Legislation Details:

UPDATE: 6/27/2024 - HB 2553 was Enacted into law on 6/27/2024. Public Act 104; Effective Date 1/1/2025. View the final version of the bill HERE. 

The final Enacted version of this bill authorizes a pharmacist, pharmacy intern, and pharmacy technician to administer vaccines to an individual three (3) years of age and older, subject to certain certification requirements. This is a change from existing law that authorizes the administration of certain vaccines by a pharmacist, not an intern or technician, at age eleven (11) and all other vaccines at age eighteen (18). See a summary description of the bill below: 

SECTION 2. amends Hawaii Revised Statutes §461-1, related to pharmacists and pharmacy definitions, under the definition of the "practice of pharmacy."

Subsection (2) (E) (i) to authorize a pharmacist to administer a vaccine orally, by injection, or by intranasal delivery to persons aged three (3) years and older. This is a change from existing law that authorizes a pharmacist to administer a vaccine orally, by injection, or by intranasal delivery to persons aged eighteen (18) years of age and older. This report also recommends removing subsections (2) (E) (ii) and (2) (E) (iii) that authorize a pharmacist to administer certain vaccines to a person between the ages of fourteen (14) and seventeen (17) years and other certain vaccines to persons between the ages of eleven (11) and seventeen (17) years.

SECTION 3. amends Hawaii Revised Statutes §461-8, related to pharmacist and pharmacy renewal of licenses; continuing education requirement, is amended under subsection (e).

Subsection (e) is amended to require a pharmacist who administers a vaccine to a child three (3) years of age or older to complete a training program approved by the board within every other biennial renewal period and submit proof of successful completion of the training program to the board before administering any vaccine to persons three (3) years of age and older. This is a change from existing law that requires a pharmacist meet such requirements before administering certain vaccines to a person eleven (11) years of age through seventeen (17) years of age.

SECTION 4. amends Hawaii Revised Statutes §461-11.4, related to pharmacist and pharmacy vaccinations; children, to amend subsections (a) through (d).

Subsection (a) is amended to authorize a pharmacy intern and pharmacy technician to administer a vaccine to a person three (3) years of age and older; provided certain conditions are met, including certain training programs, licensing requirements, certification requirements, reporting criteria, and patient notification requirements. This is a change from existing law because it authorizes a pharmacy intern and pharmacy technician to administer vaccines in addition to a pharmacist authorized to administer a vaccine in existing law. This subsection also authorizes the pharmacy intern and pharmacy technician to administer a vaccine to children as young as three (3) years of age.

Subsection (b) is amended to include a pharmacy intern and pharmacy technician to the requirement for a pharmacist to provide a vaccination record to the patient immediately after a vaccination is administered.

Subsection (c) is amended to include a pharmacy intern and pharmacy technician to the requirement for a pharmacist to report the vaccination information to the patient's medical home and to the Hawaii Immunization registry within seventy-two (72) hours of vaccine administration.

Subsection (d) is amended to remove language related to pharmacists vaccinating persons between the ages of eleven (11) and seventeen (17) with certain vaccines being required to complete a training program and submit the completion of certificate for the training program to the board before administering a vaccine. This subsection is amended to include pharmacy interns and pharmacy technicians to the training program requirement for pharmacists and to lower the age of a person who can be vaccinated by a pharmacist, pharmacy intern, or pharmacy technician from age eleven (11) to seventeen (17) for certain vaccines to age three (3) for all vaccines.

NVIC OPPOSES this enacted version of the bill because it puts the lives of those receiving a vaccine at risk by authorizing a non-medically trained pharmacist and lesser qualified pharmacy employees to administer vaccinations that carry the risk of potentially life altering and even deadly adverse events to children as young as three years of age. 

UPDATE: 5/2/2024 - HB 2553 was transmitted to the Hawaii Governor Josh Green on 5/2/2024.  

UPDATE: 5/1/2024 - HB 2553 passed the full House final reading as amended in CD 1 by a vote of 47 Ayes, 0 Ayes with reservations, 4 Noes, and 0 Excused on 5/1/2024. 

UPDATE: 5/1/2024 - HB 2553 passed the full Senate final reading as amended in CD 1 by a vote of 24 Ayes, 1 No, and 0 Excused on 5/1/2024. 

UPDATE: 4/25/2024 - HB 2553 was reported with the recommendation to pass as amended in CD 1 in the Conference Committee by a vote of 10 Ayes, 0 Nays, on 4/25/2024. View the Conference Report HERE. 

