Vermont Legislature SmartTranscripts:

[Chair Theresa Wood]: Okay, welcome back, folks. We are back live with the Commissioner of Health, Doctor. Hildebrandt, to follow-up on any questions that we may have and any further information he may like to provide regarding where the committee is headed with H-five 45. Since it's been a day or two since you started us off, Doctor. Hildebrand, thank you one for being here this morning. And we've had a lot of testimony in the meantime, which I'm sure you've either listened to or been briefed on. And so we appreciate you being back here to answer any questions that the committee may have and offer any insights of your own with regard to any of the testimony that's occurred in the meantime. So I guess first I'm going to open it up to you to see if you have any further insights or responses or reactions to the testimony that we've heard today.

[Dr. Rick Hilbert, Commissioner of Health]: Thank you so much for having me. And again, the record, Rick Hilbert, Commissioner of Health. Yes, I do. And a lot of the discussion I've heard has been around evidence and science, which is something I can certainly speak to. There's decades of rigorous scientific research, real world surveillance data, global public health evaluations around the safety and efficacy of vaccines. They save millions of lives. There's been an analysis by the WHO and international health organizations that estimated that somewhere between four and five million deaths each year is averted by vaccination against measles, diphtheria, tetanus, pertussis and influenza. I've certainly seen that in my clinical experience where real world examples of folks who come into my care unfortunately because they did not receive vaccines against some of these illnesses. And we have, again, loads of evidence and data on this. Hepatitis B is another example where we know what the situation was like in America prior to routine recommendation of the hepatitis B vaccine where we saw over ten thousand kids acquire hepatitis B, a chronic hepatitis B infection, and following the initiation of the universal vaccination for children, we saw that drop ninety nine percent, which is again remarkable. So loads of loads of evidence around that. You know, the second thing I wanna say is that we are not mandating vaccination. That is not the intent of this bill in any way, shape, or form. It is intended to preserve access to people for vaccines, to be open and transparent about the process that we are using to recommend these vaccines so that we can reduce confusion to the best of our ability and maintain the trust that we have with our public. The science and the recommendation of this are our driving principles that will always be our driving principles at the health department, not anything else. And we think that's really important. We wanna be clear about that. And this bill does does further that. It does maintain a system that's been effective for decades. You know, the the truth is that most of Vermonters do choose to vaccinate their children. It's, I don't know, something like 5% or something of Vermonters choose not to and that the overwhelming majority of us do. And that's based on the recommendations of pediatricians and the health department and decades of experience with that. So, you know, just in a sort of short list of what this does do, what it doesn't do, this allows Vermont to have the flexibility to follow vaccination schedules, our trusted scientific sources such as the AAP and the AAFP, the American Association of Pediatrics and the American Association of Family Practice. It allows the immunization to purchase recommended vaccines at the lowest available cost and have the flexibility to select that vendor if we cannot use the CDC and the VFC program, which we have relied on for decades, and we are concerned that we may not be able to rely on them to both acquire and distribute these vaccines in the future. It allows us to acquire those vaccines from the lowest available source costing source. It it helps to have coverage so that there's no cost to Vermonters for these vaccines and that insurers will continue to, which they currently are, cover the cost of vaccination as recommended by the health department. It allows our pharmacy and pharmacy techs to continue to allow them to administer vaccines, which again has been very, very helpful to allow for access. Access is very important to ensure that people can get these easily and don't have to rely on scheduling appointments with the primary care physicians, which sometimes can be challenging. And it does allow, I know there's been some discussion around liability protection. And I want to be a little, I want be very clear on that. This is not about pharmaceutical company liability protection or anything of that nature. This is if the health department has a recommendation for vaccine schedule and a provider administers the vaccines that are in that schedule, it provides the protection in that scenario and that scenario only. If a provider or anyone is performing egregious acts or in some way doing actions that cause harm to individuals, it's not protective of that. Hey, if you follow the vaccine schedule that we publish and administer in the way that we recommend it, you're not gonna be held liable for doing that action. Okay? And that's, you know, I know there was some confusion and questions around that. It does, you know, ensure that all of our healthcare providers are able to continue to administer those vaccines in a system that has been safe and effective for decades without that sort of risk. And then again, I think a lot of questions have been around freedom and the choice, the freedom to choose, and in my view that this is exactly what this does. It continues to allow patients to have the freedom to make the choices, to discuss it with their providers and decide whether a vaccine is right for them. Without it, we would be in a scenario where the federal government would be restricting access to vaccines for people who want them, and that does not feel consistent with what Vermont feels is right. Certainly not what I feel is right. And we wanna continue to preserve that access. So, are, I know a couple of questions that have come up. I'm welcome to answer any other questions that people have or any other points of this bill.

