What's happening
This bill requires immunization against human papillomavirus (HPV) for schoolchildren in New York, adding HPV to the list of mandatory vaccines.
Why it matters
Expands school vaccine requirements to include HPV. , meaning parents must ensure their children receive the HPV vaccine in order to attend school—potentially increasing overall vaccination rates and reducing future HPV-related cancers and diseases.
Aligns school immunization standards with CDC recommendations. , strengthening public health efforts by ensuring that students receive vaccines that are broadly endorsed by national health authorities.
May prompt more routine discussions between healthcare providers, parents, and students about HPV and its link to cancer. , raising public awareness and reducing stigma or misinformation about the HPV vaccine.
Could affect school enrollment and attendance for unvaccinated children. , as families who do not comply with the new requirement may face administrative barriers or need to seek exemptions (where allowed), impacting their access to education.
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Who cares
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Require HPV Vaccines for Kids
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History
- Referred to health
- Referred to health
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
132
2017-2018 Regular Sessions
IN SENATE (Prefiled)
January 4, 2017
Introduced by Sen. HOYLMAN -- read twice and ordered printed, and when printed to be committed to the Committee on Health
AN ACT to amend the public health law, in relation to requiring immunization against human papillomavirus (HPV)
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. The section heading and subdivisions 2, 3, 5 and 6 of section 2164 of the public health law, as amended by chapter 401 of the laws of 2015, are amended to read as follows:
Definitions; immunization against poliomyelitis, mumps, measles, diphtheria, rubella, varicella, human papillomavirus (HPV), Haemophilus influenzae type b (Hib), pertussis, tetanus, pneumococcal disease, meningococcal disease, and hepatitis B.
2. a. Every person in parental relation to a child in this state shall have administered to such child an adequate dose or doses of an immunizing agent against poliomyelitis, mumps, measles, diphtheria, rubella, varicella, human papillomavirus (HPV), Haemophilus influenzae type b (Hib), pertussis, tetanus, pneumococcal disease, and hepatitis B, which meets the standards approved by the United States public health service for such biological products, and which is approved by the department under such conditions as may be specified by the public health council.
b. Every person in parental relation to a child in this state born on or after January first, nineteen hundred ninety-four and entering sixth grade or a comparable age level special education program with an unassigned grade on or after September first, two thousand seven, shall have administered to such child a booster immunization containing diphtheria and tetanus toxoids, [and] an acellular pertussis vaccine, and human papillomavirus (HPV), which meets the standards approved by the United States public health service for such biological products, and which is
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05324-02-7
S. 132 2
approved by the department under such conditions as may be specified by the public health council.
c. Every person in parental relation to a child in this state entering or having entered seventh grade and twelfth grade or a comparable age level special education program with an unassigned grade on or after September first, two thousand sixteen, shall have administered to such child an adequate dose or doses of immunizing agents against meningococcal disease as recommended by the advisory committee on immunization practices of the centers for disease control and prevention, which meets the standards approved by the United States public health service for such biological products, and which is approved by the department under such conditions as may be specified by the public health and planning council.
3. The person in parental relation to any such child who has not previously received such immunization shall present the child to a health practitioner and request such health practitioner to administer the necessary immunization against poliomyelitis, mumps, measles, diphtheria, Haemophilus influenzae type b (Hib), rubella, varicella, human papillomavirus (HPV), pertussis, tetanus, pneumococcal disease, meningococcal disease, and hepatitis B as provided in subdivision two of this section.
5. The health practitioner who administers such immunizing agent against poliomyelitis, mumps, measles, diphtheria, Haemophilus influenzae type b (Hib), rubella, varicella, pertussis, human papillomavirus (HPV), tetanus, pneumococcal disease, meningococcal disease, and hepatitis B to any such child shall give a certificate of such immunization to the person in parental relation to such child.
6. In the event that a person in parental relation to a child makes application for admission of such child to a school or has a child attending school and there exists no certificate or other acceptable evidence of the child's immunization against poliomyelitis, mumps, measles, diphtheria, rubella, varicella, hepatitis B, pertussis, tetanus, and, where applicable, Haemophilus influenzae type b (Hib), meningococcal disease, and pneumococcal disease, the principal, teacher, owner or person in charge of the school shall inform such person of the necessity to have the child immunized, that such immunization may be administered by any health practitioner, or that the child may be immunized without charge by the health officer in the county where the child resides, if such person executes a consent therefor. In the event that such person does not wish to select a health practitioner to administer the immunization, he or she shall be provided with a form which shall give notice that as a prerequisite to processing the application for admission to, or for continued attendance at, the school such person shall state a valid reason for withholding consent or consent shall be given for immunization to be administered by a health officer in the public employ, or by a school physician or nurse. The form shall provide for the execution of a consent by such person and it shall also state that such person need not execute such consent if subdivision eight or nine of this section apply to such child.