The Conference Report recommends the following changes:

(1) clarifying mandatory training and continuing education requirements for pharmacy technicians;

(2) clarifying the requirements for proof of completion of required training by pharmacy interns and pharmacy technicians;

(3) changing the effective date to January 1, 2025; and 

(4) Making technical, nonsubstantive amendments for purposes of clarity, consistency, and style. 

NVIC does not take a position on this recommended version of the bill as it does not substantially change the portions of the bill that NVIC opposes. 

UPDATE: 4/19/2024 - The Senate Conferees, Keohokalole, San Buenaventura, Rhoads, and Fevella were appointed on 4/19/2024. 

UPDATE: 4/17/2024 - The House Conferees, Takenouchi, Nakashima, Tarnas, Amato, Sayama, and Souza were appointed on 4/17/2024. 

UPDATE: 4/11/2024 - HB 2553 was sent to conference after the House disagreed with Senate amendments on 4/11/2024. 

UPDATE: 4/9/2024 - HB 2553 passed the Senate 3rd Reading as amended in SD 2 in the Senate Judiciary Committee (JDC) by a vote of 24 Ayes, 1 No, 0 Excused on 4/9/2024. 

UPDATE: 4/4/2024 - HB 2553 was recommended to be passed with amendments in the Senate Judiciary Committee (JDC) hearing by a vote of 4 Ayes, 0 Noes, 1 Excused, on 4/4/2024. View the Committee Report HERE. 

View the amended version SD 2 HERE. The amendments make the following changes:

(1) clarifies that this bill authorizes pharmacists to order and administer vaccines to persons three years of age or older, not only persons between the ages of three and seventeen;

(2) clarifies that this bill authorizes pharmacy interns and pharmacy technicians, under the direct supervision of a pharmacist, to administer vaccinations to persons three years of age or older, not only persons between the ages of three and seventeen; and

(3) removes pharmacy interns from the requirement in SECTION 4., Subsection (a) (4) to have a Certified Pharmacy Technician certification from either the Pharmacy Technician Certification Board or National Healthcareer Association to be authorized to administer a vaccine to a person three years of age or older.

This amendment does not change NVIC's position on this bill. NVIC still opposes this bill. 

UPDATE: 3/27/2024 - HB 2553 is scheduled for a vote in the Senate Judiciary Committee (JDC) on 4/4/2024 at 10:00 AM in Conference Room 16. View the hearing agenda HERE. View the videoconference HERE. 

UPDATE: 3/22/2024 - HB 2553 passed Second Reading as amended and was referred to the Senate Judiciary Committee (JDC). 

UPDATE: 3/20/2024 - HB 2553 was passed with amendments by two committees in the joint committee hearing on 3/20/2024. The Senate Health and Human Services Committee voted 3 AYE, 1 NO, 1 Excused, and the Senate Commerce and Consumer Protection Committee also voted of 3 AYE, 1 NO, 1 Excused on 3/20/2024. The committees issued a report that can be viewed HERE. The committees amended the bill by making a few technical, nonsubstantive changes to clarify the language and insert new language that requires pharmacy interns and pharmacy technicians that administer vaccines to those between 3 and 17 years to obtain a Certified Pharmacy Technician certification from either the Pharmacy Technician Certification Board or the National Healthcareer Association. 

While the additional certification for pharmacy technicians and interns to vaccinate is seen as an improvement, NVIC still opposes this bill because pharmacists, nor lesser qualified and medically trained interns and technicians, are not trained medical professionals and should not be authorized to administer vaccinations, especially to children. 

UPDATE: 3/18/2024 - HB 2553 is scheduled for a joint hearing in the Senate Commerce and Consumer Protection Committee (CPN) and the Senate Health and Human Services Committee (HHS) on 3/20/2024 at 1:00 PM in Room 225 & Videoconference. View the hearing agenda HERE. View the videoconference HERE. 

UPDATE: 3/7/2024 - HB 2553 was received in the Senate and referred to the Senate Commerce and Consumer Protection Committee (CPN), the Senate Health and Human Services Committee (HHS), and the Senate Judiciary Committee (JDC) on 3/7/2024. 

UPDATE: 3/5/2024 - HB 2553 passed the full House by a vote of 45 Ayes, 4 Noes, and 2 Excused on 3/5/2024. 

