Authorizes pharmacy technicians to administer vaccines to children three years & older, part of larger public health and welfare bill

State: NE
Bill Number: LB 227
Position: OPPOSE
Action Required: None at this time
Status: ENACTED, Signed by Governor Jim Pillen on 6/6/2023, Effective date 6/6/2023

Legislation Details:

See Corresponding Action Alert.

UPDATE: 6/6/2023 - LB 227 was enacted. It was signed by Governor Jim Pillen on 6/6/2023. The bill had multiple sections and different effective dates. The Nebraska Constitution allows for immediate implementation of legislation that is designated under an Emergency Clause if the bill includes the emergency language and the bill passes with at least 30 senators voting for it. Both stipulations were met for Section 56, the section that increased pharmacy technician abilities, to they are authorized to vaccinate children three years and older as of 6/6/2023, the day the bill was signed by the governor. The last pages of the bill stated which portions would be in effect after three months; Section 56 was not listed here.

UPDATE: 6/1/2023 - LB 227 passed the Final Reading in the Senate with An Emergency Clause on 6/1/2023 by a vote of 47 Yes, 0 No, 2 Excused. It was then presented to Governor Jim Pillen for his signature. Page 768 of the Legislative Journal says, "Sec. 11. Since an emergency exists, this act takes effect when passed and approved according to law."

UPDATE: 5/30/2023 - LB 227 is scheduled for the Second Final Reading on 5/31/2023. (It was amended after the First Final Reading.)

UPDATE: 5/24/2022 - LB 227 was amended with a 25 page amendment and passed the Senate. The changes did not address vaccination topics or make any improvements to the bill, so NVIC continues to oppose LB 227. LB 227 advanced to enrollment and review for re-engrossment.

UPDATE: 5/2/2022 - LB 227 placed on final reading and eligible for a final vote. Contact your Senator and ask to remove Section 53 which allows pharmacy technicians to administer vaccines.

LB 227 was originally introduced 1/10/2023 by Senator Ben Hansen and it had no vaccine provisions

LB 227 has changed into a large 77 page bill with many different topics all relating to “public health and welfare.”  Sometimes we call this a “Christmas Tree Bill” because it is so broad in scope, many legislators can add their “ornaments” (changes that are not moving in stand alone bills or special interest requests). This is what happened with LB 227. On April 17, 2023, Bill Author Senator Ben Hansen,  put forward amendment AM1332, which by itself was 61 pages.  Buried on pages 38 and 39 is Section 53 which enables pharmacy technicians to administer vaccines by adding exceptions to the existing section of law 38-2891 which requires pharmacy technicians to “only perform tasks which do not require the professional judgment of a pharmacist and which are subject to verification to assist a pharmacist in the practice of pharmacy.”

These exceptions, in subsection 2, include:

(2) A pharmacy technician may administer vaccines, and such administration shall not be considered to be performing a task requiring the professional judgment of a pharmacist, when

(a) The vaccines are verified by the pharmacist responsible for the supervision and verification of the activities of the pharmacy technician prior to administration;

(b) Administration is limited to intra-muscular in the deltoid muscle or subcutaneous on the arm to a person three years of age or older;

(c) The pharmacy technician is certified as required by section 38-2890;

(d) The pharmacy technician has completed certificate training in vaccine administration that includes, at a minimum, vaccine administration, blood-borne pathogen exposure, safety measures during administration, and biohazard handling;

(e) The pharmacy technician is currently certified in basic life support skills for health care providers as determined by the board; and

(f) The pharmacist responsible for the supervision and verification of the activities of the pharmacy technician is on site.

Some Nebraska legislators already tried this session to add pharmacy technicians to administer vaccines for individuals ages 3 and up with LB 202.  This bill generated a lot of pushback from the people in Nebraska and is not moving.  LB 227 is trying to get away with passing this bad idea of pharmacy technicians giving vaccines. 

NVIC is opposed to Section 53 of  LB 227 as it trivializes very real vaccine risks and serious reactions by allowing  an 18 year old pharmacy technician, perhaps with only a GED education, to administer possibly life-threatening vaccines to adults and young children. 

