HB2166

SECTION 1. The legislature finds that the removal of religious exemptions from the vaccine schedule may create barriers to school attendance at a time when national confidence in vaccine safety has declined. Hawaii's children continue to experience rising rates of chronic disease, and a comprehensive approach to student health remains essential.

The legislature further finds that vaccines have a long record of reducing infectious diseases, and the United States Department of Health and Human Services Task Force on Community Preventive Services recommends continued school immunization requirements to maintain coverage and reduce disease. Recent national adjustments to recommended vaccines emphasize shared decision‑making, and although vaccines are effective public health tools, no medical intervention is entirely risk‑free. Hawaii also faces high levels of chronic conditions among youth, and national data show that roughly twenty per cent of children experience mental, emotional, developmental, or behavioral disorders influenced by multiple health and environmental factors.

The legislature additionally finds that some children cannot be safely immunized due to medical conditions and rely on low disease prevalence in schools. During the 2024–2025 school year, Hawaii had 192,853 enrolled students, including three hundred sixty-six students with medical exemptions, approximately 0.19 per cent of the student population. The remaining students also deserve individualized health decision‑making between their health care provider and parent or guardian to address their unique circumstances.

Accordingly, the purpose of this Act is to support the health and safety of school‑aged children by balancing infectious disease prevention with respect for individualized health considerations and ensure that families retain the ability to make informed decisions with their child's physician or health care provider regarding vaccines.

SECTION 2. Section 302A-1156, Hawaii Revised Statutes, is amended to read as follows:

"§302A-1156 Exemptions. A child [~~may~~] shall be exempted from the required immunizations:

(1) If a licensed physician, physician assistant, or advanced practice registered nurse certifies that the physical condition of the child is such that immunizations would endanger the child's life or health; or

(2) If any parent, custodian, guardian, or any other person in loco parentis to a child objects to immunization in writing on the grounds that the immunization conflicts with that person's bona fide religious tenets and practices. Upon showing the appropriate school official satisfactory evidence of the exemption, no certificate or other evidence of immunization shall be required for entry into school."

SECTION 3. Section 321-11, Hawaii Revised Statutes, is amended to read as follows:

"§321-11 Subjects of health rules, generally. The department of health pursuant to chapter 91 may adopt rules that it deems necessary for the public health and safety respecting:

(1) Nuisances, foul or noxious odors, gases, vapors, waters in which mosquitoes breed or may breed, sources of filth, and causes of sickness or disease, within the respective districts of the State, and on board any vessel;

(2) Adulteration and misbranding of food or drugs;

(3) Location, air space, ventilation, sanitation, drainage, sewage disposal, and other health conditions of buildings, courts, construction projects, excavations, pools, watercourses, areas, and alleys. For purposes of this paragraph, "pool" means a watertight artificial structure containing a body of water that does not exchange water with any other body of water, either naturally or mechanically, and is used for swimming, diving, recreational bathing, or therapy by humans;

(4) Privy vaults and cesspools;

(5) Fish and fishing;

(6) Interments and dead bodies;

(7) Disinterments of dead human bodies, including the exposing, disturbing, or removing of these bodies from their place of burial, or the opening, removing, or disturbing after due interment of any receptacle, coffin, or container holding human remains or a dead human body or a part thereof and the issuance and terms of permits for the aforesaid disinterments of dead human bodies;

(8) Cemeteries and burying grounds;

(9) Laundries, and the laundering, sanitation, and sterilization of articles including linen and uniforms used by or in the following businesses and professions: barber shops, manicure shops, beauty parlors, electrology shops, restaurants, soda fountains, hotels, rooming and boarding houses, bakeries, butcher shops, public bathhouses, midwives, masseurs, and others in similar calling, public or private hospitals, and canneries and bottling works where foods or beverages are canned or bottled for public consumption or sale; provided that nothing in this chapter shall be construed as authorizing the prohibiting of laundering, sanitation, and sterilization by those conducting any of these businesses or professions where the laundering or sterilization is done in an efficient and sanitary manner;

(10) Hospitals, freestanding surgical outpatient facilities, skilled nursing facilities, intermediate care facilities, adult residential care homes, adult foster homes, assisted living facilities, special treatment facilities and programs, home health agencies, home care agencies, hospices, freestanding birthing facilities, adult day health centers, independent group residences, and therapeutic living programs, but excluding youth shelter facilities unless clinical treatment of mental, emotional, or physical disease or handicap is a part of the routine program or constitutes the main purpose of the facility, as defined in section 346-16 under "child caring institution". For the purpose of this paragraph, "adult foster home" has the same meaning as provided in section 321-11.2;