UPDATE: 3/1/2024 - HB 2553 was recommended for passage from the House Committee on Judiciary & Hawaiian Affairs (JHA). View the committee report HERE. The bill was amended in the committee process, but there were no substantial changes. Like the original bill, the amended version does the following:

(1) Authorize licensed pharmacists to administer vaccines to persons three years of age or older;
(2) Authorize pharmacy interns and pharmacy technicians under the direct supervision of a pharmacist to administer vaccines to persons between the age of three and seventeen, if certain requirements are met; and
(3) Authorize licensed pharmacists to order the administration of vaccines for persons between the ages of three and seventeen.

UPDATE: 2/28/2024 - HB 2553 was recommended to be passed unamended by the House Committee on Judiciary & Hawaiian Affairs (JHA) hearing on 2/28/2024. View the committee report HERE.

UPDATE: 2/26/2024 - HB 2553 is scheduled for a hearing in the House Committee on Judiciary & Hawaiian Affairs (JHA) on 2/28/2024 at 2:00 PM in House Conference room 325 via videoconference. View the hearing agenda HERE. View the videoconference HERE. 

UPDATE: 2/14/2024 - HB 2553 was adopted on the House floor as amended in HD 2 by a vote of 44 Ayes, 1 Ayes with reservations, 3 Noes, and 3 Excused and referred to the House Committee on Judiciary & Hawaiian Affairs (JHA) on 2/14/2024.

UPDATE: 2/14/2024 - HB 2553 was reported out of the House Committee on Consumer Protection & Commerce (CPC) as amended in HD 2 and recommended for referral to the House Committee on Judiciary & Hawaiian Affairs (JHA) on 2/14/2024. View the committee report HERE. This committee recommendation makes some nonsubstantive changes to clarify language. NVIC does not take a position on this recommended amendment. 

UPDATE: 2/8/2024 - HB 2553 was recommended for passage with amendments by the House Committee on Consumer Protection & Commerce (CPC) hearing by a vote of 6 (Ayes), 1 (Noes), and 4 (Excused) on 2/8/2024. 

UPDATE: 2/5/2024 - HB 2553 is scheduled for a hearing by the House Committee on Consumer Protection & Commerce (CPC) on Thursday, February 8, 2024, at 2:00 PM in the House conference room 329 via video conference. View the hearing agenda HERE. View the videoconference HERE. 

UPDATE: 2/2/2024 - HB 2553 as amended in HD 1 was referred to the House Committee on Consumer Protection & Commerce (CPC) on 2/2/2024. 

UPDATE: 2/2/2024 - HB 2553 was reported out of the House Committee on Health & Homelessness (HLT) as amended in HD 1 and recommended for passage and referral to the House Committee on Consumer Protection & Commerce (CPC) on 2/2/2024. View the committee report HERE. View the committee amendment HERE. HD 1 adds two new SECTIONS to the bill that amend the definition of "practice of pharmacy" to include administering vaccines to children three years of age and older and to amend the requirements for the renewal of licenses and continuing education requirement for a pharmacist who administers vaccines to change the age of a person vaccinated from fourteen years to three years of age and older. These changes reflect the change made by the introduced version of the bill that lowers the age of a child that a pharmacist is authorized to vaccinate down to three years of age. NVIC still OPPOSES HB 2553 as amended by HD 1. 

UPDATE: 1/31/2024 - HB 2553 was recommended for passage with amendments by the House Committee on Health & Homelessness (HLT) hearing by a vote of 7 (Ayes) and 1 (Noes) on 1/31/2024. 

UPDATE: 1/29/2024 - HB 2553 is scheduled for a hearing by the House Committee on Health & Homelessness (HLT) on Wednesday, January 31, 2024, at 10:15 AM in House conference room 329 via videoconference. View the hearing agenda HERE. View the videoconference HERE. 

UPDATE: 1/26/2024 - HB 2553 was referred to the House Committee on Health & Homelessness (HLT), the House Committee on Consumer Protection & Commerce (CPC), and the House Committee on Judiciary & Hawaiian Affairs (JHA) on 1/26/2024. 

HB 2553 authorizes a pharmacist to order and administer all vaccines authorized or approved by the FDA with the recommendations of the CDC's Advisory Committee on Immunization Practices (ACIP) to persons as young as three (3) years of age. This bill also authorizes a pharmacy intern and pharmacy technician to administer any vaccine authorized or approved by the FDA with the recommendation of the CDC's ACIP to persons as young as three (3) years of age, given certain conditions are met. These provisions were temporarily in place under the PREP Act, but they are set to expire on 12/31/2024. Prior to the amendments made to the PREP Act, Hawaii law only authorized a pharmacist to administer a limited number of vaccines to children between the ages of eleven (11) and seventeen (17) and required a valid prescription before the vaccine could be administered. This bill expands the list of vaccines that can be administered by a pharmacist. Existing code limits the vaccines to human papilloma virus (HPV); tetanus, diphtheria, pertussis (TDaP); meningococcal; and influenza. This bill authorizes the administration of any vaccine authorized or approved by the FDA with recommendations by the CDC's Advisory Committee on Immunization Practices, (ACIP). Minimal training is required in this bill, including all personnel administering vaccines are required to have current CPR certification, and the pharmacist must complete a minimum of two credit hours every two years. 

