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Vaccine mandates and promotion

User:BD2412/Military anthrax cases

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Medicaid coverage

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History of Vaccines: Vaccination Exemptions

Healthcare.gov: Preventive health services (incl. vaccination)

http://www.nvic.org/vaccine-laws.aspx

STATES WITH RELIGIOUS AND PHILOSOPHICAL EXEMPTIONS FROM SCHOOL IMMUNIZATION REQUIREMENTS, NCSL, 8/23/2016

Research: Anti-vax rumors in Afghanistan, Pakistan

Liability for viral outbreak on common carriers.


As readers of the HR Defense blog know, the EEOC filed suit last year on behalf of six former employees of a hospital who were fired after refusing the flu vaccine on religious grounds. The employer allowed for an exemption, but required employees to obtain a certification by a clergy member or other third party that the employee “practices a religion where influenza vaccination is contraindicated according to doctrine or accepted religious practices.”

Requiring A Flu Shot Over Religious Objections: Risky Business, Laurie M. Weinstein on October 24, 2016

13. May an employer covered by the ADA and Title VII of the Civil Rights Act of 1964 compel all of its employees to take the influenza vaccine regardless of their medical conditions or their religious beliefs during a pandemic?

No. An employee may be entitled to an exemption from a mandatory vaccination requirement based on an ADA disability that prevents him from taking the influenza vaccine. This would be a reasonable accommodation barring undue hardship (significant difficulty or expense). Similarly, under Title VII of the Civil Rights Act of 1964, once an employer receives notice that an employee's sincerely held religious belief, practice, or observance prevents him from taking the influenza vaccine, the employer must provide a reasonable accommodation unless it would pose an undue hardship as defined by Title VII ("more than de minimis cost" to the operation of the employer's business, which is a lower standard than under the ADA).

Generally, ADA-covered employers should consider simply encouraging employees to get the influenza vaccine rather than requiring them to take it.

EEOC, EEOC Sues Baystate Medical Center for Religious Discrimination & Retaliation, 6-2-16

EEOC, Saint Vincent Health Center To Pay $300,000 To Settle EEOC Religious Accommodation Lawsuit, 12-23-16

Workplace

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In 1827, Boston enacted the first mandate. Students were required to be inoculated against smallpox.112 By 1963, 20 states and the District of Columbia required various vaccines for school entry.113 By the early 1980s, every state required students to demonstrate that they had received certain immunizations as a prerequisite for school attendance.114

112 Hodge JG, Gostin LO. School vaccination requirements: historical, social, and legal perspectives: A state of the art assessment of law and policy. Center for Law and the Public’s Health. February 15, 2002. 113 James Colgrove. State of Immunity: The Politics of Vaccination in Twentieth-Century America 176-77 (2006).

114 Id.

In September 2004, Virginia Mason Hospital, an acute care hospital in Seattle, Washington became the first facility to implement a mandatory influenza vaccination program. All employees were required to receive seasonal influenza vaccine as a condition of employment. Only those who had a religious objection or a documented vaccine allergy were exempted from the new policy.131

Following Virginia Mason, 87 facilities in 30 states and the District of Columbia have implemented similar vaccination policies. Currently, three local health departments, Cook County Health & Hospitals System in Illinois, Garland Health Department in Texas, and RiverStone Health in Montana have HCW influenza vaccination mandates. 132 131 Rosenbaum S. When Worlds Collide: Public Health and Union Rights in Virginia Mason Hospital vs. Washington State Nurses Association. Public Health Reports. September-October 2008.

132 Immunization Action Coalition. IAC’s Honor Roll for Patient Safety: Institutional Mandates. Available at: http://www.immunize.org/honor-roll/. Accessed February 17, 2011. 1

Other

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California Senate bill (SB) 277 eliminated the personal belief exemption (PBE) provision from the state’s school-entry vaccine mandates prior to the 2016-2017 school year. Previously, vaccine-hesitant parents could acquire a PBE for their child based on philosophical or religious beliefs. Now, the only pathway for an unvaccinated kindergartener to enter a public or private school in California is with a medical exemption (ME), which requires a written statement from a licensed physician describing the medical reasons that immunization is unsafe.1 Previously, MEs were only granted to children with a contraindication to vaccination; however, SB 277 gave physicians broader discretion to grant MEs for reasons other than a contraindication, including family medical history.2,3[1]

Standing orders implicates highly complex state scope of practice laws: Alexandra M. Stewart, Megan C. Lindley, Marisa A. Cox, State Law and Standing Orders for Immunization Services, American Journal of Preventive Medicine (2015)

Medicaid policy impacts provider willingness to vaccinate: Alexandra M. Stewart, Megan C. Lindley, Marisa A. Cox, Medicaid Provider Reimbursement Policy for Adult Immunizations, Vaccine 33 (2015) 5801-5808

Alexandra M. Stewart, Megan C. Lindley, Kristen H.M. Chang, Marisa A. Cox, Vaccination Benefits and Cost-sharing Policy for Non-institutionalized Adult Medicaid Enrollees, Vaccine 32 (2014)

As a companion: Alexandra M. Stewart, Arthur Caplan, Marisa A. Cox, Kristen H.M. Chang, Mandatory Vaccination of Health Care Personnel: Good Policy, Law, and Outcomes, 53 Jurimetrics, The Journal of Law, Science, and Technology (2013)

Also helpful:

U.S. Vaccine Policy course piece: Dalrymple, D.W. and Grabenstein, J.D. “Interwoven support: An historical survey of US federal programs enabling immunization.” Vaccine 32 (2014) Abstract

Access

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A handful of states already have given teens some vaccination rights. California, Delaware, Minnesota, New York and Washington, D.C., enacted laws years before the current measles outbreak giving minors the right to choose to get vaccinated against sexually transmitted diseases, such as human papillomavirus and hepatitis B. Alabama, Alaska, Idaho, Oregon and South Carolina have gone further by giving minors the right to make all health care decisions. Some of their laws date to the 1970s, said Ross Silverman, a professor of health policy management at Indiana University Medical School.

  • Several migrant children died from the flu while in U.S. custody in late 2018 and early 2019. It was reported in August of 2019, as the flu season approached, that Customs and Border Protection (CBP) was unprepared to vaccinate children being held in its detention centers. The CBP issued a statement that migrants “may receive vaccinations by medical personnel at a local medical facility, if determined necessary by the medical professional during their assessment.”due to the short term nature of CBP holding and the complexities of operating vaccination programs, neither CBP nor its medical contractors administer vaccinations to those in our custody,” and that migrants “may receive vaccinations by medical personnel at a local medical facility, if determined necessary by the medical professional during their assessment.”

References

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  1. ^ Paul L. Delamater, PhD1; Timothy F. Leslie, PhD2; Y. Tony Yang, ScD, LLM, MPH3, Change in Medical Exemptions From Immunization in California After Elimination of Personal Belief Exemptions, September 5, 2017, JAMA. 2017;318(9):863-864. doi:10.1001/jama.2017.9242
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