Physician-Led Results: Vaping Permit Requirement Established, COVID-19 Response Mixed
By Sean Price

Texas public health won a long-awaited victory by putting vaping products on the same regulatory footing as products made with tobacco.

Senate Bill 248 by Sen. Nathan Johnson (D-Dallas) requires those who sell vaping products to obtain a permit from the state comptroller, just as those who sell tobacco products do. The comptroller’s office can impose fines on those who violate the law.

“This will put a regulatory structure on e-cigarettes in the state of Texas,” said David Lakey, MD, vice chancellor for health affairs and chief medical officer at The University of Texas System. “This is the logical next step so that we know who is selling e-cigarettes and that they’re following the rules of the state.”

Maria Monge, MD, adolescent division director in the department of pediatrics at The University of Texas at Austin Dell Medical School, testified before the House Ways and Means Committee that requiring permits for retailers and penalties for underage sales of tobacco products have successfully decreased adolescent smoking rates.

“As e-cigarettes are both dangerous in their own right and because they are a gateway to other tobacco products, the regulation and enforcement mechanisms for e-cigarettes should be the same as those for tobacco products,” she said. “This bill takes important steps to recognize the serious health risks of vaping and to limit youth access to e-cigarettes.”

Dr. Monge spoke on behalf of TMA as well as the Texas Pediatric Society, the Texas Public Health Coalition, and Texas Tobacco Control Partners – a typical example of how TMA worked with coalitions to achieve legislative success.

SB 248 is definitely a win for public health, but it leaves unfinished an equally important task: taxing vaping products at the same rate as tobacco products, says John Carlo, MD, incoming chair of the Texas Medical Association’s Council on Legislation and former medical director of Dallas County Health and Human Services.

Fortunately, this year’s victory on regulation tees up the taxation discussion for the next legislative session, he says. “We seldom come out [of a legislative session] with clean wins.”

That was certainly true in the Texas Legislature’s reaction to the COVID-19 pandemic. Lawmakers passed roughly 20 bills that will change the way the state responds to the next pandemic or public health crisis.

TMA supported many of those bills. For instance, Senate Bill 969 authored by Lois Kolkhorst (R-Brenham), gives the Texas Department of State Health Services (DSHS) more authority to collect health data during a public health disaster and requires the agency to share that information with the public.

Others bills have a more complicated overall impact, says Keller pediatrician Jason Terk, MD, head of the Texas Public Health Coalition.

For instance, Senate Bill 968, also authored by Senator Kolkhorst, is a sweeping bill that, among other things, forbids Texas businesses from barring a customer’s entry or receipt of services based on that customer’s COVID-19 vaccination status. The same bill also helps to set limits on how local health authorities can respond during a declared state of disaster and creates a legislative oversight board to supervise public health disasters. All of these were positions TMA attempted to modify.

“Basically, this is a way for [legislators] to tap the brakes on actions by the governor’s office and local health authorities,” Dr. Terk said.

On the other hand, the bill creates a state stockpile of personal protective equipment (PPE) and establishes the office of a state epidemiologist – measures TMA supports, says Troy Alexander, a TMA legislative affairs director.

 TMA’s efforts to improve other pandemic-related bills frequently paid off, he says. For instance, an earlier version of SB 968 required the state epidemiologist to report to the Texas Division of Emergency Management, not DSHS – the state’s public health authority.

Dr. Carlo and others testified before the House State Affairs Committee against making the change.

“Shuffling the oversight of the chief state epidemiologist during constrained times of public health disasters will only create confusion throughout the state as to which entities serve in what roles,” he told lawmakers.

TMA’s work helped ensure that the office remained under DSHS.

The new restrictions placed on public health entities came as an obvious backlash against the measures used to combat COVID-19, Dr. Carlo says.

“We heard quite a bit of opposition to the Centers for Disease Control and Prevention and the National Institutes of Health recommendations [on COVID-19], and a lot of stuff we don’t like to see around anti-science and anti-vaccines that normally don’t have as loud a voice as they did this session,” Dr. Carlo said.

Given this atmosphere, public health champions focused much of their energy on stopping bills that would have hurt public health, Dr. Terk says. TMA-backed efforts were successful in shooting down several bills that would have damaged vaccination and other public health initiatives. “We were able to get some wins [in public health], but the overall strain of populism over science resulted in a lot of bad bills that needed to be fought,” Dr. Terk said.

One casualty of this year’s session were bills designed to reform ImmTrac2, the state’s immunization registry. TMA-backed House Bill 4272 by Rep. Stephanie Klick (R-Fort Worth) would have, among other things, improved ImmTrac2’s interoperability with electronic health records and simplified the way people give consent on whether to have their records stored in the database. The bill also would have extended the life of disaster-related vaccine records such as those for COVID 19 from five to seven years.

 Unfortunately, the legislation got caught up in a political controversy over requiring vaccine passports for COVID-19 immunizations, Mr. Alexander says. Representative Klick passed the original bill through the House with unanimous support, but it died in the Senate on the next to last day of session, he says.

Other TMA-supported public health measures that passed included: 

  • Preserving $476.9 million in funding for HIV prevention and treatment.
  • A $339 million increase in behavioral health funding, including funding for new state hospital construction.
  • Senate Bill 1353 by Sen. Boris Miles (D-Houston), which will require DSHS to report immunizations by race, age, and county. DSHS also will be required to recommend ways to decrease inequities in vaccine administration. 
  • Senate Bill 239 by Sen. Beverly Powell (D-Burleson), which directs DSHS to create a system to provide immunization information and make immunization awareness materials available for local health authorities during a disaster.
  • Senate Bill 437 by Cesar Blanco (D-El Paso), which creates an advisory committee on state planning for PPE reserves made up of health care professionals to ensure community and private practice physicians are considered in allocations.

Last Updated On

June 30, 2021

Originally Published On

June 23, 2021

Sean Price

Reporter

(512) 370-1392

Sean Price is a reporter for Texas Medicine and Texas Medicine Today. He grew up in Fort Worth and graduated from the University of Texas at Austin. He's worked as an award-winning writer and editor for a variety of national magazine, book, and website publishers in New York and Washington. He's also helped produce Texas-based marketing campaigns designed to promote public health. Sean lives in Austin and enjoys hiking, photography, and spending time with his wife and two sons.

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