New Hampshire’s Executive Council voted on Dec. 18, 2019 to accept $1.5 million from the Centers for Disease Control and Prevention (CDC) to create an Immunization Information System (IIS). According to the New Hampshire Department of Health and Human Services, New Hampshire is currently the only state without vaccine tracking system.1
The IIS electronic tracking databases, which are population-based computerized databases that have been created in states and are managed by the CDC, collect a record of every vaccine dose administered through participating providers, and aggregate the data for the purpose of:2
- Providing consolidated vaccination histories of individuals to help vaccine providers determine which federally recommended vaccines a patient has received or should receive;
- Providing aggregate data to public health officials for use in surveillance and vaccine program operations to improve vaccination rates.
- Assist the state with placing more accurate vaccine stock orders for public health clinics and other facilities providing publicly funded vaccines
Although the New Hampshire Executive Council’s vote was unanimous, it was not without controversy. Activists concerned about medical privacy and government accountability voiced opposition to creation of an electronic vaccine tracking registry in the state and carried signs protesting how the government handled the project in the past.3 Councilors took officials from the state’s Department of Health and Human Services (DHHS) to task for failing to fulfill a similar vaccine registry with a $1.36 million contract with Scientific Technology Corporation (STC) in 2014. That money was used to create a vaccine ordering and inventory system, but did not implement the vaccine tracking registry due to tensions over confidentiality protections.1
Specifically, the earlier registry was designed as an “Opt-out” system whereby all residents would be included unless they actively chose not to participate. That system stalled when advocates of medical privacy challenged the DHHS’s plans to include an individual’s decision to “opt-out” as one of the ‘vaccination events” electronically tracked by the registry rather than blocking information about the individual’s vaccination status entirely.4
The state has until June 2020 to secure a contract with a new vendor. Although it will be years before residents participating in the New Hampshire vaccine tracking registry will be able to access stored information about their vaccination histories, when it does come online, individuals will be able to “opt out.”5
Tessa Lafortune Greenberg, MD, chair of the pediatrics department at Dartmouth-Hitchcock and president of the New Hampshire Medical Society says vaccine tracking registries cut down on wasteful spending on re-administering unnecessary shots, and “being able to have a good, consistent record of vaccines for patients is huge. You can’t assume they had things they didn’t… [but] you don’t want to give anyone something they don’t need. It puts them at risk—you’re sticking a needle in their arm so there’s risk of infection, there’s risk of reaction.”5
Dr. Lafortune Greenberg has made increasing vaccination rates one of her top priorities. Currently, New Hampshire has one of the best vaccination coverage rates in the country, with only Massachusetts, Virginia and Maine having higher rates.5
According to Rebecca Coyle, Executive director of the American Immunization Registry Association, the push to create electronic databases that track all vaccinations that Americans receive (or don’t receive) began in the early 1990s, spurred by a series of measles outbreaks. During a 2017 measles outbreak in Minnesota, “They were able to look at a class roster very quickly and identify which children were at risk, which allows you to target your response very quickly,” Coyle said.5
Computerized vaccine tracking registries are promoted as a tool to help parents enroll children in school, travel abroad, or apply for a job that requires documentation of vaccinations, as well as to keep vaccination records for young children, who often move from doctor to doctor in the early years. Electronic health records (EHR),6 which are being increasingly being used in doctor’s offices, now include information from vaccine tracking registries in order to assist pharmacies, clinics, public health departments and private physicians with documenting vaccinations of all children and adults.5
Electronic medical records and vaccine tracking registries allow doctors to check an individual’s vaccination history through a centralized database, without depending on paper records.7 Vaccine registries may also track other health information such as body mass index, blood lead levels, and early hearing detection, as well as vaccine effectiveness and adverse reactions to vaccines.8 The CDC reports that 94 percent of children under age six participated in a state or local vaccine registry in 2016.9
Opponents to vaccine tracking registries raise concerns about privacy and the right to make health care decisions free from government interference.
Speaking at the Immunization Registries Workgroup on Privacy and Confidentiality in 1998, Barbara Loe Fisher, president and co-founder of the National Vaccine Information Center (NVIC) warned, “Because there can be no guarantee that an electronic database operated by the government for the purpose of tagging and tracking every citizen will not be used to punish citizens for non-compliance with federal health care or other policies, the National Vaccine Information Center opposes the creation of any tracking system, including vaccination tracking registries.”10
NVIC’s executive director Theresa Wrangham noted that vaccine registries are not limited to tracking vaccination for children. The National Vaccine Advisory Committee (NVAC) has authored a National Adult Immunization Plan (NAIP) based on Healthy People 2020 goals. She said:
The adult immunization plan also “incentivizes” doctors and other vaccine providers to convert patient data into Electronic Health Record (EHR) formats that can then be shared across state and federal electronic databases to track national vaccine coverage rates and also track and identify who is and is not vaccinated.11
The NAIP states that it will take more than providers raising awareness about the adult schedule and encouraging compliance to meet Healthy People 2020 goals. So the NAIP contains objectives that foster partnerships with your employer and your community and religious organizations to make you and all adults get every federally recommended vaccine according to the government-approved schedule.11
2 Centers for Disease Control and Prevention. Immunization Information Systems (IIS). CDC.gov June 7, 2015.
3 Associated Press. New Hampshire board accepts funding for vaccination database. SFGate.com Dec. 19, 2019.
4 Feathers T. New Hampshire remains the last state without vaccine registry, frustrating doctors. New Hampshire Union Leader Feb. 2, 2019.
5 McDermott C. Years in the making, N.H. immunization registry hits snag during rulemaking. Concord Monitor Jan. 4, 2015.
6 AU L, Oster A et al. Utilizing and Electronic Health Record System to Improve Vaccination Coverage in Children. Appl Clin Inform 2010; 1(3): 221-231
7 Immunizations Policy Issues Overview. National Conference of State Legislatures May 22, 2019.
8 Groom H, et. al. Immunization Information Systems to Increase Vaccination Rates: A Community Guide Systematic Review. Lippincott Williams & Wilkins 2014.
9 CDC. 2016 IISAR Data Participation Rates. CDC.gov Sept. 22, 2017.
10 Fisher BL. Immunization Registries Workgroup on Privacy & Confidentiality National Vaccine Information Center May 14, 1998.
11 Wrangham T. Federal Government Prepares to Track Unvaccinated Adults. The Vaccine Reaction July 3, 2015.