Hawaii-2025-HB1118-Introduced

SECTION 1. The legislature finds that school entry immunization requirements have been shown to be effective in improving immunization coverage rates. Based on decades of strong evidence of effectiveness, the United States Department of Health and Human Services Task Force on Community Preventive Servicesrecommended the continued implementation of school immunization requirements as a means of increasing immunization coverage, thereby reducing disease incidence. When ninety-five per cent of individuals in a community are immunized, those persons serve as a protective barrier against the likelihood of transmission of vaccine-preventable diseases in the community. This occurrence is referred to as "herd immunity."

High immunization rates at schools are especially important for medically fragile children. Some children have conditions that affect their immunity, such as illnesses that require chemotherapy. These children cannot be safely immunized, and, at the same time, they are less able to fight off illness when they are infected. They depend on herd immunity for their health and their lives. In Hawaii for the 2023-2024 school year, 296 students had a medical exemption from immunization; they were unable to get immunized due to a medical condition and relied on herd immunity to attend school safely.

The legislature further finds that decreasing immunization coverage due to non-medical exemptions increases the risk for vaccine-preventable disease outbreaks that can be fatal to children. In Hawaii for the 2015–2016 school year, the rate of non-medical immunization exemption was 2.5 per cent. The rate of non-medical immunization exemption more than doubled to 5.3 per cent for the 2023–2024 school year. The rate of non-medical exemptions varied by school with fifty-five of the 382 schools that reported for school year 2023-2024 having a non-medical immunization exemption rate greater than ten per cent.

The legislature finds that since the health and safety of Hawaii's keiki are paramount, the State has a compelling interest in protecting the public against deadly diseases considering an increasing trend in non-medical immunization exemptions, while honoring certain non-medical exemptions that previously have been approved.

Accordingly, the purpose of this Act is to improve the health and safety of school-aged children by minimizing exemptions from school immunization requirements.

SECTION 2. Section 302A-1156, Hawaii Revised Statutes, is amended to read as follows:

"§302A-1156 Exemptions. (a) A child [~~may~~] shall be exempted from the required immunizations[:

~~(1)~~ If] if a licensed physician, physician assistant, or advanced practice registered nurse certifies that the physical condition of the child is such that immunizations would endanger the child's life or health[~~; or~~

~~(2)~~ If any parent, custodian, guardian, or any other person in loco parentis to a child objects to immunization in writing on the grounds that the immunization conflicts with that person's bona fide religious tenets and practices. Upon showing the appropriate school official satisfactory evidence of the exemption, no certificate or other evidence of immunization shall be required for entry into school].

(b) Any child attending school who had an approved religious exemption from required immunizations for the 2024-2025 school year shall be permitted to remain exempt while continuing to attend school in Hawaii.

(c) This section does not prohibit a pupil who qualifies for an individualized education action program pursuant to federal and state law, from accessing any special education and related services required by their individualized education program."

SECTION 3. Section 321-11, Hawaii Revised Statutes, is amended to read as follows:

"§321-11 Subjects of health rules, generally. The department of health pursuant to chapter 91 may adopt rules that it deems necessary for the public health and safety respecting:

(1) Nuisances, foul or noxious odors, gases, vapors, waters in which mosquitoes breed or may breed, sources of filth, and causes of sickness or disease, within the respective districts of the State, and on board any vessel;

(2) Adulteration and misbranding of food or drugs;

(3) Location, air space, ventilation, sanitation, drainage, sewage disposal, and other health conditions of buildings, courts, construction projects, excavations, pools, watercourses, areas, and alleys. For purposes of this paragraph, "pool" means a watertight artificial structure containing a body of water that does not exchange water with any other body of water, either naturally or mechanically, and is used for swimming, diving, recreational bathing, or therapy by humans;

(4) Privy vaults and cesspools;

(5) Fish and fishing;

(6) Interments and dead bodies;

(7) Disinterments of dead human bodies, including the exposing, disturbing, or removing of these bodies from their place of burial, or the opening, removing, or disturbing after due interment of any receptacle, coffin, or container holding human remains or a dead human body or a part thereof and the issuance and terms of permits for the aforesaid disinterments of dead human bodies;

(8) Cemeteries and burying grounds;

(9) Laundries, and the laundering, sanitation, and sterilization of articles including linen and uniforms used by or in the following businesses and professions: barber shops, manicure shops, beauty parlors, electrology shops, restaurants, soda fountains, hotels, rooming and boarding houses, bakeries, butcher shops, public bathhouses, midwives, masseurs, and others in similar calling, public or private hospitals, and canneries and bottling works where foods or beverages are canned or bottled for public consumption or sale; provided that nothing in this chapter shall be construed as authorizing the prohibiting of laundering, sanitation, and sterilization by those conducting any of these businesses or professions where the laundering or sterilization is done in an efficient and sanitary manner;

