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Checklist for School-Entry Immunization Mandates

Checklist for School-Entry Immunization Mandates. Kim Thorburn Medical Director Planned Parenthood of the Inland Northwest Spokane, WA. To Mandate or Not to Mandate. Effective Public Health Tool Improves coverage Prevents VPDs Minimizes outbreaks & response. Considerations Pragmatic

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Checklist for School-Entry Immunization Mandates

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  1. Checklist for School-Entry Immunization Mandates Kim Thorburn Medical DirectorPlanned Parenthood of the Inland NorthwestSpokane, WA

  2. To Mandate or Not to Mandate Effective Public Health Tool Improves coverage Prevents VPDs Minimizes outbreaks & response Considerations Pragmatic Legal Ethical

  3. Pragmatic Considerations Less intrusive means Community threat from poor coverage Vaccine effectiveness Effect on person-to-person transmission Vaccine safety Supply Cost Potential contribution to inequity Administrative burden Acceptance

  4. Legal Considerations Constitutional standard to “protect the public health & public safety” Exemptions Process for enacting mandates Enforcement

  5. Ethical Considerations Imposition of state’s protective (police) power Transmissibility of infection Prevention of risk behavior Individual responsibility in preventing community harm Pharmaceutical industry & mandates

  6. Implementing School Immunization Mandates: Lessons Learned Anne Bailowitz, MD, MPH Baltimore City Health Department August 20, 2008

  7. Problem Definition • Maryland 2005: hepatitis B and varicella vaccines mandated for 5th-9th graders • Baltimore April 2006: 23,469 students out of compliance (29% of students) • “Great leap forward” – single grade vs multigrade mandated phase-in

  8. Goal • Full compliance by September 2006 • Full compliance by January 2007

  9. Strategy • The stick: risk of school exclusion for non-compliance via mandate (COMAR 10.06.04) • A carrot for BCHD: database monitoring of iz problems and progress via mandatory reporting to Baltimore’s Immunization Registry Program (BIRP) • Carrots for parents: letters; media (radio/TV/bus); autodialer; food gift cards • Collaborators: BCPSS, Housing, community health providers, private docs, iz coalition, BCHD

  10. TOOLS

  11. Implementation • Communication to parents: letters; media • Maximize public clinics: extended hours daily, Saturday, and via mobile clinic (TIKE) • Capacitate schools to outreach/ immunize: refrigerators supplied; vaccines stocked; consents obtained; data transfer to BCHD • Vaccination days at schools with high out-of-compliance numbers

  12. Evaluation • PDSA and QI – what works? • Evaluation of media efficacy via questionnaire: callers to BCHD; parents at clinic sites; and physicians in private practice • All surveys indicated: school letter most effective communication (89% office callers; 63% clinic parents; 78% private practices) • 2nd most effective media tool: radio ads (1% office callers; 10% clinic parents; 30% private practices)

  13. Summary • The simplest approach is sometimes best- the (free) school letter gets the message out • Mandates can help: state and city regulations • Money talks: three supplemental grants • Collaboration is key: School System, Health Department, City Housing Department, health care providers • Agency ties formed during this campaign will facilitate rapid responses to more urgent events in the future

  14. Questions? Anne Bailowitz, MD, MPH Chief, Bureau of Child Health & Immunization Baltimore City Health Department (E) Anne.Bailowitz@baltimorecity.gov (P) 410.236.9285

  15. King County and Washington State Experience: School Immunization RequirementsKrista Rietberg, Epidemiologist, Public Health – Seattle & King County Strong support for school requirements to assure high immunization rates. Desire to have provider and population acceptance first (HPV, varicella). Philosophical exemptions allowed, some school districts high exemption rates Concern about opening opportunity for negative changes (e.g. Thimerosal issue).

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