HPV Vaccine: State Legislation and Statutes

6/12/2018

MicroscopeBackground

Discussion continues about whether or not to require girls and boys to be vaccinated against Human Papillomavirus (HPV), which causes most cases of cervical cancer and genital warts. In 2006, the Centers for Disease Control and Prevention (CDC), through the national Advisory Committee on Immunization Practices (ACIP), first issued guidelines for girls between ages 11 and 12 to receive the HPV vaccine. In 2011, for the first time, ACIP expanded those guidelines to recommend the vaccine for boys between ages 11 and 12 as a form of cancer prevention. The June 2016 recommendation by ACIP recommends the routine vaccination of boys and girls between ages 11 and 12.

According to the Centers for Disease Control and Prevention (CDC), 79 million Americans are infected with HPV.  There is no cure for HPV, only treatment for related health problems. Most strains of HPV do not produce cancer or any symptoms and disappear on their own. When it does not go away, however, HPV can cause cancer and genital warts. In the United States, nearly 12,000 women are diagnosed with cervical cancer each year and over 4,000 women die from it. This number is much smaller than in other countries largely because of the Papanicolaou (Pap) test, a screening tool for cervical cancer. The American Cancer Society reports that, with early detection, cervical cancer is usually treatable.  

Currently, Gardasil 9 is the only HPV vaccine available in the United States. The Advisory Committee on Immunization Practices (ACIP) recommends administering the vaccine to girls and boys between 11 and 12 years of age, before they become sexually active. ACIP recommends an immunization schedule of 2 doses before the 15th birthday and 3 doses after the 15th birthday.

Aside from recommendations by ACIP, school vaccination requirements are decided mostly by state legislatures. Some state legislatures have granted regulatory bodies such as the health department the power to require vaccines, but they still need the legislature to provide funding. 

The debate in states has centered, in part, around school vaccine requirements, which are determined by individual states. Some stakeholders who support access to the vaccine do not support a school mandate, citing concerns about the drug's cost, safety, and parents' rights to refuse. Still others may have moral objections related to a vaccine mandate for a sexually transmitted disease. Financing is another concern. If states make the vaccine mandatory, they must also address funding issues, including Medicaid and CHIP coverage, youth who are uninsured, and whether to require coverage by insurance plans. This has caused some to push for further discussion and debate about whether or not to require the vaccine.

The CDC announced that the HPV vaccine is available through the federal Vaccines for Children (VFC) program in all 50 states, Washington DC and the eight US territories. VFC provides vaccines for children ages nine to 18 who are covered by Medicaid, Alaskan-Native or Native American children, and some underinsured or uninsured children. 

Facts About HPV

  • More HPV-associated cancers occurred in the cervix than any other site—about 11,693 per year.
  • HPV is the name of a group of viruses that includes more than 100 different types.
  • 16,479 potentially HPV-associated cancers of the head and neck (oral cavity and oropharynx) occur per year.
 

State Legislative Action

Since 2006, legislators in at least 42 states and territories have introduced legislation to: require the vaccine, fund the vaccine or educate the public or school children about the HPV Vaccine.  At least 25 states and territories have enacted legislation, including Colorado, District of Columbia, Illinois, Indiana, Iowa, Louisiana, Maine, Maryland, Michigan, Minnesota, Missouri, Nevada, New Mexico, New York, North Carolina, North Dakota, Oregon, Puerto Rico, Rhode Island, South Dakota, Texas, Utah, Virginia, Washington and Wisconsin. The Michigan Senate was the first to introduce legislation (SB 1416) in September of 2006 to require the HPV vaccine for girls entering sixth grade, but the bill was not enacted. Ohio also considered legislation in late 2006 to require the vaccine (HB 703), which also failed. 

Other State Action

While most states have addressed HPV vaccination requirements through the legislature, some states acted through the executive branch. According to the CDC, the New Hampshire Health Department announced in 2006 that it would provide the vaccine at no cost to girls under age 18. In May 2007, the department reported they had distributed over 14,000 doses in the state. On February 2, 2007, Texas became the first state to enact a mandate-by executive order from the governor-that all females entering the sixth grade receive the vaccine, with some exceptions.  Legislators in Texas passed H.B. 1098 but overrode the executive order and the governor withheld his veto. In 2015, the Rhode Island Department of Health decided to require the vaccine for seventh graders. The Department is authorized to do this without legislative approval.

