State Strategies to Prevent Disease and Promote Health

Health officials, lawmakers and parents across the country are debating immunizations, particularly government mandates of the human papillomavirus.

At Monday’s session, “State Strategies to Prevent Disease and Promote Health,” Dr. Melinda Wharton, deputy director of the National Center for Immunization and Respiratory Diseases for the Centers for Disease Control and Prevention, highlighted three particular immunization issues for state policymakers—vaccine financing, school immunization requirements and the study of thimerosal in vaccines.

Fully insured children are being brought to public health clinics for vaccinations, Wharton said, which is a major issue for state health departments.

Oregon’s immunization program is a case study Wharton cited. In that case, the state eliminated public funding for vaccinations of well-insured children and only provided certain vaccinations to children eligible for Vaccines for Children, a federal-state entitlement program. Local health departments in Oregon began to bill private insurance for vaccinations and have collected more than $2 million, which enhanced vaccine services for adults in public clinics.

Many states struggle with school laws regarding immunizations. Philosophic exemptions and involvement of vaccine manufactures in the legislative process are high-priority legislative issues. Moreover, new vaccines are much more expensive than older ones making public financing challenging.

Another hot-button issue involves the use of thimerosal in vaccines.

Thimerosal has been removed from, or reduced to trace amounts in, all vaccines routinely recommended for children age 6 and younger, with the exception of inactivated flu vaccine, according to Wharton. The CDC examined the incidence of autism as a function of the amount of thimerosal a child received from vaccines.

Preliminary results indicated no change in autism rates relative to the amount of thimerosal a child received during the first six months of life. Lawmakers remain concerned; legislation banning the use of this organic compound in vaccines has been introduced in 20 states.

The second half of the session explored changes to New Mexico’s Liquor Control Act.

The presenters highlighted actions states can take to curb alcohol consumption through reforming liquor licensing regulations. DWI was a major public health issue in New Mexico, according to alcohol epidemiologist Jim Roeber of the state’s department of health.

The previous statute allowed five violations per year before license revocation, and New Mexico had never revoked a license under this version. The governor appointed a Liquor Control Task Force to review the act. They recommended a “three-strikes rule” for revocation, which is in place in most neighboring states. Opponents claimed undue hardship to licensees and hardship for small businesses.

Gov. Bill Richardson adopted the task force recommendations in 2006 including a “three-strikes rule” and other provisions. There has been some industry pushback. The state will study whether reforms will lead to reduced over-service of bar and restaurant patrons and reduced alcohol-related harm.

—Karen Imas