Vermont Legislature SmartTranscripts:

[Sen. Ginny Lyons (Chair)]: All right, we're back. This is Senate Health and Welfare. We're moving on to H. Five forty five, a bill that has just come to us regarding issuing immunization recommendations and we have the recorder of the bill from the House. So introduce yourself for the record and then a brief overview of Ellen. Thank you very much. For the record,

[Rep. John Bistas (House reporter, Windham-1)]: my name is John Bistas. I'm the representative of Wyndham One, which serves Milford and Vernon. So h five forty five, Bill of Dan, is is a bill for the particular moment in which we find ourselves. The passage of h five forty five will enable Vermont to keep life saving immunizations available to its citizens. The bill of incineration is first crafted and requested by the commissioner of health in anticipation of potential changes in federal immunization policy at centers to receive controls and prevention. The commissioner's request was well timed indeed. Just the day before the bill was introduced to the House, the CDC introduced a series of significant policy changes for immunizations. Overnight and against the recommendations of such organizations in the American Academy of Pediatrics and the American Academy of Physicians, 35% of the CDC's previously recommended immunizations were removed from the schedule of events. This bill contains no mandates or directives for immunization for individuals or families. What this bill does do instead is to enable the state of Vermont to issue its own evidence based recommended immunization schedule. The federal schedule will still be available. It authorizes the Department of Health to continue purchasing those recommended immunizations at the lowest cost available, and it provides for continued insurance coverage at no cost to those significant immunizations. So the bill works on three levels. The first bit is just some minor technical changes that need to be made. The second is that it composes authority for ensuring recommended immunizations in Vermont. And the third level is that it offers a sunset in six years and returning the authority to current law into the Center for Disease Control and Prevention. So the main technical change language that was made in the bill was in the bill in the statute, you often find the word vaccine or vaccination. That's been changed to recommending immunization throughout. And then there were just a couple of minor changes that we're finding. But turning to the of the bill, Section one, existing law authorized insurance operated programs. What's the goals

[Sen. Ginny Lyons (Chair)]: So I'm going to recommend that you give us the high level because we're going to walk through with

[Rep. John Bistas (House reporter, Windham-1)]: Okay. All right.

[Sen. Ginny Lyons (Chair)]: Yeah. Let's do that.

[Rep. John Bistas (House reporter, Windham-1)]: All right. Okay. Your background is helpful. Alright. Yeah. Okay. Good. So the in section one, just is is the it is well, most of the bill exists. I should say that. It's current law. Yeah. The new law is that's being suggested as bill section two. And that's the point at which the Commission of Health would need to authorized to create a schedule of talking immunizations and work with Vermont immunization advisory councils to develop that schedule. Sections three through seven of the bills simply take existing law, put it here so that it's all in one place. And then the final sections eight through 13 are the sunset language for six years out. And I have the list of a long list of folks that testified for us. I'm hearing

[Sen. Ginny Lyons (Chair)]: about That sounds good. We can

[Rep. John Bistas (House reporter, Windham-1)]: look that up. Yeah. And the bill was recommended to the house on a vote of ten one zero in our committee. It was also reviewed by three other committees, two of which were unanimous, the appropriations and waste leniency, and then judiciary as well. And the photon floor? Was one I forget the exact number. There were nine negative photons.

[Sen. Ginny Lyons (Chair)]: Okay. So it was a voice oh, it's

[Rep. John Bistas (House reporter, Windham-1)]: a Oh, it a vocal. Oh. It's a male positive. Nine. Nine negative. Sounds like it was supported very well. Yeah. It's possible. Thank you. Any questions? No.

[Katie (Legislative Counsel)]: It's good to have you in committee. First time. It does.

[Rep. John Bistas (House reporter, Windham-1)]: It does. Does. Alright.

[Sen. Ginny Lyons (Chair)]: So and this came out of which committee?

[Rep. John Bistas (House reporter, Windham-1)]: Human Services. Human Services. Yeah. That would be. Alright. Okay. Thank you very much.

[Sen. Ginny Lyons (Chair)]: So and the vote was, like, one twenty seven or so?

[Rep. John Bistas (House reporter, Windham-1)]: So one twenty seven to nine. Yeah. Yeah. And there were teeth 12 absent that day. Wow.

[Sen. Ginny Lyons (Chair)]: I see there's a strike

[Rep. John Bistas (House reporter, Windham-1)]: off. Always. Always.