[Chair Theresa Wood]: Thank you, Doctor. Hildebrandt. Questions from committee members? Okay. I have one or two that I would just like to clarify. So with regard to the immunity provisions that are in the bill, those are new provisions. And I want to make sure that I understand why they are there. So, it's my understanding that they are there because there exists one, this federal fund for adverse reactions to immunizations that individuals can access. It's not easy to access, I want to point out after I did some reading on what you have to prove in order to access it. And the narrower not narrower, I'm trying to figure out how to ask this question. So the Vermont recommendations are likely to be broader following the recommendations of both the panel and the national professional sources than what the CDC is currently recommending based upon their reduction in their recommendations a few days ago. And so they have not yet modified the access to that fund. But the way I read the HRSA description, it is likely that that will be modified at some point in the not too distant future, given it references CDC recommended vaccines. So, my question is, I guess, twofold. One, are you saying that the immunity is needed because that exists right now that protects healthcare professionals? And since that will be narrowed, that we need to provide the immunity for the recommendations as existing through the Vermont Department of Health.

[Dr. Rick Hilbert, Commissioner of Health]: That's right. So, an analogy is if a provider were to prescribe a medication either for an indication or at a dose that is way in excess of recommendations, that is a thing that a person could say, Hey, that doesn't follow, you know, the recommended guidelines by the FDA, and I'm going to open a lawsuit because I had a nil effect of that. Okay? So with the updated guidelines from the CDC, someone could say, Hey, that's not the recommended CDC schedule. So what we are trying to say is, yes, we understand this is the recommendations from the health department and is appropriate to give in these scenarios. And if you give the vaccines with this particular schedule as we have done for decades, that is not in and of itself a reason that you can open a lawsuit. That's the protection we're talking about. It does not change anything about the vaccine injury law in any way or any of the current protections that are in place for individuals who have lawsuits or concerns around vaccines. It's really just keeping the status quo.

[Chair Theresa Wood]: Okay, thank you. So, and in follow-up to that, is it your understanding that individuals who may be impacted by an adverse reaction to a vaccine that is currently listed as part of the available vaccines that you can seek payment for adverse reactions, that if that list changes, I guess I'll rephrase that. My reading of what's on the HRSA website and again, the Fed's changed policy every time we turn around these days. So I'm not asking you to predict what they may or may not do. But I think that the way it's described now, that individuals who are impacted by adverse reactions to vaccines that aren't currently on that schedule still may be able to access that fund, but they have to prove the adverse reaction was related to the vaccine. Is that your understanding of that?

[Dr. Rick Hilbert, Commissioner of Health]: My understanding is that the adverse action, you know, effects and fund related to that is when a vaccine is given, that if there's an adverse, you know, a definitive adverse outcome related to that vaccine, then an individual can of course access that fund. It's not just if you give that vaccine in accordance with one schedule or another, it's you have an adverse outcome related to a vaccine. That my understanding as well is that that's not any different, whether they're following our schedule or the schedule that's published by ACIP and the CDC.

[Chair Theresa Wood]: Okay. Those are my clarifying questions that came up as a result of yesterday's testimony. And I think you addressed the other thing that we heard from a witness who presented information regarding what appeared to be less than rigorous testing of certain vaccines. And could you speak a little bit more to that, the differences between, I guess, the federal change that happened in the '80s that protected pharmaceutical companies? And thank you for pointing out that they don't have absolute protection. It's a limited amount of protection. And the vaccines that appear on the schedule. So we were presented with information that said that was a much less rigorous, essentially scientific trials and proof from manufacturers that those vaccines are effective.

[Dr. Rick Hilbert, Commissioner of Health]: And vaccines are one of the most studied things that are manufactured. There's rigorous clinical trials around these interventions. You know, the other piece though, is we have decades of clinical experience in using vaccines and have a database that very meticulously catalogs when there's adverse effects. We don't have that with many other drugs to be completely honest. We have more data around the adverse impacts of vaccines than we do most drugs that are out there. And when there are cases, if there's a cluster of cases or cases of concern, they will absolutely investigate that further. And that's one of the advantages with vaccination in this database is we know exactly what adverse outcomes there are. And if there's a concern, either in a specific patient population or some other reason, we can adjust that. And that has happened over time. We have made adjustments to recommended vaccine schedules based on experience and what research has shown. But it is a very, very highly studied intervention and something that every state and every country looks at very intently. It's not something that has minimal research on it.

[Chair Theresa Wood]: And one of the other things that we received testimony on, and I think you've touched on it as well in your previous testimony is the differences between what The United States has historically, or at least, you know, in most recent history recommended and what other countries recommend. So information was also brought up about that as well. And so is your Could you just, I guess, reiterate what you spoke of earlier last week when you spoke to the differences between The United States and let's say, Denmark, for instance, which is what has been pointed out. But there are other countries as well.