School Requirements

Three jurisdictions currently require HPV vaccines for school attendance: Rhode Island, Virginia, and District of Columbia. In July 2015, the Rhode Island Department of Health announced a HPV vaccine requirement for seventh graders starting in September 2015. As mentioned in the previous section, The Rhode Island Department of Health had the ability to do this without legislative action. The Virginia legislature passed a school vaccine requirement in 2007. The District of Columbia’s bill was enacted and the requirement started 30 days after Congressional Review Period expired. See the bills marked under the school mandate column in the table below for more information.

As of May 2018, at least eight states have proposed HPV-related legislation for the 2017-2018 sessions. Below are two tables: The first includes any proposed or enacted legislation from the 2017-2018 legislative session and the second includes any enacted legislation previous to 2017.

 

NOTE: BOLDED ROW TEXT INDICATES LEGISLATION PASSED BY LEGISLATURE.
HPV VACCINE: STATE ACTIONS AND INTRODUCED LEGISLATION 2017-2018.
State Summary Mandated for School Attendance
Georgia

HR 376 Would promote the awareness of cervical cancer prevention and the availability of HPV vaccines to parents and children. Would also recognize Feb. 24, 2017 as Cervical Cancer Prevention Day at the state capitol.  (Passed House 2/22/17)

HR 500  Would promote the awareness of cervical cancer prevention and the availability of HPV vaccines to parents and children. (Passed House 3/3/17)

No
Hawai'i SB 514 Would allow pharmacists to prescribe and administer HPV vaccines to persons between 11 and 17 years old with required training. (Passed House and Senate with amendments 4/5/17) No
Illinois SB 2043 Would allow the health department to provide information to legal guardians of children entering sixth grade about HPV and cancer, as well as recommend that children receive the vaccine. (Re-referred to committee 3/17/17) No
Minnesota SF 1129 Would allow minors to consent for HPV vaccination. (Sent to committee 2/20/17) No
Minnesota SF 1994 Would allow minors to consent for HPV vaccination. (Sent to committee 3/9/17) No
Minnesota HF 2379 Would allow minors to consent for HPV vaccination. (Sent to committee 3/13/17) No
Minnesota HF 2469 Would allow minors to consent for HPV vaccination. (Sent to committee 3/20/17) No
New Mexico SB 331 Would appropriate funds to allow the University of New Mexico to fund the operation of a statewide HPV registry. (Voted do pass from committee  2/17/17) No
New York AB 933 Would require HPV vaccines for all children born after January 1, 1994. (Pending) Yes
New York SB 132 Would require HPV vaccines for all children born after January 1, 1998. (Pending)

Yes

New York SB 4936 Would encourage the voluntary vaccination against HPV of school-aged children by their parents and guardians. (Pending) No
Texas HB 107 Would require a HPV immunization rate report by the Department of Health to be published by January 31 each year. (Sent to committee 2/13/17) No
Texas SB 2041 Would require a HPV immunization rate report by the Department of Health to be published by January 31 each year. (Sent to committee 3/28/17) No
Rhode Island SB 489 Would preclude the requirement of HPV vaccination as a precondition of school attendance. (In committee, hearing postponed 3/23/17) No

 