[Sen. Ginny Lyons (Chair)]: Oh, we do have a fun time. Good morning. Katie with the Office of

[Rep. John Bistas (House reporter, Windham-1)]: the Legislative Council. I will share my screen

[Sen. Ginny Lyons (Chair)]: As passed pass version. So

[Katie (Legislative Counsel)]: before we jump in, let me just sort of step back and tell you a little bit about what's in the bill. I think it looks daunting at 24 pages. What you should know is that there is a sunset on provisions that are put in place by the House, meaning that after six years, most of the changes go back to as they are in part one, not everything, and I'll point out where there are some differences. But in terms of drafting, what that meant is we had to duplicate the statutes that are being amended twice to show the change that would take place on passage and then the change that would take place after two years. So it almost doubles the size of the bill having that sunset in there. So I will go through that with you. The primary thing that this bill does is right now, in current Vermont law, the recommended immunization schedule for adults and children is linked throughout the BSA with the CDC's recommendations, and that governs language about how, which immunizations can be purchased, the authorization for pharmacists and pharmacy techs to administer it, how reimbursement works for health insurance. So, instead, this bill sort of decouples that link with the CDC for recommended immunizations, instead gives the Vermont Department of Health the authority to develop recommended immunizations. And it would be sort of a six year replacement of having the Commissioner of Health's recommended immunizations in place of that coupling with the CDC. Let me, I'll pause there and we'll jump into the language. So, in section one, we have a definition that's currently immunizations, and it's being changed to recommended immunizations. This is probably one of the most significant changes in the bill, is the use of recommended immunization. It means something very specific here. In current law, you'll see on lines fourteen and fifteen, these are guidelines that are established by the Advisory Committee on Immunization Practices to the Centers for Disease Control and Prevention. So right now, the definition of immunization is linked to the CDC recommendations. You'll see that language is struck through, and instead we have language that a recommended immunization is established by the commissioner pursuant to a process that's set up in this bill. So when we see the term recommended immunization, that doesn't mean any immunization. It means an immunization that's recommended by the commissioner. Another change in this definition, under current law, an immunization means a vaccine or the application of a vaccine. What this language says means a vaccine or other immunizing agent that provides protection under a particular disease or pathogen. I know you have lots of healthcare providers here to talk to and who can explain this better than I can, But the explanation in human services was that immunizations are not always administered by vaccine injections. So this is meant to be a little bit broader and capture that. So that is the definition of recommended immunizations. In this section one that we're looking at, most of this is existing law that establishes the immunization program that's administered by the Department of Health. This language governs how and which immunizations are purchased, who they're purchased from. It governs how a calculation is made to know what insurance companies have to remit to the health department to fund the program based on the number of people served by the program receiving immunizations under Vermont's program. So to take a look at that, in subsection C1, it says the department is to administer an immunization program, this is existing law, with the goals of ensuring universal access to recommended immunizations at no charge to the individual, and reducing the cost at which the state may purchase recommended immunizations. The department shall purchase, provide for the distribution of, and monitor the use of recommended immunizations as provided for in

[Sen. Ginny Lyons (Chair)]: the subsection. The cost, I was just gonna suggest that we Higher level. Sure. We won't get to everybody in the room if we keep doing

[Katie (Legislative Counsel)]: Okay, okay. I mean, high. Level dose.

[Sen. Ginny Lyons (Chair)]: We can go back in more detail later. Yes, we definitely Sure,

