01/30/2012 01:30 PM Senate HEALTH & SOCIAL SERVICES

               SB 144-STATE IMMUNIZATION PROGRAM                                                                            
                                                                                                                                
1:52:36 PM                                                                                                                    
CHAIR DAVIS announced the consideration of SB 144.                                                                              
                                                                                                                                
SENATOR  CATHY  GIESSEL,  co-sponsor,   introduced  SB  144.  She                                                               
recalled  the  history  of smallpox  inoculation  in  the  United                                                               
States  initiated by  George Washington.  She said  that smallpox                                                               
has been essentially wiped out  due to effective vaccination. She                                                               
shared  the history  of  the Iditarod  Sled  Dog Race,  initially                                                               
called the  Great Race of Mercy,  due to its role  in saving Nome                                                               
from being decimated  by diphtheria, which, today,  has also been                                                               
eradicated  due to  vaccination. Polio  has also  been eradicated                                                               
because of vaccination programs.                                                                                                
                                                                                                                                
She  spoke  of  generous  funding for  Alaska  from  Senator  Ted                                                               
Steven's  office,   which  provided  a   "universal"  vaccination                                                               
program.  In 2008  the Center  for Disease  Control began  to cut                                                               
back federal  funding for the  Alaska Immunization  Program (AIP)                                                               
from  $4.3 million  to $700,000  for FY13.  Due to  this loss  of                                                               
funding, the  state has discontinued vaccinations  for adults and                                                               
for  around 47,000  underinsured children.  SB 144  would provide                                                               
state-funded vaccinations until 2015.                                                                                           
                                                                                                                                
1:58:16 PM                                                                                                                    
JONATHAN  TAYLOR,  intern  to   Senator  Giessel,  presented  the                                                               
sectional  analysis  for the  sponsor.  He  said that  Section  1                                                               
provides  a statement  of legislative  intent pertaining  to AIP,                                                               
which is  established in  Section 2  of the  bill. It  includes a                                                               
summary of the past and future  of the program and emphasizes the                                                               
temporary nature of the program.                                                                                                
                                                                                                                                
Section 2 establishes AIP in  the Department of Health and Social                                                               
Services  (DHSS)   and  requires  the  department   to  determine                                                               
eligibility, moved to adopt regulations,  and apply for available                                                               
funds.  It  establishes  standards  for  provider  and  recipient                                                               
participation  in  the  program  and the  types  of  vaccinations                                                               
covered.                                                                                                                        
                                                                                                                                
Section  3 authorizes  the immediate  adoption of  regulations by                                                               
DHSS.                                                                                                                           
                                                                                                                                
Section 4  establishes a delayed  repeal of  the Act of  June 30,                                                               
2015.                                                                                                                           
                                                                                                                                
Section 5 provides an immediate effective date.                                                                                 
                                                                                                                                
1:59:43 PM                                                                                                                    
SENATOR GIESSEL introduced Rosalyn Singleton and George Rhyneer.                                                                
                                                                                                                                
2:00:31 PM                                                                                                                    
ROSALYN   SINGLETON,  M.D.,   American  Academy   of  Pediatrics,                                                               
testified in support of SB 144.  She recalled her experience as a                                                               
pediatrician before vaccinations were  available. She shared what                                                               
would happen  if vaccinations  were not  reinstated. If  the bill                                                               
does not  pass, next year  the state would provide  vaccines only                                                               
for children  who are eligible  under Medicaid and  Alaska Native                                                               
programs  or who  are uninsured.  This  puts Alaska  at risk  for                                                               
outbreaks of measles and other infections.                                                                                      
                                                                                                                                
2:03:13 PM                                                                                                                    
GEORGE   RHYNEER,  M.D.,   Legislative   Affairs  Chair,   Alaska                                                               
Physicians  and Surgeons,  testified  in support  of  SB 144.  He                                                               
spoke  of  the  benefits  he  and his  family  and  friends  have                                                               
received from the state vaccination  program. He said a letter of                                                               
support would be forthcoming.                                                                                                   
                                                                                                                                
2:04:21 PM                                                                                                                    
RANDI SWEET, United Way of  Anchorage, testified in support of SB
. She encouraged a long-term  funding resolution for the state                                                               
vaccination program.  She described  vaccinations as  critical to                                                               
both  adults'   and  children's  health.  She   referred  to  the                                                               
constitutional  mandate  that  the legislature  provide  for  the                                                               
promotion and  protection of  public health,  which SB  144 would                                                               
do.                                                                                                                             
                                                                                                                                
2:05:52 PM                                                                                                                    
MARY  SULLIVAN, Alaska  Primary  Care  Association, testified  in                                                               
support  of  SB  144.  She  spoke  of  the  negative  effects  on                                                               
community health centers if vaccinations are not increased.                                                                     
                                                                                                                                
2:07:40 PM                                                                                                                    
WARD  HURLBURT,   M.D.,  Director  and  Chief   Medical  Officer,                                                               
Division  of  Public  Health, Department  of  Health  and  Social                                                               
Services (DHSS), testified  on SB 144.  He said  DHSS is in favor                                                               
of the bill, but requires a  minimal fiscal note. He spoke of his                                                               
experience  in Dillingham  when  there were  no vaccinations.  He                                                               
shared that Alaska  currently rates at number 42  among states in                                                               
immunization  programs. Half  of the  children in  Alaska qualify                                                               
for federally funded vaccination  programs. About 25 percent have                                                               
coverage  through  private insurance.  The  bill  targets the  25                                                               
percent  that do  not qualify  for  federal funding  and have  no                                                               
insurance.                                                                                                                      
                                                                                                                                
