New Flu Shot Rules in New York City May Fan Debate Elsewhere, Including Calif.

A new policy requiring preschool children to receive the influenza vaccine went into effect Jan. 1 in New York City, bringing a new level of regulatory clout, as well as attention to other legislative efforts mandating immunization.

California immunization advocates support the New York City law and hope it helps spark discussions elsewhere.

“From a clinical perspective, as well as a public health perspective, it’s a great idea,” said Catherine Flores Martin, director of the California Immunization Coalition, a statewide advocacy group.

“Children are vectors. They usually get over the flu, but when they get sick they bring it home and give it to everybody else. The CDC recommends everyone over the age of six months get the flu vaccine. It used to be everyone over 65, then it was 50 and now it’s pretty much everybody.”

Regulatory efforts in California have been aimed at getting health care workers to get flu shots, but new rules such as the preschool mandate may broaden the scope.

“There will definitely be a lot of discussion about it,” Flores Martin said. “Depending on what happens in New York, I think you can expect to see some ripple effect.”

New York City’s new rules will begin to be reflected in statistical data within a year, Flores Martin said. “So we should know in the next year or two about how the new regulation affects public health.”

The debate over flu immunizations ebbs and flows partly in response to news of flu fatalities, Flores Martin said.

“Thousands of people die every year of the flu — usually elderly people. But when there’s a child death — and it does happen — that really gets people’s attention,” Flores Martin said.

California Bill Passed, Vetoed

Two years ago, the California Legislature passed a bill that would have required health care workers to get flu vaccines. Gov. Jerry Brown (D) vetoed it.

In his veto of SB 1318 by Sen. Lois Wolk (D-Davis), Brown said:

“Encouraging health care workers to be vaccinated against influenza is good policy, and I support the national goal of achieving a 90% compliance rate by 2020. Indeed, several counties and many hospitals have already adopted strict mandatory vaccination policies for their employees, and others are moving voluntarily in this direction.

“This bill would move the date up to 2015 and make compliance mandatory, which are requirements I do not believe are reasonable. I have confidence that local governments and health facilities are well equipped to make these decisions on their own.”

Flores Martin expects the issue to return to the state Legislature, but probably not this year.

“We have discussed mandatory flu shots for child health care providers and people who work with children — that might be a starting point,” Flores Martin said.

Advocates Encouraged by Exemption Decline

Immunization advocates were encouraged by statistics released last month by the California Department of Public Health showing vaccination rates for a variety of non-flu maladies among California kindergarten students are up from last year.

The California Immunization Coalition was a co-sponsor of a bill passed by the Legislature and signed by the governor in 2012 that required parents to fill out new paperwork to exempt their children from immunizations against several diseases, including chicken pox, diphtheria, polio, measles and pertussis.

“It’s great to see that bill had an impact already,” Flores Martin said. “The trend was that personal belief exemptions were going up and up and up, and now it’s started to go down.”

The new law established by AB 2109 — by Richard Pan (D-Sacramento), who was then an Assembly member and now is a state senator — required parents to obtain documentation proving they had been advised by health care practitioners about vaccines and diseases before they can opt out of vaccinating their children.

State officials reported last month that 46 of California’s 58 counties reported fewer personal-belief exemptions this year, compared with last year.

“I think what we’re seeing is a reduction in the casual use of the exemption,” Flores Martin said. “I can’t document that, but my feeling is a big part of the drop has been mostly those parents who used to opt out because it was the easiest option.”

Flores Martin said her organization’s goal is to achieve 98% vaccination of kindergartners in California.

“We’re not that far off,” she said.

‘Not an Optional Choice’

California immunization advocates point to a wide swath of recent disease outbreaks on college campuses and in children — measles, meningitis, pertussis and others — as indications that more attention needs to be paid to public health issues.

“It’s important to keep a focus on maintaining and building the basic infrastructure of public health,” Flores Martin said. “You’re seeing a lot of problems show up on college campuses lately — meningitis, mumps, measles.

“From a policy and priority perspective, public health is not an optional choice. Funding has to be solid for public health efforts. If we’re not funding them appropriately and providing support in the infrastructure, you’re going to see more of these problems.”

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