[Katie (Legislative Counsel)]: I can do that. Okay. So, we've already covered, I would like to cover C, that the department is to determine which recommended immunization shall be purchased under the program. Human services added language that the immunization program shall purchase recommended immunizations consistent with the goals of the program. So that was a change from human services. I will skip over this language about how the funding for the program works. What is noteworthy is this subsection G. This is an existing immunization funding advisory committee. This committee looks at the annual per member per month cost for recommended immunizations. They would have the same task except for recommended immunizations instead There of linked to the are some changes that are technical to the membership of the board, not substantively the members, but I flagged that because after six years, when we revert to the current language, these changes to the way this group is structured would be maintained. Got it. Okay, I'll skip over this. So section two is all new language. This is where we get the parameters for what the new authorization for the commissioner looks like. So the commissioner shall periodically issue recommendations regarding which immunizations children and adults are recommended to receive, at what age each immunization is recommended to be given, the number of immunization doses that are recommended to be administered, the recommended amount between time of doses and immunization, and any other recommendations regarding immunizations necessary to promote the maintenance of public health and disease prevention in the state. Subsection B is important. This is telling the commissioner what the commissioner needs to consider prior to issuing recommendations. So first, the commissioner has to consult with the Vermont Immunization Advisory Council. This is an existing council, an existing law. This bill does make some changes to the membership, and we'll look at that. Second, the commissioner has to consider recommendations made by various professional groups, one of which is the CDC, but also recommendations by the American Academy of Pediatrics, Family Physicians, American College of Obstetricians and Gynecologists, American College of Physicians, any other organization the commissioner may deem necessary. So that is an important subsection. Subsection C has language about immunity from liability. If a healthcare professional who prescribes, dispenses, or administers an immunization in accordance with the recommendations from the commissioner, they would be immune from civil and administrative liability for an immunization caused adverse event, unless that that professional person who's doing the prescribing, dispensing, or administering, if their action constituted gross negligence, recklessness, or intentional misconduct. Subsection D gives the commissioner the authority to issue a standing order for recommended immunizations. Subsection E, is language that was added by Human Services, it wasn't part of the original proposal, that the department is to prominently display information pertaining to recommended immunizations on its website, including how to access them. And in two, any documents that are produced by the department about recommended immunizations shall include a disclosure if the recommended immunizations differ from the recommendations of Vermont's Immunization Advisory Council. So, we know that the commissioner has to consult with this group. If the commissioner ultimately has a different recommendation than that group, then that has to be disclosed on Department of Health documentation about the recommended immunization schedule. Section three brings us back to existing law. I mentioned that the Vermont Immunization Advisory Council was existing law. The membership does change in this draft. Let's see, we have added a board of nursing, board of pharmacy rep. There had been a representative of public schools and independent schools. Independent schools was removed. There's the addition of the Department of Health's immunization program manager. The addition of two individuals who are professors, researchers, or physicians, or any combination of these individuals with expertise in infectious disease and human immunization. The addition of a family or internal medicine physician. Also, the addition of a practicing ATRN, a practicing pharmacist, and the other existing law, any other person deemed necessary by the commissioner. So the duties of this group is changing, because now, in addition to their other duties, they're also providing recommendations to the commissioner on establishing a Vermont recommended schedule. So, you'll see in subdivision C1B that we're adding this clause online, my line six and seven, I don't know how it's printed in your handout, that including advice regarding recommended immunizations as defined in 11/30. That was the

[Sen. Ginny Lyons (Chair)]: first definition we So, looked

[Katie (Legislative Counsel)]: we're adding that to their scope of this group's responsibility. Also happening in the six year period, is the addition of this language that the Secretary of Education or designee and the representative of public schools shall not vote on advice regarding recommended immunizations. So those two individuals are part of this group now, but with regard to creating a recommended schedule, those two folks would not be voting, they wouldn't be contributing to that vote. I might, we have some changes to the membership of the meeting. We can talk about that later. I'll move on. The next two sections have to do with health insurance. Right now, there's no cost to the consumer for receiving immunization as recommended by the CDC. You'll see that the language in these two sections are linked directly to the CDC recommendations. So this strikes through that reference and refers back to the definition of recommended immunization created in this bill, which again means that the Commissioner of Health created that recommendation. So that's sections four and five. Sections six and seven deal with pharmacists and pharmacy techs. Again, right now, their authority to, well for pharmacists to prescribe, or to administer, is tied to the CDC authorization. So in Roman numeral seven, you'll see that instead of having the language that links to the CDC recommendations, we're replacing that with the definition of the Commissioner of Health making those recommendations. Same thing in eight. Seven applies to pharmacy techs, and we have similar changes happening in this section. I know with regard to the pharmacy techs, OPR has reached out to me and they want to tighten up that language, so I am in the process of working with them on bringing something back

[Sen. Ginny Lyons (Chair)]: to you. That's good, we'll probably hear from them today. Okay. So,

[Katie (Legislative Counsel)]: when we get to section eight, human services worked really hard on these reader assistant headers because the bill is sort of complicated with different effective dates, but you'll see section eight becomes effective on July '31. So, we've reached the halfway point in the bill where we start going back to where the language was at the current point in time. So I'm not gonna go through all this. I think we'll have time when people aren't in the room. But needless to say, the language generally goes back to the way it is now, with some exceptions that I can point out to you. The language that, the new language that creates a new section that has the parameters for how the commissioner of health has to make the determinations for recommended immunizations. That section completely sunsets after six years, and everything else kind of reverts to where it is now, for the most part of exceptions. And then we have a complicated effective date section, which makes sense because we have a lot happening in terms of half of the bill taking effect on passage, and half of the bill taking effect to revert back to the current law of 2031. That was fast,

[Sen. Ginny Lyons (Chair)]: but No, was good. That was good, and I know that some of us are familiar with us, and as we go forward, we'll hear from folks who are deeply embedded in the process, boots on the ground. So thank you for that. Questions from Kate? I think it's pretty clear on Yeah. All right, so let's move on. I'm gonna move, I'm gonna skip over Stephanie Glintjer because she's in the building more frequently than others and move on to Tracy Tyson who's here on Zoom. Thank you for being here, doctor. Good morning. Just, know, have Our time is always limited, but thanks for being here. Thank you

