and increase state
costs."
c) AB 699 (Chan), Chapter 589, Statutes of 2006, requires
any manufacturer or distributor of the influenza vaccine,
or nonprofit health care service plan that exclusively
contracts with a single medical group in a specified
geographic area, to provide, or arrange for the provision
of, medical services to its enrollees to report specified
information regarding the supply of the vaccine upon notice
from the DPH.
6)POLICY CONSIDERATIONS . This bill would include all persons
who are not more than18 years of age among those who have
priority to receive the flu vaccine. According to the
findings and declarations contained in the bill, the current
priority list is outdated and needs to be updated to reflect
current recommendation by the CDC. However, the change in
priority sought by this bill is not consistent with current
CDC recommendations. As indicated above, the CDC began urging
a universal flu vaccination during the 2010-11 flu season in
light of the H1N1 pandemic in 2009-10. However, even with
this universal flu vaccination recommendation, the CDC
maintains that certain groups continue to be at high risk of
having serious flu-related complications: pregnant women;
children younger than five, but especially children younger
than two years old; people 50 years of age and older; people
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of any age with certain chronic medical conditions; people who
live in nursing homes and other long-term care facilities;
and, people who live with or care for those at high risk for
complications from flu. If the current priority list is to be
amended, should it also include all groups who are considered
high-risk? In the alternative, if listing all high-risk
groups invites a change in existing law every time the
priority changes, should the DPH instead be authorized to set
the priority based on CDC recommendations, or give DPH the
flexibility to set the priority when there are no CDC
recommendations?
REGISTERED SUPPORT / OPPOSITION :
Support
American Academy of Pediatrics
American Federation of State, County, and Municipal Employees,
AFL-CIO
California Senior Legislature
California School Health Centers Association
California School Nurses Organization
California State PTA
Greater Los Angeles African American Chamber of Commerce
MedImmune, Inc
SEIU California
Opposition
None on file.
Analysis Prepared by : Rosielyn Pulmano / HEALTH / (916)
319-2097