TMA’s Top Legislative Priorities: Protect Immunizations to Protect Public Health
By Jessica Ridge

Priority: Protect public health by defending Texas’ vaccine laws 

Background: Amid an increasingly vaccine-hesitant climate, Texas has a firewall of vaccine laws in place the Texas Medical Association has fought for over the years. Those safeguards are expected to come under renewed threat this legislative session, which appears poised to repeat last session’s flurry of nearly 40 bills that threatened to erode access to routine childhood and adult immunizations. TMA successfully deflected most of that onslaught and predicts a similarly defensive stance this session. 

One potential hazard on the horizon is the specter of rollbacks of school vaccination requirements, which concerns Austin neonatologist Ashley Lucke, MD. 

“We’ve absolutely seen that decreases in the legislative support or upholding of vaccine requirements is correlated with decreased rates of vaccination and then, not surprisingly at all, increased rates of preventable communicable diseases,” Dr. Lucke said. 

According to the Texas Department of State Health Services (DSHS), conscientious exemptions from vaccinations doubled from 1.5% for seventh graders and 2% for kindergartners in 2019-20 to 3%-4% respectively in 2023-24. 

Some rates of vaccine-preventable diseases, such as pertussis and invasive meningococcal disease, have seen notable spikes, according to DSHS.  

Valerie Smith, MD, past chair of TMA’s Council on Science and Public Health, sees patients whose parents already worry about whether it’s safe to send their children to school amid dropping immunization rates in Texas. 

The Tyler pediatrician provides care for many children with complex medical needs who run a greater risk of experiencing more severe health outcomes and consequences if they become sick from a vaccine-preventable illness. 

She’s also concerned the prospect of larger swaths of the population choosing to limit or forgo vaccinations, enabled by legislative rollbacks, amplifies that risk – the outcomes of which are likely to be compounded by nonmedical factors of health. For instance, the communities and families likely to be affected are those already dealing with barriers like crowded living conditions where communicable illnesses can spread easily. 

“I worry that as we approach a higher number of people who are not vaccinated and have a higher risk for outbreaks of vaccine-preventable diseases, it’s not equitable who will be impacted,” Dr. Smith said.   

Solutions: TMA is actively engaged to put public health and safety first by encouraging access to and funding for immunization efforts that protect children, adults, and the state from costly infectious disease outbreaks. TMA also will work to ensure current and future vaccine advancements are not compromised.  

The doubt or distrust that undergirds the possibility of undoing legislative progress TMA has helped achieve is best met with education, openness, and honesty, says Jimmy Widmer, MD, an internal medicine physician in Belton. 

“As trusted leaders in health care, I think it’s vitally important that we at TMA continue to educate not only our patients and the public, but also our legislators on the role of vaccines in public health,” said Dr. Widmer, the Young Physicians Section representative on TMA’s Board of Trustees. “There’s a lot of misinformation and disinformation ... and [we can] use the evidence to guide that conversation.” 

One ongoing, proactive piece of advocacy TMA plans to pursue is updating ImmTrac2, the state’s immunization registry. While the state has made strides in enhancing the system’s interoperability, room for improvement persists, Mr. Dowling says. 

“The important thing is, it works when everyone is entered into it,” Dr. Lucke said. 

TMA also will be on guard against the creation of liability risks related to the provision of vaccines, which also could hinder access to care.  

TMA’s Council on Legislation Vice Chair J. Timothy Parker, MD, adds that liability threats undermining one type of vaccine could have ripple effects for others and the public health gains Texas has made in shielding the state from the costly effects of preventable diseases.  

“We’ve got to protect the great job we’ve done in that area,” the Denison gynecologist said.