§ 2. Paragraph (a) of subdivision 7 of section 2164 of the public health law, as amended by chapter 401 of the laws of 2015, is amended to read as follows:
(a) No principal, teacher, owner or person in charge of a school shall permit any child to be admitted to such school, or to attend such school, in excess of fourteen days, without the certificate provided for in subdivision five of this section or some other acceptable evidence of
S. 132 3
the child's immunization against poliomyelitis, mumps, measles, diphtheria, rubella, varicella, human papillomavirus (HPV), hepatitis B, pertussis, tetanus, and, where applicable, Haemophilus influenzae type b (Hib), meningococcal disease, and pneumococcal disease; provided, however, such fourteen day period may be extended to not more than thirty days for an individual student by the appropriate principal, teacher, owner or other person in charge where such student is transferring from out-of-state or from another country and can show a good faith effort to get the necessary certification or other evidence of immunization.
§ 3. The opening paragraph of subdivision 8-a of section 2164 of the public health law, as amended by chapter 401 of the laws of 2015, is amended to read as follows:
Whenever a child has been refused admission to, or continued attendance at, a school as provided for in subdivision seven of this section because there exists no certificate provided for in subdivision five of this section or other acceptable evidence of the child's immunization against poliomyelitis, mumps, measles, diphtheria, rubella, varicella, human papillomavirus (HPV), hepatitis B, pertussis, tetanus, and, where applicable, Haemophilus influenzae type b (Hib), meningococcal disease, and pneumococcal disease, the principal, teacher, owner or person in charge of the school shall:
§ 4. Paragraph (a) of subdivision 1 of section 613 of the public health law, as amended by section 24 of part E of chapter 56 of the laws of 2013, is amended to read as follows:
(a) The commissioner shall develop and supervise the execution of a program of immunization, surveillance and testing, to raise to the highest reasonable level the immunity of the children of the state against communicable diseases including, but not limited to, influenza, poliomyelitis, measles, mumps, rubella, haemophilus influenzae type b (Hib), diphtheria, pertussis, tetanus, varicella, human papillomavirus (HPV), hepatitis B, pneumococcal disease, and the immunity of adults of the state against diseases identified by the commissioner, including but not limited to influenza, smallpox, hepatitis and such other diseases as the commissioner may designate through regulation. Municipalities in the state shall maintain local programs of immunization to raise the immunity of the children and adults of each municipality to the highest reasonable level, in accordance with an application for state aid submitted by the municipality and approved by the commissioner. Such programs shall include assurance of provision of vaccine, serological testing of individuals and educational efforts to inform health care providers and target populations or their parents, if they are minors, of the facts relative to these diseases and immunizations to prevent their occurrence.
§ 5. This act shall take effect on the first of September next succeeding the date on which it shall have become a law; provided, however, that sections one, two and three of this act shall apply only to children born on or after January 1, 1998.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the public health law, in relation to requiring immunization against human papillomavirus (HPV)
Purpose or general idea of bill
To ensure that immunization against HPV be administered to children in New York State in the same manner and according to the same time schedule that other immunizations are currently administered
Summary of specific provisions
Section 1 amends section 2164 of the public health law, as amended by chapter 169 of the laws of 2006.
Read the full memo (1,067 words)
Section 2 amends paragraph (a) of subdivision 1 of section 613 of the public health law, as amended by section 24 of part E of chapter 56 of the laws of 2013.
Section 3 establishes the effective date.
Justification
Cervical cancer is the second-leading cancer among women worldwide, affecting an estimated 470,000 worldwide resulting in 233,000 deaths annually. In the United States, the American Cancer Society (ACS) estimates that approximately 12,990 cases of cervical cancer were diagnosed in 2016 and approximately 4,120 women died from cervical cancer. The American College of Obstetricians and Gynecologists estimates that in New York approximately 1,000 women are newly diagnosed with invasive cervical cancer and approximately 300 women die from the disease.
