It’s July and many parents and college students are receiving their enrollment packages for the upcoming academic year. Families are also making new daycare decisions, or renewing daycare agreements.
As a parent, I have filled out my share of school enrollment packages and then mentored my adult children so that they could make their own decisions during the college enrollment process and beyond. I’ve both seen and experienced vaccine bullying, and I know first hand the importance of understanding vaccine policies and laws that govern the enrollment process.
This article provides timely vaccine resource information to assist our readers during enrollment and to prevent families and adults from being bullied into making vaccine decisions that do not align with their values and beliefs.
School Vaccine Requirements & Exemptions
NVIC receives numerous inquiries every year about school vaccine requirements and exemptions. School vaccine mandates (requirements) and exemptions vary from state to state because they are determined by each state’s legislature. You will need to understand the laws of your specific state.
State law also dictates how often school vaccine paperwork must be submitted, to whom that paperwork is submitted, as well as how personal vaccine information is shared with a state’s immunization information system (IIS), more commonly known as a vaccine registry.
State vaccine laws can also vary on which settings the law applies to, such as day care, K-12, and college, as well as whether or not the law applies to private schools. In Colorado, for example, the school vaccine law applies to day care facilities and private schools. Understanding how your state’s vaccine laws apply to a specific setting is helpful when completing enrollment documents.
Vaccine Requirements vs. Recommendations
Sadly, one of the stories often shared by parents with NVIC is that they have been incorrectly told by a school official, health care professional, or day care professional that all vaccines on the CDC’s recommended childhood schedule are required for enrollment. Exemption information is often not disclosed in these conversations.
While there are some states and private institutions that do require all federally recommended vaccines as a condition of enrollment, the majority of states require fewer vaccines than the 69 doses recommended by the CDC from birth to age 18. Additionally, most states offer varying degrees of vaccine exemptions. NVIC provides an overview of the difference between a vaccine requirement and a vaccine recommendation that many readers have found helpful as they navigate school and day care enrollment requirements.
Vaccine Registries Track Vaccine Status
As parents make their vaccine choices, it is also wise to consider how privacy rights may be impacted by these decisions.
Many states have a vaccine registry that tracks the vaccination status of school children. More recently, federal policy and state laws are expanding registries to include adult vaccination status.1 Registries are often populated by data gathered from personal electronic medical records2 that health care professionals are incentivized to use by the federal government.3 4
The majority of state vaccine registries are opt-out, meaning you or your child’s vaccine information may already be in your state’s registry, and if you do not want to share that information, you must opt out. Unfortunately, some registries only allow opting out of data-sharing, and your health department may retain your information even after you opt out. NVIC’s state pages link to each state’s registry so that readers can learn about how data is acquired, discover if their personal vaccine information is in the system, and find out what opt-in or opt-out options are available and what information is retained when opting out.
Federal Privacy Rights Trump HIPAA
Often overlooked, or misunderstood, in the enrollment process is the difference between federal privacy rights conferred by the Family Educational Rights and Privacy Act of 1974 (FERPA)5 6 in the educational setting, and the “confidentiality” offered by state vaccine registries that are governed by the Health Insurance Portability and Accountability Act (HIPAA).
FERPA protects records gathered by schools, inclusive of vaccine status information.7 Generally speaking, schools are prohibited from sharing personally identifiable information in those records without the specific written consent from the student’s parents or the adult student.8 However, not all schools are subject to FERPA and there are other exceptions that should be reviewed9 to more fully understand the privacy protections conferred by FERPA.
School vaccine information collected by other state agencies, such as the health department, is not protected by FERPA and may instead be subject to HIPAA.10 11 The primary difference between FERPA and HIPAA is that HIPAA allows information to be shared with third parties for public health related activities, without the consent or knowledge of parents and adult students.12 13 Again, we encourage our readers to take the time understand how data-sharing is governed under HIPAA prior to submitting school enrollment information to entities other than a school.
Additionally, NVIC is aware of tactics by state agencies, like those in Colorado, to circumvent FERPA14 through the introduction of legislation to change the law and allow health departments to gather school vaccine information for use in the state's vaccine registry. Abuse of authority and misleading families into giving their vaccine status information to health departments across multiple states has also been reported to NVIC. These types of activities are monitored on NVIC’s free Advocacy Portal to keep our readers informed on what is happening in their state and what actions can be taken to protect this sensitive medical information.
If you believe your FERPA rights have been violated, filing a complaint against a school is relatively easy, and must be filed within six months of the violation by the parent of the student, or the adult student.15
Any abuse of school vaccine laws should be brought to the attention of the agencies involved and copied to your state legislator asking for corrective measures. Please consider sharing this correspondence with NVIC so that we may further our advocacy efforts to protect and defend vaccine informed consent rights in your state.
Vaccine conversations unfolding in classrooms.
More recently, NVIC has received emails from parents concerned about vaccine related curriculum being taught as early as elementary school.