HPV Vaccine: State Actions and Introduced Legislation 2015-2016.
State Summary Mandated for School Attendance
New York AB 1822 Would provide for the immunization of all children born after Jan. 1, 1996 with the HPV vaccine. (Sent to committee 1/13/15)  
New York SB 117 Would encourage, through the provision of written educational materials and consultation, the voluntary vaccination against human papillomavirus (HPV) for school-aged children by their parents or guardians. (Sent to Senate committee on health and amended 1/20/16)  
New York SB 509 Would provide for the immunization of all children born after a specified date with the human papillomavirus (HPV) vaccine. (Amended in Senate committee on health 1/15/16)  
Rhode Island Rhode Island Department of Health announces a HPV vaccine requirement for seventh graders starting in September, 2015. No legislative action is required to add new vaccine mandates in Rhode Island. (July 2015) Yes
Rhode Island SB 2295 Would preclude the department of health from requiring immunization for diseases which are not transmittable in a school environment or from mandating HPV vaccinations as a precondition for school attendance. Would require the department of health to hold at least 3 public hearings on any proposed changes to the minimum standards for immunization.  (Committee recommends measure be held for further study, 3/31/16)  
Texas HB 1282 Would direct the Department of State Health Services to develolp a strategic plan to significantly reduce morbidity and mortality from HPV-associated cancer. (Passed House, sent to Senate committee 5/4/15)  
Washington SB 6562 Would require an HPV immunization report. (In first special session 3/10/16)  
Washington SR 8635 Would promote HPV awareness. (Passed Senate 3/11/15)  

HPV Vaccine: Introduced Legislation 2013-2014. BOLDED ROW TEXT indicates legislation passed by Legislature.
State  Summary Mandated for School Attendance

Indiana

 HB 1464 Would add the HPV vaccine to the list of vaccinations that pharmacists are allowed to administer with a prescription from a prescribing provider. (Passed House, Passed Senate 3/26/13, Public Law No. 113-2013)  
Kentucky  HB 358 Would require HPV vaccination of all girls entering 6th grade, ages 9-16 and all boys entering 6th grade, ages 10-16. Would require written statements to withhold consent from parents and guardians, for any reason, and that they be kept on file with other immunization certificates. (Passed House, sent to Senate committee 3/4/13)

X

Oregon  SB 722  Directs the Oregon Health Authority to conduct a study assessing activities related to human papillomavirus and to prepare human papillomavirus and related cancer comprehensive control plan. (Passed Senate and House, signed by governor 6/6/13 as Chapter 348)  

HPV Vaccine: Introduced Legislation 2011-2012
 State  Summary Mandated for School Attendance
Kentucky  HR 80 Would urge females ages 9 to 26 and males ages 11 to 26 to obtain the Human papillomavirus (HPV) vaccination and all citizens to become more knowledgeable about the benefits of HPV vaccination. (Passed House 2/21/12)  
 New Jersey

 S 1163 Would require health insurers and State Health Benefits Program and SEHBP to provide coverage for screening for cervical cancer, including testing for HPV. (Sent to Committee 1/23/12, withdrawn from further consideration 5/3/12)

 A 2185 (same as) S 1970 Would require insurers and State health care coverage programs to cover cost of HPV vaccine. (A 2185 Sent to committee 2/2/12; S 1970 Sent to committee 5/24/12)

 

 

HPV Vaccine: Introduced Legislation 2009-2010. BLUE rows indicate legislation passed by legislature.

State

 Summary

Mandated for School Attendance

California

SB 158 Would require health care service plans and health insurance policies that include coverage for the treatment of cervical cancer to also provide coverage for human papillomavirus vaccination. (Passed Senate and Assembly; VETOED BY GOVERNOR 10/11/09)

 
Georgia

HB 736  Would require public Schools to provide parents or guardians of sixth grade female students information concerning the infection and the immunization against the human papillomavirus.

 
Kansas

HR 6019  Resolution would urge the U.S. Food and Drug Administration to use caution in approving new vaccines such as Gardasil which has had a number of health problems including some deaths associated with the use of this vaccine. (Recommended "do pass" from committee and sent to full House 4/2/09)

 
Maryland

HB 411 Would require the Statewide Advisory Commission on Immunizations to study the safety of the human papillomavirus (HPV) vaccine; requires the Commission to include specified components in the study, make recommendations, and report the results of its study. (Passed House, Passed Senate, eligible for governor's desk 4/10)

 
Missouri HB 1375  Requires the development of a brochure regarding human papillomavirus and allows a physician to use expedited partner therapy by dispensing medications to certain persons who are not patients . (Signed by governor 7/13/10)  
Oregon

HB 2794 Would require health benefit plans to provide coverage of human papillomavirus vaccine for female beneficiaries who are 11 years of age or older.  (Passed Senate, Passed House, signed by governor 6/26/09, Chaptered. Chapter No. 630, 7/17/09)

 

 

HPV Vaccine: Introduced Legislation 2007-2008
 State  Summary Mandated for School Attendance
 California A.B. 16 Would require insurance coverage for HPV screening, cervical cancer treatment, as well as HPV vaccine coverage. 