According to ACS, 99.7% of all cervical cancer cases are linked to human papillomavirus (HPV). The types of HPV that cause cervical cancer are sexually transmitted. ACS estimates that at least 80% of sexually active women in the United States will have HPV by age 50, with most cases acquired soon after individuals have sex for the first time. While the majority of cases resolve on their own, for women whose body defenses are not sufficient to clear the virus, cervical cancer can develop later in life (it can take up to 20 years for an HPV infection to cause cervical cancer).
A vaccine against the types of HPV linked to most cases of cervical cancer, Gardasil, was first approved by the United States Food and Drug Administration in 2006, with a newer version, Gardasil 9, approved in 2014 to cover additional strains of the virus. The Centers of Disease Control and Prevention (CDC) and its Advisory Committee on Immunization Practices (ACIP) recommended the routine vaccination of girls 11-12 years of age, but noted that the vaccine can be given to girls as young as 9 up to age 26. When CDC has recommended the vaccination of school-age children, New York adds such recommended vaccination to the list of vaccinations required for school entry.
Gardasil is shown to protect against two types of HPV that cause about 70% of cervical cancers and two other types of HPV that cause 90% of genital warts. The vaccine is given as a series of three shots over a period of six months. Another vaccine against HPV, Cervarix, was approved by the FDA in 2009.
Cervical cancer screening, through Pap tests and other detection technologies, together with the new vaccine now make cervical cancer one of the most preventable forms of cancers. Further, vaccination against HPV has the potential to significantly reduce cervical cancer incidence and mortality within our underserved populations - poor and rural communities and black and Hispanic communities, which are disproportionately affected by cervical cancer. In 2006, ACS estimated that more than half of the women in the United States diagnosed with cervical cancer had not had a Pap test in the last three years. These women are disproportionately low income, black and Hispanic who lacked access to affordable health services.
The vaccine is most effective when given to individuals before they are infected with HPV through sexual contact. ACIP therefore recommends that females should be vaccinated before sexual activity. To significantly reduce cervical cancer deaths in this country and the world, it is necessary to achieve near-universal vaccination of girls and young women prior to sexual activity. The most effective way to achieve rapid and widespread vaccination, as suggested by the Guttmacher Institute, is by requiring children to be vaccinated prior to attending school. School-based immunization will also help to close racial, ethnic and socioeconomic gaps in immunization rates. Because many individuals have no health insurance coverage or access to affordable care, a school vaccination program will facilitate protecting individuals who are or may potentially become disconnected from health care services.
By requiring vaccination of girls at an early age, before they have engaged in sexual activity and before they have left school, we have a greater chance of preventing cervical cancer. The Guttmacher Institute reports that surveys of teens in the United States show that over 15% of them have had sex by the age of 15 and nearly 50% have had sex by age 19. And, according to the Guttmacher Institute, school dropout rates begin to increase as early as age 13. Middle school may therefore be viewed as "the last public health gate that an entire age-group of individuals pass through together-regardless of race, ethnicity or socio-economic status." Guttmacher Policy Review, Fall 2006. This bill will allow the department of health to determine the age at which girls will be required to be vaccinated in light of ACIP recommendations.
Currently, the cost of the vaccine is covered by Medicaid and Medicaid managed care plans, Child Health Plus and Family Health Plus. The federal Vaccines for Children program covers the vaccination of eligible girls under age 18.
$1.5 million was included in the governor's budget proposal in 2009 to promote and expand access to the vaccine for low-income teens and women.
Texas became the first state to require vaccination of school girls ages 11 and 12 against HPV in 2007, soon to be followed by Virginia, Rhode Island, and the District of Columbia. Since 2006, at least 42 states and territories have introduced legislation to require the vaccine, fund its expansion, or educate the public or school children about the vaccine.
Prior legislative history
S.509-A of 2015-2016 (Hoylman): Died in Health S.7315 of 2014 (Hoylman): Died in Health A.2067 of 2013-2014 (Paulin): Died in Health
Fiscal implication
Minimal to the state, offset by future healthcare costs related to the treatment of cervical cancer.
Effective date
This act shall take effect on the first of September next succeeding the date on which it shall have become a law; provided, however, that sections one of this act shall apply only to children born on or after January 1, 1996.
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