Knowledge is power and talking to your child(ren) about vaccines is important, because the reality is that the vaccine conversation may already be taking place in the classroom, and it may lack balance and information on the ethical principle of informed consent.16 17 18 Mentoring children on how to identify reliable information and resources, and exercising their informed consent rights when making health care decisions will prepare them for the health care decisions they will face as adults.
College enrollment and getting information in advance.
In fact, some of the first health care decisions young adults must make are vaccination decisions related to college admission, with meningococcal vaccine being a focus of discussion for incoming freshmen.
NVIC provides reliable information on diseases and vaccines to assist young adults and parents who are navigating these waters for the first time. As college choices are weighed, many families have found it helpful to proactively:
- research the state’s vaccine requirements and exemption laws as part of college selection process;
- ask the admissions officer for the school’s vaccination and exemption policy in writing (should be on the institution’s letterhead), if it is not already available on the institution’s website; and
- ask if there are programs, such as nursing or other medical programs which require vaccination.
It is better to have this information in advance of deciding which college to attend so that there are no surprises when filling out the college enrollment paperwork.
NVIC is your go-to resource!
The good news is that NVIC’s website provides the public with the information and resources necessary to navigate the enrollment process. In addition, please consider the following tips:
- Be aware of the difference between a legal vaccine requirement and a recommendation to prevent bullying and coercion.
- Research the state vaccine requirements and exemption laws for your setting (day care, K-12, college, private institution) to understand requirements and exemption options and how they apply to your situation.
- Research whether or not your state allows exemption from vaccination, or revaccination, if there is proof of immunity.
- If dealing with a private business or institution that is not required to follow state vaccine laws, obtain written documentation of the vaccine policy to prevent bullying and coercion in private settings.
- Understand the basics of FERPA and HIPAA and the privacy implications of your choices.
Vaccine requirements and exemptions change – stay informed
Some state laws permit health departments to add new vaccine requirements through administrative rule changes. There have also been numerous attacks on state vaccine exemption laws, as well as efforts to expand vaccine requirements.19 While vaccine mandates are determined at a state level, how vaccine requirements are implemented can vary.
The best way to know what is happening in your state and protect your ability to make informed, voluntary vaccine decisions is by registering for NVIC’s free Advocacy Portal. The portal provides links to contact your legislator, bill information and analysis, and talking points when legislation to expand or restrict vaccine freedom of choice is introduced so that contacting your legislator with your concerns is easy.
NVIC encourages our readers to use the resources discussed above, research and become knowledgeable of your rights, and join NVIC in protecting and expanding vaccine freedom of choice for children and adults now and in the future!
1 CDC. Percentage of private provider sites actively participating in a grantee
immunization information system -- United States, six cities, and eight Territories, 2009. Accessed Jul. 20, 2018.
2 CDC. Percentage of private provider sites actively participating in a grantee
immunization information system -- United States, six cities, and eight Territories, 2009. Accessed Jul. 20, 2018.
3 Centers for Medicare & Medicaid Services. Medicare & Medicaid EHR Incentive Program. Accessed Jul. 20, 2018.
4 Medical Records.com. Government EHR/EMR Incentives Information. Accessed Jul. 20,2018.
5 U.S. Department of Education. Family Educational Rights and Privacy Act of 1974 (FERPA). Mar. 1, 2018.
6 HHS. HIPAA – Does the HIPAA Privacy Rule apply to an elementary or secondary school? Jul. 26, 2013.
7 HHS. HIPAA – Does FERPA or HIPAA apply to records on students at health clinics run by postsecondary institutions? Jul. 26, 2013.
8 U.S. Department of Education. Laws & Guidance – Letter to Alabama Department of Education re: Disclosure of Immunization Records. FERPA Online Library. Feb. 25, 2004.
9 DOE. Protecting Student Privacy – Frequently Asked Questions: Exceptions - Health and Safety Emergency. Accessed Jul. 13, 2018.
10 HHS. HIPAA – Student Immunizations. Sep. 19, 2013.
11 HHS. HIPAA – Does FERPA or HIPAA apply to elementary or secondary school student health records maintained by a health care provider that is not employed by a school? Jul. 26, 2013.
12 HHS. Summary of the HIPAA Privacy Rule. Jul. 26, 2013.
13 Torrey, T. Are Medical Records Private? Verywellhealth. Jun. 6, 2018.
14 NVIC. Colorado State Vaccine Requirements. Mar. 16, 2018.
15 DOE. Protecting Student Privacy – File a Complaint. Accessed Jul. 13, 2018.
16 Council of Europe. Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine. Apr. 4, 1997
17 Nir E. Informed Consent. The Stanford Encyclopedia of Philosophy 2011 (Fall Edition).
18 Cohen J, Ezer T. Human rights in patient care: A theoretic and practical framework. Health and Human Rights Journal 2013
19 NVIC. State Vaccine Legislation in America 2015-2017. Oct. 25, 2017.
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