NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A2067
SPONSOR: Paulin (MS) TITLE OF BILL: An act to amend the public health law, in relation to
requiring immunization against human papillomavirus (HPV)
PURPOSE OR GENERAL IDEA OF BILL: To ensure that immunization against
HPV be administered to children in New York State in the same manner and
according to the same time schedule that other immunizations are
currently administered
SUMMARY OF SPECIFIC PROVISIONS: Section one amends the section head-
ing and subdivisions 2, 3, 5, and 6 of section 2164 of the public health
law, as amended by chapter 169 of the laws of 2006, subdivision 2 as
separately amended by chapter 506 of the laws of 2006, by adding human
papillomavirus (HPV) to the list of required immunizing agents, such as
those against poliomyelitis, mumps and measles, to be administered to
children in this state. Section one also adds the HPV vaccine to the
list of vaccines for which: a booster is required; a person in parental
relationship to a child shall request a vaccine if not previously admin-
istered; a health practitioner who administers such immunizing agents
shall give a certificate of immunization to the person in parental
relation to a child who has been vaccinated; a person in parental
relation shall be notified by a principal, teacher, owner or person in
charge of the school that the school has not received a certificate of
immunization or other acceptable evidence of the child's immunization. A
form shall be provided by the school to a person in parental relation-
ship to a child not yet vaccinated which allows such person to either
state a valid reason for withholding consent to immunize such child or
to give permission to the school to immunize the child. The law
currently permits a religious exemption to mandated immunizations.
Section two amends paragraph (a) of subdivision 7 of section 2164 of the
public health law, as amended by chapter 189 of the laws of 2006, by
adding HPV to the list of immunizations for which a certificate of
immunization is required by a school in order to allow a child to attend
such school in excess of fourteen days. If a student is transferring
from out-of-state or from another country and can show a good faith
effort to get the certificate or other evidence of immunization, the
time period may be extended to thirty days.
Section three amends the opening paragraph of subdivision 8-a of section
2164 of the public health law, as amended by chapter 189 of the laws of
2006, by adding HPV to the list of required immunizing agents for which
a certificate of immunization is required in relation to preventing a
child from attending school.
Section four amends paragraph (a) of subdivision 1 of section 613 of the
public health law, as amended by chapter 36 of the laws of 2010, by
adding HPV to the list of communicable diseases against which the
commissioner of health shall develop and supervise the execution of a
program of immunization, surveillance and testing in order to raise to
the highest reasonable level the immunity of children in the state.
Section five provides the effective date.
JUSTIFICATION:; Cervical cancer is the second-leading cancer among
women worldwide, affecting an estimated 470,000 worldwide resulting in
233,000 deaths annually. In the United States, the American Cancer Soci-
ety (ACS) estimates that approximately 11,150 cases of cervical cancer
will be diagnosed this year and approximately 3,670 women will die from
cervical cancer. The American College of Obstetricians and Gynecologists
estimates that in New York approximately 1,000 women are newly diagnosed
with invasive cervical cancer and approximately 300 women die from the
disease.
According to ACS, 99.7% of all cervical cancer cases are linked to human
papillomavirus (HPV). The types of HPV that cause cervical cancer are
sexually transmitted. ACS estimates that at least 80% of sexually active
women in the United States will have HPV by age 50, with most cases
acquired soon after individuals have Sex for the first time. Guttmacher
Policy Review, Fall 2006. While the majority of cases resolve on their
own, for women whose body defenses are not sufficient to clear the
virus, cervical cancer can develop later in life (it can take up to 20
years for an HPV infection to cause cervical cancer).
A vaccine against the types of linked to most cases of cervical cancer,
Gardasil, was approved last year by the United States Food and Drug
Administration. The Centers of Disease Control and Prevention (CDC) and
its Advisory Committee on Immunization Practices (ACI?) recommended the
routine vaccination of girls 11-12 years of age, but noted that the
vaccine can be given to girls as young as 9 up to age 26. When CDC has
recommended the vaccination of school-age children, New York adds such
recommended vaccination to the list of vaccinations required for school
entry.
Gardasil is shown to protect against two types of HPV that cause about
70% of cervical cancers and two other types of HPV that cause 90% of
genital warts. The vaccine is given as a series of three shots over a
period of six months. Another vaccine against HPV, Cervarix, was
approved by the FDA in 2009.
Cervical cancer screening, through Pap tests and other detection tech-
nologies, together with the new vaccine now make cervical cancer one of
the most preventable forms of cancers. Further, vaccination against HPV
has the potential to significantly reduce cervical cancer incidence and
mortality within our underserved populations - poor and rural communi-
ties and black and Hispanic communities, which are disproportionately
affected by cervical cancer. In 2006, ACS estimated that more than half
of the women in the United States diagnosed with cervical cancer had not
had a Pap test in the last three years. These women are disproportion-
ately low income, black and Hispanic who lacked access to affordable
health services.
The vaccine is most effective when given to individuals before they are
infected with HPV through sexual contact. ACIP therefore recommends that
females should be vaccinated before sexual activity. To significantly
reduce cervical cancer deaths in this country and the world, it is
necessary to achieve near-universal vaccination of girls and young women
prior to sexual activity. The most effective way to achieve rapid and
widespread vaccination, as suggested by the Guttmacher Institute, is by
requiring children to be vaccinated prior to attending school. School-
based immunization will also help to close racial, ethnic and socioeco-
nomic gaps in immunization rates. Because many individuals have no
health insurance coverage or access to affordable care, a school vacci-
nation program will facilitate protecting individuals who are or may
potentially become disconnected from health care services.
By requiring vaccination of girls at an early age, before they have
engaged in sexual activity and before they have left school, we have a
greater chance of preventing cervical cancer. ACS reports that surveys
of teens in the United States show that almost one quarter of them have
had sex by the age of 15 and 7096 have had sex by age 18. And, accord-
ing to the Guttmacher Institute, school dropout rates begin to increase
as early as age 13. Middle school may therefore be viewed as "the last
public health gate that an entire age-group of individuals pass through
together-regardless of race, ethnicity or socio-economic status." Gutt-
macher Policy Review, Fall 2006. This bill will leave to the department
of health to determine the age at which girls will be required to be
vaccinated in light of ACIP recommendations.
Currently, the cost of the vaccine is covered by Medicaid and Medicaid
managed care plans, Child Health Plus and Family Health Plus. The feder-
al al Vaccines for Children program covers the vaccination of eligible
girls under age 18.
$1.5 million was included in the governor's budget proposal in 2009 to
promote and expand access to the vaccine for low-income teens and women.
Texas recently became the first state to require vaccination of school
girls ages 11 and 12 against HPV and legislation requiring vaccination
in the schools is currently being considered in 18 other states and the
District of Columbia.
PRIOR LEGISLATIVE HISTORY: A.699, 2011 and 2012 referred to health. A.
778, 2009 and 2010 referred to health. A.5810, 2007 and 2008 referred
to health.
FISCAL IMPLICATION: Minimal to the state, offset by future healthcare
costs related to the treatment of cervical cancer.
EFFECTIVE DATE: This act shall take effect on the first of September
next succeeding the date on which it shall have become a law; provided,
however, that sections one, two and three of this act shall apply only
to children born on or after January 1, 1996.