[Dr. Rick Hilbert, Commissioner of Health]: There's many other countries and countries have their own vaccine schedules. I think if you look globally, ours is most closely aligned with Canada, which I suppose is not terribly surprising given the proximity to America. You know, difference in different public health systems and different health systems around the globe very dramatically affect the vaccine schedule. So having access to universal healthcare is a big, big impact. You know, that's something that Denmark has that we don't. And it's sort of comparing apples and oranges to say, hey, here's a system and we should take this one piece of their public health infrastructure and use that without adopting the rest of the pieces. I would love to have a discussion about universal health care in America. I don't think that one would be widely supported.

[Rep. Esme Cole]: So I mean, I think

[Chair Theresa Wood]: that's what there's murmurs around the room, as you can probably tell. So I want to make sure that I'm clearly understanding. Denmark has a universal public health system. So that's a very key difference between what we have that's insurance based in The United States. We have Rep. Sam Cole has a question.

[Rep. Esme Cole]: Thank you, Doctor. Gillibrand. So, yeah, I appreciate you referencing the research because that seemed like one of the key concerns, like the rigorous study of when vaccines go really well and when maybe in minor cases when something happened and it didn't. So a lot of people more, I think than in modern history are questioning the research and the actions of our federal government are sort of exacerbating that and politicizing that, I believe. So I would love, I think maybe for, especially like new parents who are coming up with new questions about what's required and what's not because of this difference. Can you maybe point to, we heard witnesses saying, but they couldn't find the research. So like for a normal Vermont family, where would you refer them to to find these databases that you're talking about?

[Dr. Rick Hilbert, Commissioner of Health]: Yeah, I mean, truthfully, and I've said this in every venue, people should talk to their pediatricians.

[Rep. Esme Cole]: Of course, yeah, that's number one.

[Dr. Rick Hilbert, Commissioner of Health]: And that's, they're going to be able to give them the most information because generally speaking, people don't have broad questions. They have very specific questions about a vaccine or a series of vaccines and the pediatricians, they do this their entire career. They're the best equipped and they can provide any resources that a family or an individual wants around, hey, where's the research on this or where's the risks associated with this? Both positive and negative. Something I've spoken of often is around risk and is the risk of doing anything in medicine. Of course, there's always side effects. The most common side effects in vaccines are sore arms. Sometimes people feel run down for a period of time or have a fever. Are there more serious adverse effects? Of course there are. But there's risks of not taking a vaccine as well. And if we minimize the risk of not taking a vaccine and only focus on of taking one, we're missing the picture. So I would encourage people strongly to talk with their family physicians or with their pediatricians. That's really the best resource for us.

[Rep. Esme Cole]: If it's okay, I'll go ahead and you just brought up universal healthcare. And unfortunately now more than ever, people don't have primary care doctors, is really obviously devastating in my personal opinion. People are bound to go to the internet, I think. And so if they do, in this second best case scenario, where would we look to? Just I know there's so much out there, let's say they do go to the internet, what would you recommend?

[Dr. Rick Hilbert, Commissioner of Health]: I would recommend going to the American Association of Pediatrics and American Association of Family Physicians. They have well documented and published both vaccine schedules and reference the evidence where it's coming from on their website. And that's really the best, you know, that's where I often go because it's a really good research, sorry, resource specifically on vaccines. Every specialty society within medicine has a niche about things I would go to them for, but when I'm looking for a vaccine schedule specifically for children, you go to the AEP. They're really the best source.

[Rep. Esme Cole]: Appreciate it. Thank you.

[Dr. Rick Hilbert, Commissioner of Health]: Any

[Chair Theresa Wood]: other questions for Doctor. Hildebrandt? Thank you very much for being back here, Doctor. Hildebrandt, and recognize adjustments that you needed to make to do that. So I just wanted to say thank you. Appreciate it.

[Dr. Rick Hilbert, Commissioner of Health]: If you ever need me, do not hesitate, please. I would be happy to come back. If there's any questions that come up, that's part of what I'm here for. Okay? So please do not hesitate to reach out. I'm happy to come back.

[Chair Theresa Wood]: Okay. Thank you very thank you very much.

[Dr. Rick Hilbert, Commissioner of Health]: Have a good day now. Okay,

[Chair Theresa Wood]: folks. So we're going to see a new version of H545 as soon as Katie is able to incorporate the changes that we talked about this morning. And we'll take another look at that when we are able to. Right now, I think what we'll do is take a ten minute break. Then we will so we'll come back at ten after. And we will then take up some committee discussion about what the future FY twenty seven budget process is going to look like.