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 144. 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.