BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 2009
AUTHOR: Galgiani
AMENDED: May 31, 2012
HEARING DATE: June 6, 2012
CONSULTANT: Rubin
SUBJECT : Communicable disease: influenza vaccinations.
SUMMARY : Deletes the requirement that local agencies receiving
influenza (flu) vaccine from the Department of Public Health
(DPH) prioritize vaccine provision to persons 60 years of age
and older, and instead requires DPH to provide guidance to those
local agencies as to whether one or more population groups shall
have priority for the vaccine.
Existing law:
1.Establishes the Immunization Branch within DPH to provide
leadership and support to public and private sector efforts to
protect the population against vaccine-preventable diseases.
2.Requires DPH to provide appropriate flu vaccine to local
government or private, nonprofit agencies at no charge in
order that the agencies may provide the vaccine at a minimal
cost, at accessible locations, and in order of priority, first
for all person 60 years of age or older and then to any other
high-risk groups identified by the United States Public Health
Service.
3.Requires that administration of the flu vaccine be performed
by a physician, a registered nurse, or a licensed vocational
nurse acting within the scope of their professional practice
acts, and requires that a registered nurse or licensed
vocational nurse demonstrate satisfactory familiarity with
specified immunization procedures to a supervising physician.
4.Permits physicians, nurses, physician assistants, medical
assistants, and pharmacists to administer immunizations under
specified circumstances.
This bill:
1.Finds and declares that current law related to prioritization
for influenza vaccines is outdated and needs to be updated to
reflect current federal Centers for Disease Control and
Continued---
AB 2009 | Page 2
Prevention (CDC) recommendations, that CDC currently
recommends annual seasonal influenza vaccination for all
persons six months of age and older, that children have the
highest rates of influenza infection and are the major vectors
for transmission of the virus to adults, and that eligible
low-income and uninsured children can access vaccine at no
cost through the Vaccine for Children Program.
2.Deletes the requirement that local agencies receiving flu
vaccine from DPH prioritize the provision of vaccine first to
persons 60 years of age and older and then to other high-risk
groups, and instead requires DPH to provide guidance to local
agencies as to whether one or more population groups shall
have priority for the vaccine.
3.Requires that the guidance provided by DPH to local agencies
be developed out of consideration of CDC recommendation or
other criteria and with the goal of ensuring that the
vaccination program is efficient and effective in meeting
public health goals.
4.Allows DPH to issue guidance to local agencies without taking
regulatory action under the Administrative Procedure Act.
5.Deletes the requirement that flu vaccine administration be
performed by specified health care professionals and the
requirement that a registered nurse or licensed vocational
nurse must demonstrate satisfactory familiarity with specified
immunization procedures to a supervising physician.
FISCAL EFFECT : The Assembly Committee on Appropriations
analysis of this bill indicates negligible state costs.
PRIOR VOTES :
Assembly Health: 18- 0
Assembly Appropriations:17- 0
Assembly Floor: 73- 0
COMMENTS :
1.Author's statement. According to the author, the CDC
recommends annual seasonal influenza vaccines for all
individuals ages 6 months and older. Children have the highest
rate of influenza infection and school-aged children are the
major vectors for influenza transmission that spread the virus
to adults and the elderly. Over the past few years, the use of
free vaccines by people over 60 years of age has been
AB 2009 | Page
3
declining due to Medicare coverage while use by people under
the age of 18 has been increasing. Last year, the state had
over 90,000 unused flu vaccines; it is our job to see that flu
vaccines are made available to those in need of the assistance
and those at risk.
2.Influenza. According to the CDC's website, the flu is a
contagious respiratory illness caused by influenza viruses
that infect the nose, throat, and lungs. It can cause mild to
severe illness - often with symptoms including fever, chills,
cough, sore throat, runny or stuffy nose, muscle or body
aches, headaches, fatigue, vomiting, and diarrhea - and at
times can lead to death. Flu viruses spread mainly when
droplets made by infected people coughing, sneezing, or
talking land in the mouths or noses of people nearby; less
often, a person might also get flu by touching something with
flu virus on it and then touching their own mouth, eyes, or
nose. The flu can typically be passed to someone beginning a
day before the infected person is symptomatic and up to five
to seven days after becoming sick.