[Dr. Tracy Tyson (Pediatrician; President-elect, Vermont AAP)]: for having me. My name is Doctor. Tracy Tyson. I'm a board certified general pediatrician in private practice in St. Albans, as well as the president-elect of the Vermont American Academy of Pediatrics. I'm so glad to be here today. This is my third time speaking on this bill. I can't impress upon everyone how important this bill is. Like this is important enough that I've canceled three days of clinic to make sure that we can speak about this, and it's extremely important. So what we are seeing right now is some unprecedented times when it comes to the increase in preventable diseases. So we're having some of the largest amounts of pediatric death in over two decades from the flu, which is coming along with the timing of the CDC changing the recommendations to the flu vaccine to not being routine for everyone. So we saw even more decrease in flu vaccination rates this year. We're having the largest measles outbreak in thirty years, as well as whooping cough and all of these preventable diseases, which are directly related to the public's mistrust of vaccinations. The American Academy of Pediatrics has been pretty clear on the recommendations, and we now have the 12 major medical societies in The United States that have all backed the American Academy of Pediatrics vaccination schedule in opposition of the CDC's non science based recommendations. What are we actually seeing and what are we hearing from families? They are very confused. They don't understand what it means and they're making decisions without true informed consent. So we're hearing from our hospitals that there is increasing numbers of families declining the hepatitis B vaccination at birth, not because they have concerns, but because they think it's not recommended anymore. In clinic, we have families in record numbers that are decreasing the want for vaccinations, but we also have a lot of families that are very concerned that they're not going to have access to vaccines, that they are not going to have them be able to be paid for, and they are asking questions like, am I gonna have to go to Canada to get my child's vaccinations? What are you going to do to try to make sure that we have access? We also have providers who are fearful for how are they going to continue to provide care if they are not feeling confident, which vaccine schedule are they legally allowed to do. We saw when the COVID vaccine rates, when the recommendation changed, we weren't able to get it. And there were pharmacies that might not feel comfortable giving it. So when these lapses in care happens, we're gonna start to see significant preventable illness. Part of this bill, we also have a lot of negative attitudes towards physicians related to vaccinations. And so we also have concerns. The state medical board is also having to get involved when doctors like myself are giving evidence based information regarding vaccinations. If that is different than the CDC, there have been reports where families have even made reports to the board of medicine that we are not following guidelines. So this is extremely important, and I'll be honest, I'm worried how I'm gonna do my job if we don't have something like this. And I thank you so much for taking a look at this bill and everything that's been done up to this point.

[Sen. Ginny Lyons (Chair)]: Oh, thank you very much. That was concise and well done. Five minutes. I did not realize, Doctor. Hildebrand, that you have a hard stop at 11:00. I do. So why don't we just quickly bring you up, and Doctor. Tyson, if you don't mind sending your testimony in, that would be great.

[Dr. Rick Hildebrand (Commissioner of Health)]: Thank you for having me. Rick Hillbrand, Commissioner of House of the Record, and I will build on what Doctor. Tyson has said.

[Sen. Ginny Lyons (Chair)]: You have a team here, so

[Dr. Rick Hildebrand (Commissioner of Health)]: I do.

[Sen. Ginny Lyons (Chair)]: Okay, that's fine.