(Passed Senate and concurred by Assembly on 7/14/08. Vetoed by governor 9/30/08 )

  

Iowa HF 2145 Would require insurance companies to cover HPV vaccinations. (Signed by governor 4/18/08)  
 Kentucky HB 396 Would require immunization against HPV for school-age children; requires parental statements to withhold consent to be filed with the immunization certificate; requires the department to provide educational resources to the public and all schools with specific information; permits parent to withhold consent for immunization for any reason with a signed statement.  (Passed House, sent to Senate 2/20/08)

 X

Louisiana HB 359 Would require schools to provide HPV information and vaccines under certain circumstances. (Passed House, Passed Senate, Became Act 210 without governor's signature 6/16/08)  
 Michigan

HB 5322 (SB 415) Would require schools to provide HPV information and vaccines under certain circumstances. (passed House 2/12/08, passed Senate 4/24/08, signed by governor on 5/8/08 as Public Act 121)

 
 Michigan HB 5171 (see chart below)  

 

HPV Vaccine: Introduced Legislation 2006-2007. BLUE rows indicate legislation passed by legislature.
State Summary Mandated for School Attendance                    
 California ±

A.B. 1429 Would expand any insurance plan that covers cervical cancer screening or surgery to also cover the HPV vaccine with a referral from the healthcare provider. Passed Legislature, sent to Governor

 

 Colorado
Session Ended

Co. Chapter No. 41 (2007) (S.B. 97) Allocates four percent of state tobacco settlement money to the cervical cancer immunization fund. Signed into Law
Co. Chapter No. 212 (2007) (H.B. 1292) Includes information on HPV, the link to cervical cancer and the vaccine in sexual education in schools. Signed into Law
Co. Chapter No. 318 (2007) (H.B. 1301) Creates the cervical cancer immunization program. Encourages use of the HPV vaccine and adds it to the list of Medicaid benefits. Also requires certain health insurance providers to cover the cost of the vaccine. Appropriates funds for the program. Signed into Law

 

 

 

 District of Columbia ±

B.17-0030 Would mandate the HPV vaccine for girls before the age of 13 and gives parent's the right to opt-out their daughter. (Passed City Council, passed Congressional Review Period 5/4/07)

X

 Illinois ±

Public Act 095-0422 (2007) (S.B. 937) Requires the Department of Health to provide all female students who are entering sixth grade and their parents or legal guardians written information about the link between HPV and cervical cancer, and the availability of the vaccine. Requires insurance companies to provide coverage for the HPV vaccine. It also requires the department of health to cover girls under 18 that are not covered by a provider. The department shall develop standards. Effective August 24, 2007. Signed into Law.

 

 Indiana
Session Ended

Public Law No. 80 (2007)  (S.B. 0327) Requires the parents of girls entering the sixth grade to receive information about the link between HPV and cervical cancer and the availability of an HPV vaccine. Parents of sixth graders must sign a statement notifying the school of their decision to vaccinate or not vaccinate their child.  The school must provide the information to the state Health Department.  This bill does not mandate the vaccine for school attendance. Effective July 1, 2007. Signed into Law.

 

 Iowa ±
Session Ended

H.F. 611 Requires that educational content for the seventh grade also include information on HPV and the availability of the HPV vaccine. Effective July 1, 2007. Signed into Law.

 
Maine±
Session Ended

MaineChapter No. 73 (2007) (L.D. 137) Establishes financial coverage for the HPV vaccine through the MaineCare program and improve public awareness of the vaccine. Signed into Law

 

 Maryland
Session Ended

Md. Chapter No. 191 (2007) (H.B. 1049) Establish a task force for the HPV vaccine. Duties would be to make recommendations for a state plan for the vaccine including possible requirements, cost and education efforts. (Crossfiled with SB 774). Effective July 1, 2007. Signed into Law

Md. Chapter No. 190 (2007) (S.B. 774) Establishes the HPV subcommittee in the Cervical Cancer of the Maryland Comprehensive Cancer Control Plan. Effective Jule 1, 2007). Signed into Law