3.Flu vaccine. The CDC's website indicates that the single best
way for an individual to prevent the flu is to get a flu
vaccine each season. There are two types of flu vaccines: flu
shots of inactivated vaccines that contain killed viruses and
are given with a needle, and the nasal-spray flu vaccine that
is made with live, weakened viruses and is given as a nasal
spray (sometimes called LAIV for Live Attenuated Influenza
Vaccine). While there are many influenza viruses, the seasonal
flu vaccine protects against the three viruses that research
suggests will be most common. About two weeks after
vaccination, antibodies develop that protect against influenza
virus infection. Variability in the nature and use of the flu
vaccine can contribute to the flu's unpredictability: the
CDC's website indicates that the flu's severity can vary
widely from one season to the next depending on which flu
viruses are spreading, how much flu vaccine is available, when
vaccine is available, how many people get vaccinated, and how
well the flu vaccine is matched to flu viruses that are
causing illness.
4.Recommended flu vaccine use. According to a CDC press
release, the Advisory Committee on Immunization Practices
(ACIP), which advises the CDC on vaccine issues, voted in
February 2010 to expand the recommendation for annual
AB 2009 | Page 4
influenza vaccination to include all people ages 6 months or
older. The vote took place against a backdrop of incremental
increases in the numbers and groups of people recommended for
influenza vaccination in years past, and lessons learned from
the world's then-ongoing first flu pandemic in 40 years - the
2009 H1N1 flu pandemic. On their website, the World Health
Organization defines a pandemic as the worldwide spread of a
new disease; early outbreaks of flu caused by a new H1N1 flu
virus were first detected in North America in April 2009, and
by February 2010, the virus had rapidly spread to reach most
countries in the world. According to the DPH website, 596
deaths in California were attributable to the 2009 H1N1 virus
by August 28, 2010. The new CDC recommendations of 2010 were
intended to remove barriers to influenza immunization and
signal the importance of preventing the flu across the entire
population. While CDC advocates for universal vaccination of
anyone over 6 months of age, the CDC website indicates that it
is especially important that certain people get vaccinated
either because they are at 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, including children younger than 5 and
especially those younger than 2 years old, adults 65 years of
age or older, and people with specified medical conditions
such as asthma, heart disease, and chronic lung disease.
5.Flu vaccination program for older adults. California's
program, which would be amended by this bill, was designed to
use voluntary assistance from public or private sectors in
administering flu vaccines. DPH provides participating local
governmental or private nonprofit agencies flu vaccine at no
charge in order for the agencies to provide the vaccine for no
more than two dollars per person to offset administrative
costs. Agencies are tasked with providing flu vaccine to
individuals in all high-risk groups, but first to those who
are 60 years and older. According to DPH, over the last
decade, the pattern of flu vaccine administration under this
program has shifted toward younger people: for example, in the
2000-01 season vaccine was administered to 15,456 people ages
18 years and less, 146,722 people ages 19 to 59 years, and
546,047 people of age 60 or greater; by contrast, in the
2010-11 season, vaccine was administered to 121,675 people
aged less than 18 years, 315,512 people aged 19-59 years, and
165,243 people of age 60 or greater. DPH indicates that the
increase in the number of individuals under the age of 60 who
have received the flu vaccine is consistent with the expansion
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in age groups prioritized in federal recommendations to be
immunized against influenza in the last decade.
6.Related legislation. AB 2109 (Pan) adds to existing
requirements, that allow a child to be exempt from a school's
immunization requirements because immunization is contrary to
the child's parent's or guardian's beliefs, statements signed
by a health care practitioner and the parent or guardian
indicating the provision and receipt of information regarding
the benefits and risks of immunization. AB 2109 is pending in
the Senate Health Committee.
7.Prior legislation. AB 2064 (V. Manuel P�rez) of 2011 would
have required health plans and insurers to reimburse
physicians and physician groups for specified costs related to
the administration of vaccines. AB 2064 was held on suspense
in the Assembly Appropriations Committee.