[Dr. Rick Hildebrand (Commissioner of Health)]: I have Lauren Layman, my general counsel, and I've got Meredith Plumpton in my accusation subject matter, as well as Jessica. There's been a lot of confusion that we've seen across the state, across the country related to falsehoods and untreats that have been spread. There's confusion that we have had at the health department because we are not clear where the changes of these recommendations have come from. There's years of scientific, a number of scientific research that have demonstrated the value and the schedule that we use to immunize some children, and those were changed in an abrupt manner that has caused a lot of disruption. We are committed to preserving access to vaccines to our home office, and that's something we've heard as a need from nutritionists, we've heard from the monitors. We need to make some changes to ensure we preserve that access. There's a number of things that are in this bill. I would try to hit on some of the highlights and some of the reasons we're doing this. Transparency is critical here. We wanna make sure that we are very clear as to where these recommendations are coming from and why we are making them, which is why we are trying to assemble a panel of experts and use a relied upon sources such as the AAP and the AFP, which have guided the aids that for every single iteration of the recommendations except for this one, but we did not take them in 2020 when they were developing their guidance. AASIT was also foundational in creating AASIT, is why it's very confusing why they were diverted from that practice of the service. The current federal system provides three elements that we're trying to protect human science based reviews and recommendations of the vaccine schedule, purchase of vaccines at a low cost, and protection for healthcare providers. Three of these are currently in place at the federal level. We are trying to maintain them in spite of the changes that have happened recently. These are not new things that we're doing, we're just trying to preserve them. So there's a number of bullets here that have been touched on already, and I will reinforce, we will have the flexibility to follow the vaccine schedules from ACIP and CDC in addition to the professional medical organizations such as AAF, AFB, and ACOG Dose three professional organizations routinely publish vaccine schedules that have for decades, and it's something that we've relied on as providers, and frankly, ACIP has relied on for many years. So we likely need that in addition to effective vaccine. The immunization program will be able to purchase the vaccines at the lowest available cost. So the purchasing, the program that we use, Meredith can go into much more detail than I can, but we acquire vaccines from the CDC at a lower cost use, group purchasing platform to provide the vaccines to us and distribute it to our practices here in Vermont. If we lose the ability to do that, which we are worried may happen, we need to have an alternative that needs legislative changes to allow us to do that. We want to have the same cost of homeowners and the same distribution ability. If CDC goes away as a source, we run another one. That has not changed to date, okay? To be clear, the changes that have happened so far have not compared our ability to acquire vaccines. I'm very fearful, though, that that would be common. Insurers currently provide coverage for vaccines that respond. We are a universal vaccine state. It is covered by insurance companies. This is not state dollars we're asking for to cover this. The insurers will continue to provide those vaccines as recommended by me and by science based recommendations to me to look them on. Pharmacies and pharmacy techs have been allowed to administer these vaccines. Access is important. The number one thing I hear from patients when I'm seeing them in the hospital as to why they didn't get a vaccine is, I just haven't had time, it's been inconvenient, I couldn't get into my primary care office. Access is important. If we make access available, people will do what they know is right or what they feel is right, because oftentimes it's access, obviously we wanna preserve that access with different pharmacies. We want to have the ability to have a standing order so that we can administer the recommended vaccines as recommended, and then there's a liability for vaccines. Again, there is a federal program that has been in place for many, many, many years around vaccines to help compensate individuals who are harmed by any ill effects of vaccines. There are readily rare cases where people are harmed and they're covered by this program. This extends the protection to providers using the recommended vaccine schedule. Anybody who has an injury related to a vaccine is eligible for this program regardless of what schedule you'll follow. There's immunity currently in place if you follow the recommended vaccine schedule by ACEV that you will not be under personal protocol. And again, Lauren can answer all these questions. I am not a legal scholar. She can answer all these much better than I can. This just continues the protections that have been in place for the vaccine schedule, okay? And again, I can't say this loudly enough, this is not a vaccine mandate, this does not mandate anything from anyone, okay? This is just preserving the access to vaccines for our monitors, it's at the lowest possible cost, allows for access in pharmacies, and provides a liability protection for the providers. So that is very high level, very quick, but I did want to leave some time for questions because oftentimes there are questions and I do have things that people have left us back before we

[Rep. John Bistas (House reporter, Windham-1)]: go to narrative or go on.

[Sen. Ginny Lyons (Chair)]: I don't have a question, have

[Rep. John Bistas (House reporter, Windham-1)]: a comment. Yes. Thank you for doing the work of this. It's an important medical process for the state, which is really appreciated.

[Sen. Ginny Lyons (Chair)]: And I know that once you mentioned the word vaccine and vaccination and immunization, that it raises all kinds of issues with people that we need to continue what we've been doing in the state to maintain the health of the state. We're number three in the

[Rep. John Bistas (House reporter, Windham-1)]: country, and it's partially due to this kind of That was short and sweet. I'd be short and sweet.

[Sen. Ginny Lyons (Chair)]: Some people may not think it was sweet, but I know.

[Dr. Rick Hildebrand (Commissioner of Health)]: And if there are questions that arise as a result of either the conversation with Meredith or Lauren, please.

[Sen. Ginny Lyons (Chair)]: I know there are a lot more slides than what we have looked at.

[Dr. Rick Hildebrand (Commissioner of Health)]: Right. Those would be with Meredith and with Lauren.

[Sen. Ginny Lyons (Chair)]: So we're gonna continue that. And do you two wanna come up together, or is

[Katie (Legislative Counsel)]: it better that you be separate? Probably separate but a vocal company.

[Sen. Ginny Lyons (Chair)]: Yeah. We like quick. I know. You know, we don't have a lot of time. So if you can concise in your testimony, it is extremely well. Thank you for being here. Sure. We haven't introduced ourselves, and you're new to the committee, so I was gonna have us do that right now.

[Meredith Plumpton (Immunization Program Manager, Vermont Department of Health)]: Sure, I'm Meredith Fulton and not you,

[Sen. John Morley III (Member)]: John Morley from Orleans. John Benson from Orange.

[Sen. Ginny Lyons (Chair)]: Ginny Lyons, Chittenden Southeast. Martine Larocque Ginny Chittenden, Central. Ann Cummings, Washington. Thank you. Now, Heather Bacher. I'm Mary Colton.

