RELATING TO IMMUNIZATIONS.

HB2166

HOUSE OF REPRESENTATIVES

H.B. NO.

2166

THIRTY-THIRD LEGISLATURE, 2026

STATE OF HAWAII

A BILL FOR AN ACT

relating
to immunizations
.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

����
SECTION
1.
�
The legislature finds that the
removal of religious exemptions from the vaccine schedule may create barriers
to school attendance at a time when national confidence in vaccine safety has
declined.
�
Hawaii's children continue to
experience rising rates of chronic disease, and a comprehensive approach to
student health remains essential.

����
The
legislature further finds that vaccines have a long record of reducing
infectious diseases, and the United States Department of Health and Human
Services Task Force on Community Preventive Services recommends continued
school immunization requirements to maintain coverage and reduce disease.
�
Recent national adjustments to recommended
vaccines emphasize shared decision
‑
making, and although
vaccines are effective public health tools, no medical intervention is entirely
risk
‑
free.
�
Hawaii also faces high levels of chronic
conditions among youth, and national data show that roughly twenty per cent of
children experience mental, emotional, developmental, or behavioral disorders
influenced by multiple health and environmental factors.

����
The
legislature additionally finds that some children cannot be safely immunized
due to medical conditions and rely on low disease prevalence in schools.
�
During the 2024�2025 school year, Hawaii had
192,853 enrolled students, including three hundred sixty-six students with
medical exemptions, approximately 0.19 per cent of the student population.
�
The remaining students also deserve
individualized health decision
‑
making between their health
care provider and parent or guardian to address their unique circumstances.

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Accordingly,
the purpose of this Act is to support the health and safety of school
‑
aged
children by balancing infectious disease prevention with respect for
individualized health considerations and ensure that families retain the
ability to make informed decisions with their child
'
s physician or health care provider regarding vaccines.

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

����
"
�302A-1156
�

Exemptions.
�
A child [
may
]

shall
be exempted from the required immunizations:

����
(1)
�
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."

����
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;

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(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;

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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;

���
(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;

���������
(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;

���
(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;
]
medical examination,
vaccination, revaccination, or immunization conflicts with that person's bona
fide religious tenets and practices;

���
(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.

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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."

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

����
"
�325-34
�

Exemptions.
�
(a)
�
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
]

(b)
�
Except as provided 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,
]
vaccination,
revaccination, or immunization conflicts with the person's bona fide religious
tenets and practices,
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.

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

INTRODUCED BY:

_____________________________

Report Title:

Immunizations;
Exemptions; Schools; Medical Examinations; Vaccinations; DOH; Rulemaking
Authority; Infectious and Communicable Diseases; Bona Fide Religious Tenets and
Practices

Description:

Requires,
rather than authorizes, schools to provide an exemption from required
immunizations.
�
Specifies that for
purposes of the Department of Health's rulemaking authority and authority
regarding infectious and communicable diseases, no child shall be subjected to
medical examination, vaccination, revaccination, or immunization if a parent or
legal guardian objects based on bona fide religious tenets and practices.

The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.