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HB1118
HOUSE OF REPRESENTATIVES
H.B. NO.
1118
THIRTY-THIRD LEGISLATURE, 2025
STATE OF HAWAII
A BILL FOR AN ACT
RELATING TO NON-MEDICAL EXEMPTIONS TO IMMUNIZATION
REQUIREMENTS.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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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 Services
recommended 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."
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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.
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SECTION
2.
�
Section 302A-1156, Hawaii Revised
Statutes, is amended to read as follows:
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"
�302A-1156
�
Exemptions.
�
(a)
�
A
child
[
may
]
shall
be exempted from the required immunizations[
:
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(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
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(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
].
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(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.
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(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.
"
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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;
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(2)
�
Adulteration
and misbranding of food or drugs;
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(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;
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(4)
�
Privy vaults and cesspools;
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(5)
�
Fish and fishing;
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(6)
�
Interments and dead bodies;
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(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;
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(8)
�
Cemeteries and burying grounds;
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(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;
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(11)
�
Hotels, rooming houses, lodging houses,
apartment houses, tenements, and residences for persons with developmental
disabilities including those built under federal funding;
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(12)
�
Laboratories;
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(13)
�
Any place or building where noisome or
noxious trades or manufacturing is carried on, or intended to be carried on;
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(14)
�
Milk;
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(15)
�
Poisons and hazardous substances, the
latter term including any substance or mixture of subs
tances
that:
���������
(A)
�
Is corrosive;
���������
(B)
�
Is an irritant;
���������
(C)
�
Is a strong sensitizer;
���������
(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;
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(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;
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(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;
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(20)
�
Device as defined in section 328-1;
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(21)
�
Sources of ionizing radiation;
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(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
];
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(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;
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(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;
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(25)
�
Ambulances
and ambulance equipment;
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(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.
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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."
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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.
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[
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."
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SECTION 5.
�
Statutory material to be repealed is bracketed
and
stricken.
�
New statutory material is underscored.
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SECTION
6.
�
This Act shall take effect upon its
approval.
INTRODUCED BY:
_____________________________
BY REQUEST
Report Title:
Immunizations; Non-Medical Exemptions; Repeal
Description:
Repeals the non-medical exemption from immunization
requirements.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.