[Meredith Plumpton (Immunization Program Manager, Vermont Department of Health)]: I'm the Immunization Program Manager with Vermont Chartered Health.

[Rep. John Bistas (House reporter, Windham-1)]: Thank you. So, go right ahead.

[Meredith Plumpton (Immunization Program Manager, Vermont Department of Health)]: So, Doctor. Gulick talked a little bit about the way that our program works. I just want to dive into a little bit more detail so that you have a good understanding of the need for changes. Currently, we utilize the CDC contract to purchase vaccines for all children and adults age 19 through 64, and I'll explain that in a minute. We use a combination of federal funds insurer funds in order to purchase those vaccines. We distribute them to all primary care providers' offices in Vermont, And we currently align with, in the past we have aligned with ACIP recommendations. So, a little bit about the universal program. I'm a visual learner. I like little grapples. You can see that the Vaccines for Children program is a federal program that serves about fifty percent of kids in Vermont. And those vaccines are for Medicaid eligible, uninsured, or children that are on Medicaid. And there's a couple of other smaller buckets. And then we use insurer funding for about the other half of children. We get a very small bucket of money from the federal government for uninsured adults. It's about 10% of the vaccines that we purchase for adults, and then the private insurers pay for the other 90%. We do this through the Vermont Vaccine Purchasing Program, which that funding that Katie was talking about, that funding committee is comprised of people who look at what the per member per month's cost is to those insurance companies that they pay to the health department so that

[Rep. John Bistas (House reporter, Windham-1)]: we can purchase those vaccines.

[Sen. Ginny Lyons (Chair)]: So, it's a little bit confusing.

[Meredith Plumpton (Immunization Program Manager, Vermont Department of Health)]: No, that's good. We want to be able to continue to offer all recommended vaccines. And like Doctor. Kellgren said, if those vaccines are restricted through the CDC contract or no longer offered through the CDC contract, we want to be able to go to another vendor, still the same vaccines themselves, but go to another vendor to have those vaccines shipped to our providers so that

[Rep. John Bistas (House reporter, Windham-1)]: they can continue to do so. I

[Meredith Plumpton (Immunization Program Manager, Vermont Department of Health)]: said that our program is for birth through age 64. It's because Medicare is currently paid into our program. So, we don't offer vaccines for her mom after 65 and older right now. We are working on a solution to that, and I hope to see you guys in the future. The next slide just talks about how we communicate with providers. The providers are our customers, and we communicate with them regularly with information, with newsletters, with webinars, with all sorts of information. And then I have three examples. I'm just gonna choose one in the interest of time. I think I'm gonna go to the hep B example. So, ACIP made a recommendation to remove the universal hepatitis B for Arctos. Recommendation is The universal would hepatitis B Ark That recommendation's been in place since 1991, and we've actually seen a reduction of ninety nine percent of hepatitis B cases in children and adolescents since that universal recommendation was put in place. So, we would still like to recommend that universally. All of the national medical organizations are still recommending it universally. My fear is that they take a look at our hepatitis B cases, which are below a dozen a year in Vermont, and say, You can only have vaccines for one hundred kids. And we have over five thousand births a year. So this is where that new flexibility with the build language would come in and we'd still be able to purchase hepatitis C vaccine for all infants, parents, mothers, and children vaccine. There is a slide about the new changes to the vaccine schedule. I'm not gonna go into details with it, but just wanted you to have that information. And again, I will reiterate what Doctor. Hildebrand says is that this bill has nothing to do with mandates. We're not looking at changing childcare and school requirements. This is just to maintain

[Rep. John Bistas (House reporter, Windham-1)]: the access of your early kids.

[Sen. Ginny Lyons (Chair)]: Any questions? Good. Questions? We know where to find it. We do. Lauren,

[Katie (Legislative Counsel)]: we need the legal. Yes. And

[Sen. Ginny Lyons (Chair)]: I forgot, you are at CDA. I put you at

[Katie (Legislative Counsel)]: OPR earlier. Was not in here with the other one, Jess, was it? You were still at OPR? Numeral No. For me.