DR.  HURLBURT  related  that from  a  public  health  standpoint,                                                               
without an  immunization rate  of 80 percent,  there is  no "herd                                                               
immunity", which means  there is a risk to  the whole population.                                                               
Alaska has  the highest percentage  of "parental hesitancy"  at 9                                                               
percent. The department is working  on that issue. He gave credit                                                               
to  the   health  care  workers   in  Talkeetna,   a  challenging                                                               
community, for their efforts to increase the immunization rate.                                                                 
                                                                                                                                
CHAIR DAVIS  commented that  a fiscal  note was  forthcoming from                                                               
DHSS.                                                                                                                           
                                                                                                                                
2:11:56 PM                                                                                                                    
CHUCK  WHEELER, Nome,  testifying  on his  own  behalf, spoke  in                                                               
support of SB 144. He said the  state was notified in 2008 of the                                                               
funding cuts and last year he  was aware of federal funding cuts.                                                               
He noted that immunization costs  keep escalating and the funding                                                               
keeps decreasing. He  shared statistics of high  disease rates in                                                               
Northwest  Alaska. Vaccinations  are not  available in  Nome. The                                                               
uninsured cannot  afford vaccinations. He  supported vaccinations                                                               
as a needed prevention program.                                                                                                 
                                                                                                                                
2:15:18 PM                                                                                                                    
GEORGE BROWN, M.D.,  testified in support of SB  144. He inquired                                                               
about medical costs  per child of the whooping  cough vaccine, as                                                               
opposed  to  the  cost  of  the outbreak  of  whooping  cough  in                                                               
Southeast  Alaska in  2007-8.  He said  the  vaccine costs  about                                                               
$2.40.  He   asked  about   the  cost   of  the   H1N1  influenza                                                               
vaccination, versus the cost of  the epidemic in 2009-10. He said                                                               
the cost  of the vaccine  was about  $3.20. He reported  that the                                                               
cost savings for the measles,  mumps, and rubella vaccination was                                                               
$16  for  every   dollar  invested.  He  noted   that  the  child                                                               
vaccination program in Washington State  consists of a pooling of                                                               
federal, private,  and state  funds to  assure that  all children                                                               
receive all recommended immunizations.                                                                                          
                                                                                                                                
2:18:20 PM                                                                                                                    
CHAIR  DAVIS  said  she  was  familiar  with  Washington  State's                                                               
program  and  suggested  pooling  might   be  a  good  method  of                                                               
providing an immunization  program for Alaska. She  said the task                                                               
at  hand  is  to  fund   Alaska's  program  for  this  year.  She                                                               
emphasized that SB 144 was a very important bill.                                                                               
                                                                                                                                
SENATOR EGAN  referred to  page 3,  subsection (f)(1),  and asked                                                               
why   meningococcal  and   human  papillomavirus   vaccines  were                                                               
exempted.                                                                                                                       
                                                                                                                                
DR. HURLBURT  responded that the  two vaccines were  not included                                                               
because they  are very costly and  the cost benefit ratio  is not                                                               
as good.  For most other  vaccines, the savings in  medical costs                                                               
is about  $8 per child  for every dollar  spent. The goal  of the                                                               
legislation is  to make  the program  affordable and  provide the                                                               
best protection, first for the  children, and then for adults who                                                               
don't have other coverage.                                                                                                      
                                                                                                                                
SENATOR EGAN wondered  why this issue couldn't  be addressed long                                                               
term, rather than temporarily.                                                                                                  
                                                                                                                                
SENATOR  GIESSEL  stated  that  the reason  the  bill  only  goes                                                               
through  2015 is  because the  plan  is to  research other  state                                                               
immunization  programs  in order  to  come  up with  a  long-term                                                               
program for Alaska.                                                                                                             
                                                                                                                                
DR.  HURLBURT  spoke  of  models  found  in  Washington  and  New                                                               
Hampshire. There  are cost and  supply advantages for a  state to                                                               
purchase  all  immunizations  in  order  to  create  a  universal                                                               
program. Alaska is attempting to have a universal program.                                                                      
                                                                                                                                
2:23:55 PM                                                                                                                    
SENATOR  DYSON  said   he  thought  the  bill   could  move  from                                                               
committee.                                                                                                                      
                                                                                                                                
SENATOR DAVIS said she would prefer  to have a fiscal note first.                                                               
She added that  another issue which merits attention  is the "opt                                                               
out" choice parents have.                                                                                                       
                                                                                                                                
SENATOR MEYER questioned how to  address the 9 percent of parents                                                               
who are reluctant to have their children immunized.                                                                             
                                                                                                                                
DR.  HURLBURT  said he  thought  education  was the  solution  to                                                               
dispelling false information about  immunizations. He referred to                                                               
a British study which promoted  a misconception that vaccinations                                                               
caused autism. There is also  the issue that a two-year-old needs                                                               
about  15  shots  over  the first  couple  years,  which  bothers                                                               
parents. Cost is also a  concern. Public health nurses and school                                                               
requirements  are part  of the  solution. Mississippi  has a  law                                                               
that requires a provider's note  to excuse a child from receiving                                                               
vaccinations.                                                                                                                   
                                                                                                                                
SENATOR MEYER asked  what the average rate  of parental hesitancy                                                               
was.                                                                                                                            
                                                                                                                                
DR. HURLBURT  explained that 9  percent is the number  of parents                                                               
who  opt  out  of  having   their  children  immunized.  Alaska's                                                               
immunization  rate   is  currently  60  percent.   Alaska  Native                                                               
children have an immunization rate of 90 percent.                                                                               
                                                                                                                                
CHAIR DAVIS held SB 144 in committee.