(11) Hotels, rooming houses, lodging houses, apartment houses, tenements, and residences for persons with developmental disabilities including those built under federal funding;

(12) Laboratories;

(13) Any place or building where noisome or noxious trades or manufacturing is carried on, or intended to be carried on;

(14) Milk;

(15) Poisons and hazardous substances, the latter term including any substance or mixture of substances that:

(A) Is corrosive;

(B) Is an irritant;

(D) Is inflammable; or

(E) Generates pressure through decomposition, heat, or other means,

if the substance or mixture of substances may cause substantial personal injury or substantial illness during or as a proximate result of any customary or reasonably foreseeable handling or use, including reasonably foreseeable ingestion by children;

(16) Pig and duck ranches;

(17) Places of business, industry, employment, and commerce, and the processes, materials, tools, machinery, and methods of work done therein; and places of public gathering, recreation, or entertainment;

(18) Any restaurant, theater, market, stand, shop, store, factory, building, wagon, vehicle, or place where any food, drug, or cosmetic is manufactured, compounded, processed, extracted, prepared, stored, distributed, sold, offered for sale, or offered for human consumption or use;

(19) Foods, drugs, and cosmetics, and the manufacture, compounding, processing, extracting, preparing, storing, selling, and offering for sale, consumption, or use of any food, drug, or cosmetic;

(20) Device as defined in section 328-1;

(21) Sources of ionizing radiation;

(22) Medical examination, vaccination, revaccination, and immunization of school children. No child shall be subjected to medical examination, vaccination, revaccination, or immunization, whose parent or guardian objects in writing thereto on grounds that the [requirements are not in accordance with the religious tenets of an established church of which the parent or guardian is a member or adherent, but no objection shall be recognized when, in the opinion of the department, there is danger of an epidemic from any communicable disease;] medical examination, vaccination, revaccination, or immunization conflicts with that person's bona fide religious tenets and practices;

(23) Disinsectization of aircraft entering or within the State as may be necessary to prevent the introduction, transmission, or spread of disease or the introduction or spread of any insect or other vector of significance to health;

(24) Fumigation, including the process by which substances emit or liberate gases, fumes, or vapors that may be used for the destruction or control of insects, vermin, rodents, or other pests, which, in the opinion of the department, may be lethal, poisonous, noxious, or dangerous to human life;

(25) Ambulances and ambulance equipment;

(26) Development, review, approval, or disapproval of management plans submitted pursuant to the Asbestos Hazard Emergency Response Act of 1986, Public Law 99-519; and

(27) Development, review, approval, or disapproval of an accreditation program for specially trained persons pursuant to the Residential Lead-Based Paint Hazard Reduction Act of 1992, Public Law 102-550.

The department of health may require any certificates, permits, or licenses that it may deem necessary to adequately regulate the conditions or businesses referred to in this section."

SECTION 4. Section 325-34, Hawaii Revised Statutes, is amended to read as follows:

"§325-34 Exemptions. (a) Section 325-32 shall be construed not to require the vaccination or immunization of any person for three months after a duly licensed physician, physician assistant, advanced practice registered nurse, or an authorized representative of the department of health has signed two copies of a certificate stating the name and address of the person and that because of a stated cause the health of the person would be endangered by the vaccination or immunization, and has forwarded the original copy of the certificate to the person or, if the person is a minor or under guardianship, to the person's parent or guardian, and has forwarded the duplicate copy of the certificate to the department for its files.

[No] (b) Except as provided under section 302A-1154, no person shall be subjected to vaccination, revaccination, or immunization, who shall in writing object [~~thereto~~] on the grounds that [~~the requirements are not in accordance with the religious tenets of an established church of which the person is a member or adherent,~~] vaccination, revaccination, or immunization conflicts with the person's bona fide religious tenets and practices, or, if the person is a minor or under guardianship, whose parent or guardian shall in writing object thereto on such grounds, but no objection shall be recognized when, in the opinion of the director of health, there is danger of an epidemic from any communicable disease."

SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 6. This Act shall take effect upon its approval.

INTRODUCED BY:

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HOUSE OF REPRESENTATIVES	H.B. NO.	2166
THIRTY-THIRD LEGISLATURE, 2026
STATE OF HAWAII