[Lauren Layman (General Counsel, Vermont Department of Health)]: Thank you, I'm Lauren Layman. I'm General Counsel for the Department of Health. I'm not gonna, I think I'll reiterate what my colleagues said about access. This is about ensuring continued access and emulating a system that is on the federal level that is changing overnight in ways that are unpredictable and not always scientifically based or evidence based that we can tell. When these impacts started to affect us, when we anticipated them, we engaged in collaboration with a number of other across agency departments, as well as with other stakeholders in the community to talk about what things needed to change, and that's what H5-fifty four is. It's what you see before it. And we identified not only problems, but solutions for those changes. We wanted a clear, transparent process for issuing those immunization recommendations that considered the science, considered other recommendations. We wanted to allow the flexibility to purchase, as Meredith just said. We wanted to ensure private insurers continue to cover, and they've been supportive so far and without cost to the individual. No copay, no coinsurance, no deductible. And we also wanted to address some of the potential barriers that might deter healthcare providers from offering vaccines and immunizations more globally. So I'm really here to talk to you about those protections, in particular that liability protection you see in the bill. I think that was concern over on the house side and, you know, I wanted to walk through that a little bit with folks. So right now on the federal level, if you have a injury that is from a vaccine, very rare as Doctor. Gulick said, but if even one case, it could result in a tort case for a provider that's very lengthy, very costly. And in the 1980s, this was deterring healthcare providers and manufacturers for both manufacturing and providing the medications for the immunization. The federal government may defer a vaccine injury compensation program. It prohibits now. If you have an injury over $1,000 you cannot go to the civil court. Civil courts can't award any damages above $1,000 you have to petition the vaccine injury compensation program for any compensation. And the injury compensation to the family is then paid out through a fund that is paid into by excise taxes. So it's just for covered vaccines. Those vaccines are put in there by the feds, or by the, sorry, the Congress by adding an excise tax to a vaccine, fills the fund, there's an injury, it's paid out of the fund, insulates the manufacturers and the providers from liability, families get compensated, and things can move forward without that torturous case law. We can't build that on the state level, But what we can do is to continue to ensure access, we protect providers who are acting solely in accordance with the recommendations from the commission. So this provision in the bill is much more limited than that federal protection. Our concern is that there will be changes to the Vaccine Injury Compensation Program, vaccines will be removed. It's Congress to add a vaccine. The Secretary of Health and Human Services can remove one by a dual duty. So we're concerned that vaccines will be removed, injuries will be no longer covered, and so we would like to be able to provide some liability protection on the state level so that if a provider is acting 100% in accordance with the recommendations, they will not be liable for neglect contraceptive use. Just

[Sen. Ginny Lyons (Chair)]: so right now, see a year ago, there was a CCD set of guidelines. If somebody felt that

[Rep. John Bistas (House reporter, Windham-1)]: the child

[Sen. Ginny Lyons (Chair)]: themselves were negatively affected by getting this, that, and using you got a shot from their doctor, Similar to workers' comp, rather than go and tie everybody up and you would go to this board and there is a compensation mechanism. What this bill would do is say rather than CDC recommended vaccines, the provider is protected if they are doing the state recommended vaccines under all the proper guidelines. So it's not changing anything. It's not extending protection to anyone that didn't use to have protection.

[Lauren Layman (General Counsel, Vermont Department of Health)]: That is absolutely correct. In fact, it provides less protection than the federal level because the federal level also provides liability protection for manufacturers as well as providers. So, drug companies, ours would not do that. And this also, you know, there's still a lot of reports people would have in the court system. So, for example, if there was an injury caused not by the administration of a vaccine in accordance with the schedule and the age and all that stuff, there was a method for failure to provide informed consent, failure to put it in the wrong arm, and it's not, you can check the, do what your process what you

[Sen. Ginny Lyons (Chair)]: should have done. There's still liability protection. Okay. If if it's done according to oil Yeah. It's it's it's but it doesn't extend it to manufacturers. The Fed has to do because I've heard concern about COVID and extending That's

[Rep. John Bistas (House reporter, Windham-1)]: how

[Sen. Ginny Lyons (Chair)]: Yeah. Immunity. Whatever immunity is there is presently in federal law. If the feds remove that immunization, we are not restoring it to manufacturers. You know? Merely two administrators who are legally allowed to administer and it's and they have to do it

[Lauren Layman (General Counsel, Vermont Department of Health)]: accordingly. We legally required medically practiced, refracticed statements. Scientifically sound, evidence based, transparent decision between the provider, recommended by a provider, doing it in accordance with the state recommendations, doing everything that they're supposed to do in accordance with science. One in a million of kids have a person will have a reaction. That's nobody's that's having it. The next testifier. I would be well

[Rep. John Bistas (House reporter, Windham-1)]: happening.

[Dr. Rick Hildebrand (Commissioner of Health)]: So, the CDC level, there's a fund that I think you said for somebody has a vaccine or something. CDC is no longer going to do that under certain types of immunizations. The

[Rep. John Bistas (House reporter, Windham-1)]: state of Vermont's going to do it?

