KAILUA-KONA — As of last month, the state Department of Health is reviewing more than 800 testimonies submitted in response to the state’s proposed updated immunization requirements for schools.
If enacted, the rule changes would bring the state in line with recommendations from a federal panel tasked with developing recommendations related to vaccinations.
The updated requirements’ inclusion of the human papillomavirus (HPV) vaccine for students entering seventh grade would make Hawaii just the third state in the country to require that particular vaccination for school attendance.
Dr. Sarah Park, the state epidemiologist, said the updates aren’t targeted at any specific vaccination, however, and for parents whose kids are up-to-date with vaccinations, things won’t seem any different.
“If you’ve been having your child go to a health care provider and getting their vaccines on time, you have nothing to worry about, because these rules will not affect you,” she said. “You won’t notice a difference, really, because if you’re making sure your child is appropriately vaccinated, then that’s all we’re trying to do, is make sure that that’s reflected in our requirements.”
If approved, Hawaii’s requirements are expected to go into effect in time for the 2020-21 school year. Exemption requests will continue to be available for parents who wish to claim a medical or religious exemption for their child.
INTRODUCING HPV
Among the proposed required vaccines for seventh grade attendance is the vaccine against HPV, a sexually transmitted infection.
Only two other states, Rhode Island and Virginia, require the vaccine for school attendance, as does Washington, D.C., according to the National Conference of State Legislatures.
In Hawaii, the percentage of youth getting the vaccine has climbed in the years before the proposed requirement.
In 2014, 38 percent of Hawaii girls 13-17 and 30.9 percent of boys 13-17 had received three doses of the HPV vaccine, according to the CDC’s National Center for Immunization and Respiratory Diseases. By 2017, the rate had grown to 58 percent of girls and 40.2 percent of boys.
The CDC estimates that nearly 80 million people in the U.S. are currently infected with HPV and about 14 million people become infected each year.
While most people with HPV never experience any symptoms or problems and 90 percent of infections go away within two years, the virus can sometimes last longer and cause certain cancers in men and women.
Among the cancers linked to HPV is cervical cancer, which the National Cancer Institute under the U.S. Department of Health and Human Services estimated resulted in 4,170 deaths last year.
The CDC attributes 91 percent of the average 11,866 cervical cancers to HPV.
An average of 33,737 cancers a year in both men and women in the United States are attributed to HPV by the CDC, more than 31,000 of which, the agency says, HPV vaccination can stop from ever developing.
NEW, OLD REQUIREMENT
While Hawaii would be among a very small group of states to include the vaccine among its requirements for students, Park pointed out that a vaccine against HPV has been licensed since 2006.
“It’s now 2019,” she said, “so I don’t know that Hawaii really is that forward, to be frank, when it’s been 13 years since an anti-cancer vaccine has been licensed and recommended.”
That said, she emphasized that pursuing the updates isn’t about any specific vaccine as much as it’s about making sure the state’s requirements are up to date and in line with the national recommendations of the Advisory Committee on Immunization Practices, a group of medical and public health experts responsible for developing recommendations related to vaccines.
Park said Department of Health staff are currently in the process of reviewing testimony submitted in response to the proposed updates.
“We’re taking our responsibility very seriously to review every single one of these testimonies and provide an appropriate response back to each and every one of them,” she said. “So that takes some time.”
Heather Winfield-Smith, Vaccines for Children program coordinator, said the testimonies are being categorized according to the points raised within them and the department will prepare responses to the points raised.
In total, the department received about 800 testimonies in addition to those given at public hearings held throughout the state and about 62 percent of it has been opposed and 36 percent in support. The rest only provided comments.
Park said that reading into those numbers as being reflective of the community is “very skewed.” Much of the opposition has come from individuals, while the testimony in support has generally been from organizations with large memberships.
And Winfield-Smith said the testimony from all angles has offered “some interesting perspectives” for the department’s consideration.
“It’s helpful to hear some of these things, even from those who are opposed,” she said. “Because among some of those who are opposed, we find that maybe there’s just one sticking point that it’s really a misunderstanding of what they’re interpreting.”
WHAT THE NUMBERS SAY
When state lawmakers in 2017 considered a bill that would let pharmacists give vaccines — including the HPV vaccine — to children aged 11-17, many of those who testified against the bill raised safety concerns with the vaccine, citing reports of adverse reactions recorded in a federal system designed to detect potential issues with vaccines in the United States.
A frequent argument from opponents argued that by the end of September 2015, there were 37,474 reports made to the Vaccine Adverse Event Reporting System, or VAERS, “associated with Gardasil vaccinations,” — a figure that appears to reference reports to VAERS following vaccination with Gardasil — which is no longer available in the country — as well as Gardasil 9 — which is currently the only HPV vaccine available in the country, according to the CDC.
From its licensure at the end of 2014 through December 2017, the CDC said, about 29 million doses of Gardasil 9 have been distributed in the United States.
A VAERS search on Saturday returned 9,717 reports that had been received following a Gardasil 9 vaccination as of the end of last year, almost 97 percent of which weren’t considered serious.
A similar search of reports that were received following Gardasil vaccinations returned 36,419 reports, 93 percent of which were classified as not serious.
The CDC said from the FDA’s 2006 approval of Gardasil through December 2017, more than 80 million doses of Gardisal had been distributed in the country.
In both cases, the most commonly reported symptoms included dizziness, headaches and fainting.
The CDC has also found no causal link between the vaccination and 117 deaths that were reported after a vaccination. A study published in the journal of the American Academy of Pediatrics “did not find any deaths causally associated” with the HPV vaccine or any other.
The VAERS website itself also carries a disclaimer saying its data “should be used with caution” and users researching the data are repeatedly advised that the inclusion of adverse reports doesn’t imply the vaccine is responsible.
State residents have also in the past raised moral objections to mandating the vaccine, arguing the state has no place in requiring parents to vaccinate their kids.
“I believe everyone has a right to choose whether to vaccinate or not vaccinate based on their free will,” wrote one person in public testimony for an unsuccessful 2016 bill that would have required children to get at least one dose of the HPV vaccine before attending seventh grade.
EXEMPTIONS STILL AVAILABLE
Judy Strait-Jones, president of the Hawaii Immunization Coalition, said she’s confident in the steps the Department of Health is taking in updating the vaccination requirements, specifically referencing the amount of time the department takes collecting and looking at testimony.
“It’s a very rigorous process,” she said. “It’s not something that is just sort of flippant.”
She recommended those with questions about the vaccines look to the CDC or contact the Department of Health, and both Park and Winfield-Smith recommended parents with concerns speak with their family doctor.
The new requirements in Hawaii aren’t expected to go into effect until July 2020 and be in effect for schools that fall, which will give the department time to get the word out to parents.
Park added that they haven’t yet developed an education campaign for the community, but noted that the immunization program doesn’t get any funding from the Legislature.
“We will do our best,” she said, saying they are trying to use social media and revamp their websites to become “more user-friendly.”
The DOH also said the rules have no impact on the medical and religious exemptions, which will continue to be available for those seeking to request one.