(10) Hospitals, freestanding surgical outpatient facilities, skilled nursing facilities, intermediate care facilities, adult residential care homes, adult foster homes, assisted living facilities, special treatment facilities and programs, home health agencies, home care agencies, hospices, freestanding birthing facilities, adult day health centers, independent group residences, and therapeutic living programs, but excluding youth shelter facilities unless clinical treatment of mental, emotional, or physical disease or handicap is a part of the routine program or constitutes the main purpose of the facility, as defined in section 346-16 under "child caring institution". For the purpose of this paragraph, "adult foster home" has the same meaning as provided in section 321-11.2;

(11) Hotels, rooming houses, lodging houses, apartment houses, tenements, and residences for persons with developmental disabilities including those built under federal funding;

(12) Laboratories;

(13) Any place or building where noisome or noxious trades or manufacturing is carried on, or intended to be carried on;

(14) Milk;

(15) Poisons and hazardous substances, the latter term including any substance or mixture of substances that:

(A) Is corrosive;

(B) Is an irritant;

(D) Is inflammable; or

(E) Generates pressure through decomposition, heat, or other means,

if the substance or mixture of substances may cause substantial personal injury or substantial illness during or as a proximate result of any customary or reasonably foreseeable handling or use, including reasonably foreseeable ingestion by children;

(16) Pig and duck ranches;

(17) Places of business, industry, employment, and commerce, and the processes, materials, tools, machinery, and methods of work done therein; and places of public gathering, recreation, or entertainment;

(18) Any restaurant, theater, market, stand, shop, store, factory, building, wagon, vehicle, or place where any food, drug, or cosmetic is manufactured, compounded, processed, extracted, prepared, stored, distributed, sold, offered for sale, or offered for human consumption or use;

(19) Foods, drugs, and cosmetics, and the manufacture, compounding, processing, extracting, preparing, storing, selling, and offering for sale, consumption, or use of any food, drug, or cosmetic;

(20) Device as defined in section 328-1;

(21) Sources of ionizing radiation;

(22) Medical examination, vaccination, revaccination, and immunization of school children[. No child shall be subjected to medical examination, vaccination, revaccination, or immunization, whose parent or guardian objects in writing thereto on grounds that the requirements are not in accordance with the religious tenets of an established church of which the parent or guardian is a member or adherent, but no objection shall be recognized when, in the opinion of the department, there is danger of an epidemic from any communicable disease];

(23) Disinsectization of aircraft entering or within the State as may be necessary to prevent the introduction, transmission, or spread of disease or the introduction or spread of any insect or other vector of significance to health;

(24) Fumigation, including the process by which substances emit or liberate gases, fumes, or vapors that may be used for the destruction or control of insects, vermin, rodents, or other pests, which, in the opinion of the department, may be lethal, poisonous, noxious, or dangerous to human life;

(25) Ambulances and ambulance equipment;

(26) Development, review, approval, or disapproval of management plans submitted pursuant to the Asbestos Hazard Emergency Response Act of 1986, Public Law 99-519; and

(27) Development, review, approval, or disapproval of an accreditation program for specially trained persons pursuant to the Residential Lead-Based Paint Hazard Reduction Act of 1992, Public Law 102-550.

The department of health may require any certificates, permits, or licenses that it may deem necessary to adequately regulate the conditions or businesses referred to in this section."

SECTION 4. Section 325-34, Hawaii Revised Statutes, is amended to read as follows:

"§325-34 Exemptions. Section 325-32 shall be construed not to require the vaccination or immunization of any person for three months after a duly licensed physician, physician assistant, advanced practice registered nurse, or an authorized representative of the department of health has signed two copies of a certificate stating the name and address of the person and that because of a stated cause the health of the person would be endangered by the vaccination or immunization, and has forwarded the original copy of the certificate to the person or, if the person is a minor or under guardianship, to the person's parent or guardian, and has forwarded the duplicate copy of the certificate to the department for its files.

[No] Except as required under section 302A-1154, no person shall be subjected to vaccination, revaccination, or immunization, who shall in writing object thereto on the grounds that the requirements are not in accordance with the religious tenets of an established church of which the person is a member or adherent, or, if the person is a minor or under guardianship, whose parent or guardian shall in writing object thereto on such grounds, but no objection shall be recognized when, in the opinion of the director of health, there is danger of an epidemic from any communicable disease."

SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 6. This Act shall take effect upon its approval.

INTRODUCED BY:

_____________________________

BY REQUEST

HOUSE OF REPRESENTATIVES	H.B. NO.	1118
THIRTY-THIRD LEGISLATURE, 2025
STATE OF HAWAII