[Lauren Layman (General Counsel, Vermont Department of Health)]: No. So thank you for clarifying. So the right now, nothing's changed at the vaccine injury compensation program at that federal level, though we anticipate it might. And we would not provide that. We would this provision solely protects any of the provider for blinding if they're following the state regulations. So the person who's injured, we still seek compensation for any other injury, for any other problem through the court system. You can pursue it against the manufacturer if they want, but it wouldn't be against that one provider who administered the vaccine following all the patents for the city. Gotcha. Thank you. One other thing, I'm open to of course, go back to other questions about liability, but I wanted to touch quickly on informed consent because that came up in the House Student Services as well. So under Vermont law, healthcare providers are required to provide informed consent for every person. If they don't, they're subject to medical malpractice liability. And there's a statute, it's 12 BSA nineteen oh nine-nineteen oh nine. And that walks through what is required in informed consent, which is that the provider tell the patient how all foreseeable risks of a procedure or treatment. That's important because it defers to the provider to be the expert in their field and make sure they disclose to their patients that here's all the things we know from the science, from the studies, etcetera, and prove and establish a foreseeable risk in this medication or procedure. And we've decided many times not to make specific informed consent standards for different types of procedures that are much riskier than a vaccine. I know that the department for access purposes, etcetera, would like to keep that standard as is and not in a different informed consent standard for

[Rep. John Bistas (House reporter, Windham-1)]: vaccines. There's also

[Sen. Ginny Lyons (Chair)]: a What was this called BSA what? 1909. Oh, 1909.

[Lauren Layman (General Counsel, Vermont Department of Health)]: It's 1909. And there's also federal requirements right now that we disclose vaccine information, so it's etcetera.

[Sen. Ginny Lyons (Chair)]: Going back to my last question. Before consent, right now, if and I assume continually, as long as our list is complies with the federal investigation, if there's a negative reaction or the families have access to this federal recompense program. If when this goes into effect, there is a negative reaction and the CDC has removed that CV from the list then would the family be told that they didn't have they can't sue the doctor and there's no reference program. They could sue the manufacturer which is a much deeper pocket because if the provider did something wrong like these dirty needles, the provider that is not protected. But why don't I need to be protected? So I guess the the alternative would be rather than sue your local provider, it would be to sue the manufacturer because the problem would be with the vaccine, as

[Dr. Rick Hildebrand (Commissioner of Health)]: long

[Sen. Ginny Lyons (Chair)]: as the provider said, oh, and if in the rare case your child would develop no. That's the syndrome that could pass. Yeah. I mean, so as long as that's disclosed and it's done correctly, so you would have to sue the manufacturer. Right. Alright. I need to interrupt because I wanna make sure that no one in the room is reporting the activities. They are available on YouTube, so I can't keep going.

[Lauren Layman (General Counsel, Vermont Department of Health)]: So I did wanna say that, yes, so you're correct. So if, for example, the doctor would disclose there's a small risk of being on bryoside, which is a autoimmune infection, the parent or the individual would say, I accept that risk. Just like you go and you get your anesthesia or a med tea oriented and say, I accept that risk, you know, I have blood risk. So that's already in place. It's already something that needs to be done. If after the fact the child develops the Alvear's syndrome and it's not covered in the VACP and it always, and you know, the child was safer grade age, it's the right dose range, it's the right schedule, and it was an important stage, then all the sanitation, there was no gross negligence, which is being reckless or careless, not following procedure. If at that point that provider has done everything right, they're not gonna be liable for the reaction of the The pain patcher still can be, if they are neglectful, adversely due to negligent. If they do something like using, don't sanitize needles or something, then they could still be liable. That's all I? That's it? That's it.

[Rep. John Bistas (House reporter, Windham-1)]: We a question. I understand what you just said. Think it of course, raises the critical in terms of actually getting in compensation because now you're gonna go up against the badger the badger. But set that aside. What I was curious about is what about the state itself? We were adopting a different set of standards and the state, if all of you need potential lawsuits or or the green courts as they speak forward?

[Katie (Legislative Counsel)]: It's an interesting question. We have very strong state sovereignty law and case law,

[Rep. John Bistas (House reporter, Windham-1)]: so in most cases we would be protected, but it's a real interesting question. That's why we can do things with standard of care, scientifically based evidences, so we would have that backing for our recommendations, showing the eye of the eyes, loss of the eyes.

[Sen. Ginny Lyons (Chair)]: Question. Are there questions? Are there questions? I'm gonna suggest that we Doctor. Tyson, were you coming in to say something? I'm gonna suggest that we postpone Stephanie Winter's for another day. Is that acceptable? We'll take some more testimony. I know the folks who have asked to testify on this, and then we'll make sure that our questions are answered. I think it's been really helpful to have Department of Health and Ann today.

[Rep. John Bistas (House reporter, Windham-1)]: On our fourteenth.

[Sen. Ginny Lyons (Chair)]: Thank you. Thank you. That was a little off line.