A Dose of Reality: Texans Stand Up for Immunizations

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 ConferenceMay 29, 2013 ~ Odessa, Texas

The Immunization PartnershipWho 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

Community Immunity Activity

BackgroundBenefit of Stakeholder Engagement

Exchange informational need through informal dialogue

Identify opportunities and evaluate policy options

Communicate through legislative/grassroots efforts

BackgroundStakeholder Assessments

2008 2010 2012

Town Hall Meetings

8 meetings125 participants

10 meetings412 participants

4 meeting169 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

Legislative Reforms 2009ImmTrac and Adults (SB 346)Sen. Jane Nelson and Rep. Lois KolkhorstAdults may now enter their information into the state immunization registry, ImmTrac.

ImmTrac and Interstate Data Sharing (SB 347)Sen. Jane Nelson and Rep. Lois KolkhorstAllows 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 WatsonEffective January 2010, any student entering a dormitory for the first time must have the meningitis vaccine.

http://www.immunizehouston.org/advocate/

Legislative Reforms 2011Meningitis 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.


2012 Stakeholder AssessmentTown Hall Meetings

Location of Immunization Stakeholder Meetings, 2012

2012 Stakeholder AssessmentTown Hall Meetings

• Review immunization topics on the national and state front

• Discuss immunization challenges and identify priorities

• Share advocacy strategies and techniques

2012 Stakeholder AssessmentWeb-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

Summary of Recommendations1. 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.

Stakeholder Assessment FindingsImmunization Funding and Policies

“We turn away approximately 80-100 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

“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

Stakeholder Assessment FindingsEnhancements to ImmTrac


Extent to which Current Process of Obtaining Consent for ImmTrac Contributes to the Following Issues, 2012


ImmTrac Users Rank Five Categories of Enhancements to ImmTrac, 2012


Childhood Screening Features Desired by ImmTrac Users, 2012

Stakeholder Assessment FindingsProvider Utilization of ImmTrac

Percentage of Respondents Who Believe the Following Perceptions Among Providers are Barriers to Using

ImmTrac, 2012

Stakeholder Assessment FindingsProvider Utilization of ImmTrac

Percentage of Respondents Who Believe the Following are Barriers to Physician Utilization of ImmTrac, 2012

Stakeholder Assessment FindingsVaccine Hesitancy

Stakeholder Assessment FindingsVaccine 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

Stakeholder Assessment FindingsVaccine Exemptions



Percentage of K-12th Grade Students Invoking the Personal Belief Exemption, Texas, 2003 - 2012


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

Stakeholder Assessment FindingsImmunization Uptake

Among Childcare Providers

Stakeholder Assessment FindingsImmunization Uptake

Among Childcare ProvidersIndividuals working at childcare centers should be required to

show proof that they have been vaccinated against certain VPDs.

Stakeholder Assessment FindingsBacterial Meningitis

Stakeholder Assessment FindingsBacterial Meningitis Legislation

The New Law Results in More College Students Receiving Preventive Health Checks


Extent to Which the Following Issues Make It More Challenging for College Students to Get their

Meningococcal Vaccination, 2012


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?


If proposed to make the booster dose a requirement in Texas, how likely would you be to support such a measure?

Stakeholder Assessment FindingsPertussis

Pertussis

Legislative Proposals 2013Bill Number Intent Current Action

House Bill 772Rep. Donna Howard

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.

Passed House (99 votes)Referred to Senate HHSNot set on agenda

Senate Bill 62 Sen. Jane Nelson

Rep. Jodie Laubenberg

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.

Passed Senate/HouseSigned in both chambersSent to the Governor

Senate Bill 63 Sen. Jane NelsonRep. J.D. Sheffield

Broadens the categories of individuals who can consent to immunizations to include minors with children.

Passed Senate/HouseSigned in both chambersSent to the Governor

Senate Bill 64 Sen. Jane NelsonRep. John Zerwas

Requires licensed childcare facilities to develop and implement policies for their employees, in order to protect the children in its care from VPDs.

Passed SenateAmended in HouseSent to conferenceSenate concurredSigned in Senate/House


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.


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

How Big is Your Sphere of Influence?

Nidhi M. Nakra, MPHDirector of Education and [email protected]

Thank You!

mailto:[email protected]

Documents

A Dose of Reality: Texans Stand Up for Immunizations