NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A933
SPONSOR: Paulin (MS) TITLE OF BILL:
An act to amend the public health law, in relation to requiring immuni-
zation 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 sched-
ule that: other immunizations are currently administered.
SUMMARY OF SPECIFIC PROVISIONS:
Section one amends the section heading and subdivisions 2, 3, 5, 6, 7,
and 8 of section 2164 of the public health law, as amended by chapter
401 of the laws of 2015, 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 boost-
er is required; a person in parental relationship to a child shall
request a vaccine if not previously administered; 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 relationship 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 accepta-
ble evidence of the child's immunization. A form shall be provided by
the school to a person in parental relationship 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.
Paragraph (a) of subdivision 7 is amended 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.
The opening paragraph of subdivision 8-a is amended by adding HPV to the
list of required immunizing agents for which a certificate of immuniza-
tion is required in relation to preventing a child from attending
school.
Section two amends paragraph (a) of subdivision 1 of section 613 of the
public health law, as amended by section 24 of part E of chapter 56 of
the laws of 2013, 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 three 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 Society (ACS) esti-
mates that approximately 11,150 cases of cervical cancer will be diag-
nosed this year and approximately 3,670 women will die from cervical
cancer. The American College of Obstetricians and Gynecologists esti-
mates 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).
In addition, the Centers of Disease Control and Prevention reports that
every year, over 9,000 males are affected by cancers caused by HPV
infections that do not go away. HPV can cause cancers of the anus,
mouth/throat (oropharynx), and penis in males.
The CDC and its Advisory Committee on Immunization Practices (ACI)
recommends routine vaccination against HPV for both girls and boys 11-12
years of age, but noted that the vaccine can be given to individuals as
young as 9 and 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
vaccination before sexual activity. To significantly reduce deaths
caused by cervical cancer and cancers of the mouth/throat, anus, and
penis, it is necessary to achieve near-universal vaccination of girls
boys 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 socioeconomic gaps in immunization
rates. Because many individuals have no health insurance coverage or
access to affordable care, a school vaccination 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, according 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 indi-
viduals pass through together-regardless of race, ethnicity or socio-e-
conomic status." Guttmacher Policy Review, Fall 2006. This bill will
leave to the department of health to determine the age at which children
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 Vaccines for Children program covers the vaccination of eligible
girls under age 18. In addition, HPV vaccines for the recommended age
groups of males and females, Pap tests, and HPV testing for women are
all covered under the preventative care mandates of the federal Afforda-
ble Care Act.
The District of Columbia, Rhode Island, and Virginia currently require
vaccination for school entry, and legislation requiring vaccination for
school entry has recently been under consideration in twenty-four other
states.
PRIOR LEGISLATIVE HISTORY:
A.1822, 2016 and 2017 referred to health.
A.2067, 2013 and 2014 referred to health.
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 and other cancers caused by HPV.
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.