According to the Nebraska Department of Health and Human Services website and the Nebraska Revised Statute - 38-2890, a pharmacy technician must meet the following qualifications: 

  • be at least 18 years old 
  • be a high school graduate or recognized by the State Department of Education as having the equivalent level of education 
  • have never been convicted of any non-alcohol, drug-related misdemeanor or felony 
  • be registered by DHHS as a pharmacy technician 

Pharmacy technicians do not have enough training about all the vaccines, risks, prescreening, contraindications, emergency interventions for reactions, reporting reactions to Vaccine Adverse Events Reporting System, and advising parents and patients about the statute of limitations and instructions for filing a claim with the National Vaccine Injury Compensation Program

Vaccine Information Statements list many reasons why patients shouldn’t be vaccinated, and current law prohibits a pharmacy technician from counselling a person on the treatment they are providing so it is unlikely anyone will talk to the person or their parent and discuss all the reasons not to vaccinate in them.   

These are some of the reasons to not vaccinate that are recorded in federally required vaccine information statements that a pharmacist or pharmacy technician with limited training on vaccines is unlikely to catch:  

  • Will pharmacists or pharmacy technicians screen for things like allergic reactions to ingredients in the vaccine and are they going to cover all these ingredients of every vaccine?  
  • Will they check if a child is allergic to yeast (contraindication in HPV vaccine)?  
  • Are they going to perform an exam at the pharmacy and take the child’s temperature to make sure they don’t have a fever since fever is contraindicated for some vaccines in the VIS statements?  
  • Are they going to know if the child has a weakened immune system due to disease (such as cancer or HIV/AIDS), medical treatments (such as radiation, immunotherapy, steroids, or chemotherapy), if they have a history of seizures, if they have a parent, brother, or sister with a history of seizures, or if they have a parent, brother, or sister with a history of immune system problems?  
  • Will they screen if the child has a condition that makes them bruise or bleed easily, if they might be pregnant (some vaccines cannot be given in pregnancy), or if they are taking aspirin?  
  • Will they know if a child has recently had a transfusion or if they have ever had Guillain-Barre syndrome post vaccination?  
  • Will they know if a child has had a serious or a life-threatening reaction to any vaccine?  

Most pharmacies and grocery stores don’t have lifesaving defibrillators like they do in doctors’ offices to save the lives of infants and children who have an immediate life-threatening reaction to vaccines.  Will pharmacists or pharmacy technicians have the equipment and training to be able to tell the difference between cardiac arrest, anaphylaxis, fainting, and act accordingly to save the lives of babies and children who react at the time of vaccination? 

This bill undermines the doctor patient relationship and removes critical health history screenings prior to vaccination. Neither pharmacists or less qualified pharmacy technicians have the necessary medical history of an infant or child or the time to prescreen for contraindications based on a child’s personal and family history and unique heath needs prior to vaccination. Vaccines, just like all pharmaceutical products, can cause injury and death in some people. As of January 1, 2023, The United States Government has paid out more than $4.9 billion dollars to vaccine victims through the National Vaccine Injury Compensation Program (VICP). As of 1/13/2023, There were 43,431 deaths and 2,407,011 adverse events reported to the US government's Vaccine Adverse Events Reporting System. Clearly, there are dangers associated with vaccines that should not be ignored with increasing those who can administer them.  

When vaccines administered by nurses and doctors have caused shoulder damage, it is irresponsible allow 18 year olds to administer vaccines into shoulders. 

The Vaccine Injury Table, listed under the National Vaccine Injury Compensation Program lists "Shoulder injury related to vaccine administration" in ten separate entries. Vaccine induced shoulder injuries are eligible for compensation through the Vaccine Injury Compensation Program. Furthermore, the description of shoulder injuries in the Vaccine Injury Table includes the following description: 

“Shoulder injury related to vaccine administration (SIRVA). SIRVA manifests as shoulder pain and limited range of motion occurring after the administration of a vaccine intended for intramuscular administration in the upper arm. These symptoms are thought to occur as a result of unintended injection of vaccine antigen or trauma from the needle into and around the underlying bursa of the shoulder resulting in an inflammatory reaction. SIRVA is caused by an injury to the musculoskeletal structures of the shoulder (e.g. tendons, ligaments, bursae, etc.)” 

America’s biopharmaceutical research companies are developing 258 vaccines.  The U.S. Vaccine Market alone was $36.45 billion in 2018, and is expected to reach $58.4 billion by 2024 and pharmacies stand to increase their profits substantially by allowing pharmacy technicians to put those shots into customers.   

This conflict is compounded by the fact that neither Pharmacists nor pharmacy technicians will have liability for the injuries and deaths caused by the vaccines they administer to children. Vaccines administrators are shielded from liability for vaccine injuries and deaths through the combination of the law passed by Congress in 1986 establishing the National Vaccine Injury Compensation Program and the 2011 Supreme Court Decision BRUESEWITZ ET AL. v. WYETH LLC, FKA WYETH, INC., ET AL. - text, status, and history of LB 227