007 Vaccination Requirements to Protect All Children (Amendments to C&B)

Submitted by:  American Association of Public Health Physicians

WHEREAS the recent re-emergence and widespread dissemination of serious vaccine preventable disease within the United States invites a reexamination of State, federal, and AMA immunization policies; and

WHEREAS there is widespread confusion regarding state regulations that require mandatory immunizations for entry into schools and similar settings; and

WHEREAS the granting of religious and philosophical (or “personal belief”) exemptions from mandatory vaccination has the potential to undermine population immunity; and

WHEREAS in many communities and schools, religious and philosophical exemptions have led to dangerously low vaccination levels, with predictable consequences; and

WHEREAS, as was evident from the recent “Disneyland”  measles outbreak, today’s mobile society accelerates the geographic spread of vaccine preventable diseases, and

WHEREAS the recent re-emergence experience has clearly established that states which limited the granting of exemptions for only certain indicated medical conditions were much more effective in preventing  the spread of vaccine preventable diseases than states that did not, therefore be it

RESOLVED that our AMA will provide materials on vaccine efficacy to states, and encourage them to eliminate philosophical and religious exemptions from state immunization requirements (directive to take action); and be it further

RESOLVED that our AMA recommends that states have in place: (a) an established decision mechanism that involves qualified  public health physicians to determine which vaccines will be mandatory for admission to school and other identified public venues (based upon the recommendations of ACIP and AAP); (b) exemptions to these immunization mandates only for medical reasons, because disease exposures, importations, infections, and outbreaks may occur without warning in any community, and (c) a procedure whereby a licensed physician may certify a medical exemption using science based criteria as documented on the vaccine information sheets for specific vaccines (http://www.cdc.gov/vaccines/hcp/vis/), with State oversight to ensure timeliness and consistency [new HOD policy, see existing H-440.970].

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RELEVANT AMA POLICY

H-440.970 Religious Exemptions from Immunizations

Since religious/philosophic exemptions from immunizations endanger not only the health of the unvaccinated individual, but also the health of those in his or her group and the community at large, the AMA (1) encourages state medical associations to seek removal of such exemptions in statutes requiring mandatory immunizations; (2) encourages physicians and state and local medical associations to work with public health officials to inform religious groups and others who object to immunizations of the benefits of vaccinations and the risk to their own health and that of the general public if they refuse to accept them; and (3) encourages state and local medical associations to work with public health officials to develop contingency plans for controlling outbreaks in exempt populations and to intensify efforts to achieve high immunization rates in communities where groups having religious exemptions from immunizations reside. (CSA Rep. B, A-87; Reaffirmed: Sunset Report, I-97; Reaffirmed: CSAPH Rep. 3, A-07)

[Submitters note that the second “Resolved” would strengthen H-440.970(1) by clarifying that the removal of religious and philosophic exemptions is AMA policy, not just AMA encouragement to state medical associations, and by recommending a general policy framework for recommending State policies and for dealing with exemption requests in each state.]

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D-440.947 Support for Immunizations

1. Our AMA will provide materials on vaccine safety and efficacy to states and encourage them to enact more stringent requirements for parents/legal guardians to obtain personal belief exemptions from state immunization requirements.

2. Our AMA, in collaboration with the Immunization Alliance, will develop educational materials that can be distributed to patients and their families clearly articulating the benefits of immunizations and highlighting the exemplary safety record of vaccines.

3. Our AMA will communicate and work with other concerned organizations about effective ways to continue to support immunizations while rejecting claims that have no foundation in science.

4. Our AMA will continue its ongoing efforts with other immunization advocacy organizations to assist physicians and other health care professionals to effectively communicate to patients, parents, policy makers, and the media that vaccines do not cause autism and that decreasing immunization rates have resulted in a resurgence of vaccine-preventable diseases and deaths; and will continue to support ongoing research into the etiology and treatment of autism.

5. Our AMA will actively oppose any vaccine legislation that would deviate from evidence-based recommendations and guidelines of the Centers for Disease Control and Prevention, the Advisory Committee on Immunization Practices, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists.

6. Our AMA encourages physicians to follow medical contraindications to vaccines when parents seek a note for a medical exemption from vaccines to attend school. (Res. 922, I-08; Reaffirmed: Res. 501, A-09; Appended and Reaffirmed: Res. 501, A-09; Reaffirmed and Appended: Res. 911, I-09; Appended: Res. 505, A-13)

[Submitters note that the first “Resolved” would strengthen D-440.947(1) by encouraging states to eliminate religious and philosophical (“personal belief”) exemptions altogether, thus bringing D-440.947 into conformance with H-440.970.]

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H-440.992 National Immunization Program

Our AMA believes the following principles are required components of a national immunization program and should be given high priority by the medical profession and all other segments of society interested and/or involved in the prevention and control of communicable disease: (1) All US children should receive recommended vaccines against diseases in a continuing and ongoing program.

(2) An immunization program should be designed to encourage administration of vaccines as part of a total preventive health care program, so as to provide effective entry into a continuous and comprehensive primary care system.

(3) There should be no financial barrier to immunization of children.

(4) Existing systems of reimbursement for the costs of administering vaccines and follow-up care should be utilized.

(5) Any immunization program should be either (a) part of a continuing physician/patient relationship or (b) the introductory link to a continuing physician/patient relationship wherever possible.

(6) Professionals and allied health personnel who administer vaccines and manufacturers should be held harmless for adverse reactions occurring through no fault of the procedure.

(7) Provision should be made for a sustained, multi-media promotional campaign designed to educate and motivate the medical profession and the public to expect and demand immunizations for children and share responsibility for their completion.

(8) An efficient immunization record-keeping system should be instituted. (Res. 44, A-77; Reaffirmed: CLRPD Rep. C, A-89; Reaffirmed: Sunset Report, A-00; Reaffirmed: Res. 501, A-09; Reaffirmation I-10)