BILL ANALYSIS Ó AB 2069 Page 1 Date of Hearing: April 22, 2014 ASSEMBLY COMMITTEE ON HEALTH Richard Pan, Chair AB 2069 (Maienschein) - As Amended: April 21, 2014 SUBJECT : Immunizations: influenza. SUMMARY : Requires the State Department of Public Health (DPH) to post educational information regarding influenza (flu) vaccinations on its Internet Website. Specifically, this bill : 1)Requires DPH to annually post educational information regarding flu and the availability of flu vaccines on its Internet Website prior to the annual flu season, including, but not limited to, all of the following: a) The health benefits of a flu vaccine; b) That the flu vaccine may be a covered benefit for those with health insurance coverage; and, c) That flu vaccines may be available for a minimal fee to those individuals who do not have health insurance coverage. 2)Authorizes DPH to use additional available resources to educate the public about flu vaccination, including public service announcements, media events, public outreach to individuals and groups who are susceptible to flu, and any other preventive and wellness education efforts recommended by public health officials. 3)Makes various findings and declarations regarding the importance of flu vaccination. EXISTING LAW : 1)Requires DPH to promptly identify, prevent, and control infectious diseases that pose a threat to public health, including emerging and re-emerging infectious diseases, vaccine-preventable agents, bacterial toxins, bioterrorism, and pandemics. AB 2069 Page 2 2)Requires DPH to provide appropriate flu vaccine to local governmental or private, nonprofit agencies at no charge so the agencies may vaccinate people, at a minimal cost, at accessible locations. Requires DPH and the California 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)Requires general acute care hospitals (GACHs) to offer, prior to discharge, immunizations for flu and pneumococcal disease to inpatients, aged 65 year or older, based upon the adult immunization recommendations of the Advisory Committee on Immunization Practices (ACIP), the Center for Disease Control and Prevention (CDC), and the recommendations of appropriate entities for the prevention, detection, and control of flu outbreaks in California GACHs. FISCAL EFFECT : This bill has not been analyzed by a fiscal committee. COMMENTS : 1)PURPOSE OF THIS BILL . According to the author this bill will provide additional information to the public regarding the importance of getting a flu vaccine. The author further states that Sacramento County data show that the majority of people hospitalized or who died from the flu in 2013 had not been immunized and that state officials have been quoted as saying that unfortunately, people are becoming ill or dying because they do not take advantage of available vaccines. 2)BACKGROUND . a) Influenza. According to DPH's Website, influenza, or flu, is a contagious respiratory illness caused by flu viruses, that can cause mild to severe illness and at times can lead to death. The best way to prevent flu 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 indicate will cause the most illness during the flu season. AB 2069 Page 3 In February 2010, the ACIP, which advises the CDC on vaccine issues, voted to recommend that all people aged six months and older obtain a flu vaccine. However, the CDC also points out that while everyone should get flu vaccine each flu season, it is especially important that the following groups get vaccinated either because they are at a 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. b) National and California seasonal flu immunization rates. According to CDC estimates, the California rate of immunization was below the national average during each of the last four flu seasons for individuals age six months and older. i) 2009-10 season: National average: 41.2%. California average: 36.9%; ii) 2010-11 season: National average: 43%. California average: 38.9%; iii) 2011-12 season: National average: 41.8%. California average: 40.5%; and, iv) 2012-13 season: National average: 45%. California average: 44.2%. 3)SUPPORT . The American Federation of State, County and Municipal Employees, AFL-CIO (AFSCME) states this bill would help hospitals combat the flu by educating discharged patients about the vaccine available to protect them from contracting the virus. AFSCME also notes, given the level of misdirected hysteria surrounding the use of vaccinations, it would benefit patients to have access to information regarding the advantages of vaccinating against preventable ailments. The California Children's Hospital Association also supports this bill and says they believe educating the public on the availability of vaccinations that can prevent a potentially deadly virus infection is a critical component in reducing the severity of the annual flu season. 4)PREVIOUS LEGISLATION . AB 2069 Page 4 a) AB 689 (Bonta) of 2013 would have required each GACH to offer an onsite flu vaccine annually to all patients prior to discharge, as specified, and required hospitals to inform patients they may be required to pay for the vaccination. AB 689 was held in the Assembly Appropriations Committee. b) AB 599 (Donnelly) of 2013 would have provided that existing law, which allows a minor who is 12 years of age or older and who may have come into contact with an infectious, contagious, or communicable disease to consent to medical care, as specified, does not authorize a minor to receive a vaccine without the consent of the parent or guardian of the minor. AB 599 failed passage in the Assembly Judiciary Committee. c) AB 2109 (Pan), Chapter 821, Statutes of 2012, requires on and after January 1, 2014, a separate form prescribed by DPH to accompany a letter or affidavit to exempt a child from immunization requirements under existing law on the basis that an immunization is contrary to beliefs of the child's parent or guardian. d) AB 106 (Berg), Chapter 378, Statutes of 2007, requires a GACH to offer, prior to discharge, immunizations for flu and pneumococcal disease to its inpatients aged 65 years of age or older, as specified. e) AB 1711 (Strickland), Chapter 58, Statutes of 2005, authorizes a registered nurse or licensed pharmacist in skilled nursing facilities to administer flu and pneumococcal immunizations to a patient over 50 years of age, pursuant to standing orders and without patient specific orders, if the immunization standing orders that are not patient-specific meet prescribed federal recommendations and are approved by the medical director of the facility. f) AB 691 (Daucher), Chapter 36, Statutes of 2004, requires specified nursing facilities to offer immunizations for flu and pneumococcal disease to residents that are 65 years or older. 5)SUGGESTED AMENDMENTS . DPH currently posts educational AB 2069 Page 5 information regarding the flu and the availability of vaccinations on its Internet Website, although not all of the information required by this bill. In order to improve the content on the DPH Website, committee staff suggest the following amendments: a) Delete the requirement that information be posted prior to flu season, and require it to be posted year round; and, b) Require DPH to include information on where low or no-cost flu vaccinations can be obtained. REGISTERED SUPPORT / OPPOSITION : Support American Academy of Pediatrics, California District IX American Federation of State, County and Municipal Employees, AFL-CIO Biocom California Children's Hospital Association Opposition None on file. Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097