 

 Minnesota ±
Session Ended

2007 MN Laws, Chapter 147 (H.F. 1078) Reconvenes the cervical cancer elimination study with assistance from the Minnesota advisory committee on immunization practices. The study will be on the risks, benefits, availability, efficacy and coverage of the HPV vaccine. (Part of a health and human services finance bill). Signed into Law

 

 Nevada
Session Ended
Nev. Chapter No. 527 (2007) (S.B. 409) Requires insurance companies to cover the cost of the HPV vaccine for policyholders and their dependents without prior authorization. Effective July 1, 2007. Signed into Law  
 New Jersey

New Jersey Chapter No. 134 (2007) (S. 2286) Requires distributing information about HPV to parents and guardians. Also proposes a public awareness campaign. Effective immediately. Signed into Law (Identical Bill: A.B. 3920)

 

 New Mexico
Session Ended

NM Chapter No. 278 (2007) (S.B. 407) Requires insurance plans in the state to cover the FDA-approved HPV vaccine for girls age 9 to 14. Existing deductibles and coinsurance may apply. Signed into Law

H.J.M. 39 Will create the human papilloma virus- papanicolaou advisory panel to study cervical cancer disparities and find cost-effective strategies for primary and secondary cervical cancer interventions, including the HPV vaccine. Adopted

S.B. 1174 Would require the HPV vaccine for girls between nine and 14 years of age. Allows parents to elect not to have their child vaccinated. Also provides information to parents. Vetoed

 

 

 

SB 1174 X

 New York ±

NY Chapter No. 54 (2007) (A.B. 4304) Budget bill that allocates five million dollars to promote the HPV vaccine. (Identical: S.B.2104) Effective immediately. Signed into Law

 

 North Carolina ±
Session Ended

NC Session Law 2007-59 (S.B. 260) Requires the department of health to distribute information on the HPV and the vaccine through schools to all parents of children in grades five through 12. Effective July 1, 2007. (Companion: H.B.938Signed into Law

 
 North Dakota
Session Ended

North Dakota Chapter No. 232 (2007) (H.B. 1471) Provides funding for distribution of educational materials on HPV and the HPV vaccine. Effective July 1, 2007. Signed into Law

 
 Rhode Island ±
Session Ended

H.B. 5061 Would require providers to cover the cost of the HPV vaccine. Signed into Law

  

 South Dakota
Session Ended

H.B. 1061 Gives the Department of Health $9.2 million to offer the HPV vaccine to young women age 11 to 18. Signed Into Law

 
 Texas
Session Ended

H.B. 1098 Will prohibit any elementary or secondary school requirement for the HPV vaccine. Mandates that schools distribute medically accurate, scientific, unbiased, and peer reviewed information about the vaccine to parents or legal guardians at the appropriate time in the immunization schedule. Overrides Executive Order 4 to mandate the vaccine. Effective Immediately. Signed into Law. (S.B. 438 is identical. H.B.1115 is duplicate)

H.B. 1379 Requires the Department of Health to develop and distribute educational materials to the public in both English and Spanish.  Includes a number of statements that must be included in the materials. Effective September 1, 2007. Signed into Law

Executive Order 4 signed by Governor Rick Perry February 2, 2007 - Mandates that all females entering the sixth grade must receive the HPV vaccine.  Orders the Vaccines for Children program to make the vaccine available to eligible children up to age 18 and the state Medicaid program to finance the vaccine for eligible females age 19-21.  Allows parents to refuse the vaccine for their daughters. Signed into Law- Overridden by H.B.1098

 

 

 


Exec. Order X
 

 Utah
Session Ended

H.B. 358 Establishes an awareness campaign on the causes, prevention, and risks of cervical cancer. Signed into Law

 
Washington ±
Session Ended

Wash. Chapter No. 276 (2007) (H.B. 1802) Provides every parent of sixth grade girls with information on HPV and where they can get the vaccine. Does not require the vaccine. Effective July 22, 2007. Signed into Law

 

± Represents a state that will carryover bills from 2007 to the 2008 legislative session.

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Source:  National Conference of State Legislatures, 2018.

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