HB 2553 amends Section 461-11.4, Hawaii Revised Statutes, related to vaccinations and children, to amend subsections (a) through (d), summarized as follows:

(a) authorizes a pharmacy intern and pharmacy technician to administer a vaccine to a person between three (3) and seventeen (17) years of age; given certain conditions are met. This is a change from existing law that authorizes only a pharmacist to vaccinate a person between fourteen and seventeen years of age with a prescription from a licensed physician; and persons between eleven and seventeen years of age with a prescription from a licensed physician for certain vaccines, including human papillomavirus (HPV); tetanus, diphtheria, pertussis (Tdap); meningococcal; or influenza vaccine. 

This bill authorizes the pharmacist to order and administer, and the pharmacy intern and pharmacy technician to administer, any vaccine, not just certain vaccines for certain ages, to a child between three and seventeen years of age without a prescription from a licensed physician, given the following conditions are met: 

(1) The vaccine is authorized or approved by the United States Food and Drug Administration (FDA); 

(2) The vaccine has been ordered by a pharmacist and administered in accordance with the recommendations of the United States Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP); 

(3) The pharmacy intern or pharmacy technician has completed a practical training program approved by the Accreditation Council for Pharmacy Education;

(4) The pharmacist, pharmacy intern, or pharmacy technician has a current certificate in basic cardiopulmonary resuscitation (CPR); 

(5) The pharmacist has completed a minimum of two credit hours in vaccine-related continuing education courses during each licensing biennium;

(6) The pharmacist is in compliance with all applicable recordkeeping and reporting requirements, including complying with adverse events reporting requirements;

(7) The pharmacist, pharmacy intern, or pharmacy technician has reviewed the patient's vaccination records prior to administering the vaccine;

(8) The pharmacist has informed the patient and the patient's primary guardian or caregiver of the importance of a well-child visit with a pediatrician; and

(9) Where a prescription has been ordered by a physician, the pharmacist, pharmacy intern, or pharmacy technician is required to verify that the prescriber is the patient's medical home. 

(b) requires the pharmacy intern or pharmacy technician under direct supervision of a pharmacist to provide the patient with a vaccination record, including certain information. 

(c) requires the pharmacy intern or pharmacy technician to report the vaccine administration information to the patient's medical home and to the State Department of Health's Immunization Registry within seventy-two hours of administration, including certain information. This is an addition to the existing reporting requirement for a pharmacist to report such information to the patient's medical home and the state immunization registry within seventy-two hours. 

(d) requires an additional requirement for pharmacy interns and pharmacy technicians under the direct supervision of a pharmacist who administer a vaccine to a child between three and seventeen years of age to complete a training program and submit a completion certificate to the pharmacy board prior to administering any vaccine. 

If passed, HB 2553 will become effective immediately. 

NVIC OPPOSES HB 2553 because it allows vaccination by non-medical personnel who are likely unaware of family and individual medical and vaccine history. According to PTCBtestprep.com, Hawaii does not regulate pharmacy technicians; there are no board exams to pass. The requirements are to have a high school diploma or GED, 9th grade math skills or higher, and a criminal abstract no older than 30 days. There are inherent risks associated with vaccines which are not recognized by authorizing teenagers with limited experience to administer vaccines to young children.

Pharmacists, pharmacy interns, and pharmacy technicians do not have enough training about vaccines, vaccine risks, prescreening requirements, 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 it is highly unlikely a pharmacy personnel have the time to ask about all the reasons not to vaccinate.   

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

• Will they 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 pharmacy personnel 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 nor lesser qualified pharmacy technicians and pharmacy interns 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 medical 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.  

There is no doubt the pharmacy groups will support this bill, but it presents a serious conflict of interest because of the financial benefits they will receive if this bill passes.  

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. 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.   

NVIC does not take a position on provisions in the bill that are unrelated to vaccines.

https://data.capitol.hawaii.gov/session/measure_indiv.aspx?year=2024&billtype=HB&billnumber=2553 - text, status, and history of HB 2553