House Bill 1118, which is part of the Governor's legislative package, passed with amendments through the House Committee on Judiciary and Hawaiian Affairs on Friday, Feb. 21, after more than three hours of testimony. The measure is headed to the Senate next month.
Last week, Aloha State Daily reported on a rally at the Hawaiʻi State Capitol, where organizers opposed the bill that would repeal non-medical exemptions to vaccines for all first-time students entering childcare, preschool, K-12, and post-secondary schools statewide.
Public interest in the bill is high. Nearly 1,500 pages of written testimony were submitted for a Feb. 7 hearing on the bill, and just over 2,000 pages submitted Feb. 21. By ASD's count, scrolling through the 2,000 pages, about 1,643 people opposed the bill while 75 people testified in support. People identifying themselves as educators and health care professionals could be found on both sides of the issue.
ASD reached out to the state Department of Education and the Hawaiʻi Association of Independent Schools (HAIS) to learn more about the types of immunizations currently required by grade, and who chooses, reviews and enforces them.
HAIS Executive Director Phil Bossert told ASD by email, “We are just a membership support group for Hawaiʻi’s 112 private and parochial schools. HAIS has no guidelines or regulations for our member schools. They are each an independent, nonprofit organization and set all their own rules and guidelines, which includes with respect to vaccination. ... but it is up to each individual school to enforce them."
DOE officials told ASD that immunization requirements are part of state law (HRS §302A-1154), which reads, “No child shall attend any school in the state unless the child presents to the appropriate school official documentation satisfactory to the Department of Health that the child has received immunizations against communicable diseases as required by the Department of Health.”
“Required immunizations depend on the age and/or grade of the student. The Covid vaccine is not one of the required vaccinations,” the DOE confirmed.
The full list of statewide immunizations can be viewed here: vaxtoschoolhawaii.com, or below:
–Childcare or preschool (8 vaccines): Diphtheria-Tetanus-Pertussis (DTaP); Haemophilus influenzae type b (Hib); Hepatitis A (Hep A); Hepatitis B (Hep B); Measles-Mumps-Rubella (MMR); Pneumococcal Conjugate Vaccine (PCV); Polio (IPV); Varicella (chickenpox)
–Grades K-12 (9 vaccines): Diphtheria-Tetanus-Pertussis (DTaP); Hepatitis A (Hep A); Hepatitis B (Hep B); Human Papillomavirus (HPV)*; Meningococcal Conjugate (MCV)*; Measles-Mumps-Rubella (MMR); Polio (IPV); Tetanus-diphtheria-pertussis (Tdap)*; Varicella (chickenpox).
*Prior to attendance in 7th grade or higher, students must show evidence of receiving these immunizations.
–Post-secondary (3 to 4 vaccines): Measles-Mumps-Rubella (MMR); Tetanus-diphtheria-pertussis (Tdap); Varicella (chickenpox); Meningococcal Conjugate (MCV)*
*First-year students living in on-campus housing only.
Currently, public school children may be exempted from immunization requirements for medical or religious reasons with proper documentation.
According to the DOH’s latest Immunization and Examination Requirements Report, for the 185,579 public and private school students enrolled, data shows a religious exemption rate averaging 4.07% during the 2023-2024 school year, up from 2.1% in 2019-2020. Medical exemptions remained low at 0.16% in 2023-24, while 2.76% had no immunization record and 14.33% of students were missing immunizations. In total, 21.33% student immunization records were not up to date across Hawai‘i's public and private schools.
In written testimony in support of HB1118, the DOH wrote, "During the 2023-2024 school year, Hawai‘i’s overall non-medical exemption rate grew to 5.3% with 55 of 382 schools reporting non-medical exemption rates exceeding 10% of their student populations. Decreasing immunization coverage due to rising rates of exemptions, which have no medical basis, increases the risk for vaccine-preventable disease outbreaks that can be potentially fatal to children who attend school."
What happens when children show up unvaccinated or with incomplete vaccination records? The DOE said, "School health staff follow up with parents and guardians directly for compliance. Parents and guardians are notified that provisional (temporary) entrance for students may be allowed if written proof of an appointment to complete the immunization requirements is submitted prior to or on their child's first day of school.
"Certification that the required immunizations have been completed must be submitted to the school no later than three months after the child provisionally entered school. If these requirements are not completed, the child may be denied further school attendance until requirements are met."
The DOH answered other questions we had via email.
Aloha State Daily: Is the Covid-19 vaccine required, why or why not?
Hawaiʻi Department of Health: No, Covid-19 vaccine is not required for schools but is highly recommended.
ASD: How are the vaccines chosen and by whom?
DOH: Vaccines are chosen and approved at the federal level for recommended use in various populations for more details, please see below. The DOH has adopted the Advisory Committee on Immunization Practices (ACIP) recommendations for routine vaccination with certain exceptions. Vaccines that have a maximum age for final dose that is younger than the age to start school (e.g. RSV and rotavirus) are not required, and vaccines that would be administered annually (e.g. influenza and Covid-19) are recommended but not required.
At the federal level, immunizations are chosen by The Food and Drug Administration’s (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC), [which] recommends vaccines after evaluating scientific data concerning safety, effectiveness and appropriate use of vaccines. VRBPAC’s recommendation is forwarded for FDA’s review and approval.
To make a recommendation after FDA approval, the ACIP carefully reviews all data about a vaccine. This includes:
- The safety and effectiveness of the vaccine for people in different age groups
- The seriousness of the disease that this vaccine is designed to prevent
- The estimated number of people who would get the disease if the vaccine didn't exist
After ACIP makes a recommendation to add a vaccine to a schedule, the Centers for Disease Control and Prevention (CDC) Director decides whether to approve the recommendation. If the CDC Director approves, the new vaccine will be added to the immunization schedule.
You may have seen the recommended schedule for vaccinations at your doctor's office. CDC creates these schedules each year with help from a group of medical and public health experts called the Advisory Committee on Immunization Practices (ACIP):
[See also, the CDC on vaccine development here and more on immunizations here.]
ASD: How often are vaccines reviewed for safety and effectiveness?
DOH: Vaccines are constantly monitored by CDC. The vaccine safety system in the U.S. ensures vaccines remain safe and effective for use. Health experts constantly monitor a vaccine's safety — starting as soon as FDA approves it.
The systems below are designed to monitor vaccine safety and effectiveness from multiple systems:
Vaccine Adverse Event Reporting System (VAERS): Anyone can submit a report of adverse events (serious health problems) after vaccination, regardless of whether it is vaccine related.
Vaccine Safety Datalink (VSD): Scientists can analyze health information from over 24 million people and determine if possible adverse effects are actually related to vaccination.
Post-Licensure Rapid Immunization Safety Monitoring (PRISM): Researchers can monitor vaccine safety, analyzing data from 190 million people.
Clinical Immunization Safety Assessment (CISA) Project: This collaboration between CDC and medical research centers helps experts conduct vaccine safety studies.
For more information about school health requirements in Hawaiʻi, click here.
Kelsey Kukaua Medeiros can be reached at kelsey@alohastatedaily.com.