AB 699 (Chan), Chapter 589, Statutes of 2006, requires a
manufacturer or distributer of the influenza vaccine, or a
nonprofit health plan that exclusively contracts with a single
medical group in a specified geographic area to provide
medical services to its enrollees, to report information about
the supply of the vaccine to the Department of Health Services
(DHS, now DPH) upon notice from DHS.
SB 1220 (Midgen) of 2006 would have created within DHS an
influenza vaccine purchasing and distribution program for
smaller physician practices in order to facilitate the timely
distribution of the vaccine to the public, and would have
authorized the DHS to recover all costs from the sale of the
vaccine. SB 1220 was vetoed.
SB 1711 (Ortiz) of 2006 would have required DHS or its
contractor to evaluate the effectiveness of distributing
vaccines to local governmental and private nonprofit agencies
and report its findings to the Legislature. SB 1711 was held
on suspense in the Assembly Appropriations Committee.
AB 2620 (Wyland) of 2002 would have required an elevated level
of state funding for the provision of flu vaccines during the
2003-04 flu season, and would have required DHS to conduct a
study of existing flu vaccination practices and the increased
occurrence of short-term flu vaccine shortages and report its
findings to the Legislature. AB 2620 failed passage in the
AB 2009 | Page 6
Assembly Health Committee.
8.Support. The American Academy of Pediatrics indicates that
children have a higher rate of influenza infection than any
other age group, are more contagious than adults, and often
spread the disease to vulnerable groups including the elderly
and infants, who are too young to receive the vaccine. The
California Academy of Family Physicians states that
unvaccinated children can contract and spread dangerous or
life-threatening diseases and lessen the effect of "herd
immunizations" in the population as a whole. The California
School Nurses Association adds that for many school-aged
children, seasonal influenza is a yearly occurrence that
causes school absences that interfere with learning and the
loss of work days for their parents/guardians; it is also not
unusual for children to return to school early and spread the
virus to their friends, teachers, and staff. The California
State PTA and the Greater Los Angeles African American Chamber
of Commerce concur that seasonal flu in children can cause
absenteeism from school and impair learning, and ultimately
impact the entire community by disrupting work and child care
arrangements. MedImmune states that the requirement to
prioritize free flu vaccine for seniors in California was
added in the 1970s when Medicare did not cover flu vaccines
and the vaccine was not as readily available to seniors at
their local pharmacy or physician's office, but that now,
seniors are able to obtain a free flu vaccine fairly easily
while children do not always have the same coverage options
and as seniors and can benefit from free flu vaccine
administered by a school nurse or a clinic organized by their
local health department. The American Federation of State,
County, and Municipal Employees adds that this bill would
align California's prioritization of flu vaccine
administration with recommendations from ACIP.
9.Author's amendment. This bill allows DPH to provide guidance
to local agencies as to whether one or more population groups
shall have priority for the provided flu vaccine, and requires
DPH to consider the influenza recommendations of ACIP or other
criteria. In order to provide guidance for local agencies in
the absence of DPH-issued guidance, the author has agreed to
add the following to the end of Health and Safety Code Section
120392.3 (b): "In the absence of guidance from the department,
local agencies shall be guided by the influenza
recommendations of ACIP."
AB 2009 | Page
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10.Technical amendments. To maintain consistency, the committee
staff recommends:
a. On Page 6, Line 9, after "Immunization Practices",
insert "(ACIP)";
b. On Page 6, Line 20, strike "United States Public
Health Service", and insert "ACIP";
c. On Page 6, Line 39, strike out "to a person 60 years
of age or older or to members of high-risk groups
identified by the United States Public Health Service";
and
d. On Page 6, Line 16, strike out "pneumococcal", and
insert "pneumonia".
SUPPORT AND OPPOSITION :
Support: American Academy of Pediatrics California
American Federation of State, County, and Municipal
Employees
California Academy of Family Physicians
California Pharmacists Association
California School Employees Association
California School Health Centers Association
California School Nurses Organization
California Senior Legislature
California State PTA
Greater Los Angeles African American Chamber of
Commerce
MedImmune
Service Employees International Union California
5 individuals
Oppose: None received.
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