Vaccination Registry Funding

At a Fiscal Committee meeting on Nov 19, 2021 the committee voted to accept $22.5M to “fund the Immunization Program as mandated by the American Rescue Plan.” One might take this to mean vaccinating more people or encouraging more people to get vaccinated. However this isn’t the case.

From the presentation by DHHS: “Right now with most of our providers who have electronic health records … they’re putting that information in their system. It would be more efficient for them to then have a connectivity to our Immunization Information System … that allows one system to be able to talk to another system … and that is what much of this funds is going to right now …”

The clip running about 1.5 minutes contains the full context of this statement near the end.

If more evidence is needed, at a Fiscal Committee held Dec 2, 2021 DHHS requested $70,011,374 (that’s seventy million dollars) “to continue to provide COVID-19 vaccinations and boosters to individuals across the State” and “to provide an additional van and continue supporting the mobile COVID-19 vaccination efforts” and “for COVID-19 testing at four (4) locations across the State.”

Clearly, the $27M approved over the past months was strictly to build out the vaccination opt-out database to include all vaccinated people AND those who refuse the vaccine. It should be noted that the database is opt-out by DHHS rule only, not specifically called for in law.

This clip contains DHHS’ explanation of the ‘requirement’ for an opt-out system:

The law designating the creation of an Immunization Registry is RSA 141-C:20-f and it is included in its entirety at the end of this page. You will note it was passed in 1998 and the rules implementing it (He-P 307) weren’t begun until 2017 while actual implementation wasn’t started until Jan 2021. That law has no explicit reference to “opt in” or “opt out.”

DHHS is relying on these two clauses of the law in making the claim that the law requires the system to be opt out:

II. No patient, or the patient’s parent or guardian if the patient is a minor, shall be required to participate in the immunization registry.

VI-(c) Procedures for the patient, or the patient’s parent or guardian if the patient is a minor, to decline to participate in the registry.

While these clauses may be satisfied by creating an opt out system they appear to be satisfied by creating on opt in system as well. Further, in 2018, two years before implementation of the sytem began the people of New Hampshire passed this constitutional amendment:

An individual’s right to live free from governmental intrusion in private or personal information is natural, essential, and inherent.

This constitutional amendment appears to conflict with the decision to make the registry opt out.

It should also be noted that the Executive Council attached a resolution to their approval of this grant stating the following:

The Governor and Executive Council support making the New Hampshire Immunization Registry established in RSA 141-C:20-f an opt in system.

I am not aware that any effort has been made by the Executive branch to move to an opt in system.

As indicated above the system requires all vaccination events to be recorded in the database and the refusal to receive a vaccine is one of the events to be recorded. Here are the relevant parts of the rules:

PART He-P 307 IMMUNIZATION/VACCINATION REGISTRY

He-P 307.05 Content and Submission of Vaccination Event Reports.

(a) For each patient who, after being given the opportunity to opt out of participating in the registry in accordance with He-C 307.06, does not exercise the option to opt out, an administering or current health care provider who is participating in the registry shall report vaccination events to the registry within 7 business days of the event through an electronic web-based interface at www.vaxnh.org.

He-P 307.02 Definitions.

(r) “Vaccination event” means an immunization/immunoglobulin administration, exemption, refusal as defined in (p) above, adverse reaction.

141-C:20-f Immunization Registry

I. The department shall establish and maintain a state immunization registry. The registry shall be a single repository of accurate, complete and current immunization records to aid, coordinate, and promote effective and cost-efficient disease prevention and control efforts.
II. No patient, or the patient’s parent or guardian if the patient is a minor, shall be required to participate in the immunization registry.
III. Physicians, nurses, and other health care providers may report an immunization to the immunization registry unless the patient, or the patient’s parent or guardian if the patient is a minor, refuses to allow reporting of this information.
IV. Access to the information in the registry shall be limited to primary care physicians, nurses, other appropriate health care providers as determined by the commissioner, schools, child care agencies, and government health agencies or researchers demonstrating a legitimate need for such information as determined by the commissioner.
V. The information contained in the registry shall be used for the following purposes:
(a) To ensure that registrants receive all recommended immunizations in a timely manner by providing access to the registrant’s immunization record.
(b) To improve immunization rates by facilitating notice to registrants of overdue or upcoming immunizations.
(c) To control communicable diseases by assisting in the identification of individuals who require immediate immunization in the event of a disease outbreak.
VI. The commissioner shall adopt rules under RSA 541-A concerning the following:
(a) The establishment and maintenance of the immunization registry.
(b) The methods for submitting and content of reports of immunizations.
(c) Procedures for the patient, or the patient’s parent or guardian if the patient is a minor, to decline to participate in the registry.
(d) Procedures for the registrant, or the registrant’s parent or guardian if the registrant is a minor, to review and correct information contained in the registry.
(e) Procedures for the registrant, or the registrant’s parent or guardian if the registrant is a minor, to withdraw consent for participation at any time and to remove information from the registry.
(f) Limits on and methods of access to the registry by those authorized to gain access under paragraph IV of this section.
(g) Procedures for managed care organizations to obtain summary statistics of immunization information on managed care organization members from the immunization registry.
VII. Any person reporting, receiving, or disclosing information to or from the immunization registry as authorized by this section or by any rule adopted pursuant to this section shall not be liable for civil damages of any kind connected with such submission or disclosure of immunization information.
VIII. Nothing in this section is intended to affect the obligations of persons under RSA 141-C:20-a to have their children properly immunized.
IX. Nothing in this section shall preclude the right of the patient, or the patient’s parent or guardian if the patient is a minor, to claim exemption from immunization as defined in RSA 141-C:20-c; nor shall anything in this section require such patient to be included in the registry if the patient, or the patient’s parent or guardian if the patient is a minor, objects thereto on any grounds, including but not limited to, that such registry conflicts with the religious beliefs of the patient, or the patient’s parent or guardian if the patient is a minor.
X. No health care provider shall discriminate in any way against a person solely because that person elects not to participate in the immunization registry.
Source. 1998, 183:3, eff. Aug. 14, 1998.