Senate Bill 54 amended to narrow emergency vaccine mandates, set pharmacist refusal limits and cap quarantine at 21 days; moves to full committee

The Medical Affairs Subcommittee voted to send Senate Bill 54 to the full committee after adopting five amendments that narrow the Department of Public Health's authority to mandate certain vaccines, set limits on when pharmacists may be required to fill prescriptions during a declared public-health emergency, and set a 21-day release rule for asymptomatic quarantine.

The chairman of the Medical Affairs Subcommittee said Amendment 1 removes the term "novel vaccine" and clarifies the bill does not alter the Department of Public Health's existing childhood immunization schedule. "The term novel vaccine was dropped in response to the concerns brought up during subcommittee meetings last year that the flu shot would be considered a novel vaccine," the Committee chairman said.

The nut graf: supporters said the changes address concerns raised by pediatricians and pharmacists during prior testimony, while opponents warned some wording could limit officials' ability to respond to unusual outbreaks. The committee adopted amendments on the floor and moved the bill to the full committee for further consideration.

Amendment highlights and debate

Amendment 1: childhood-immunization language The committee adopted Amendment 1 to strike the phrase "novel vaccine" and to clarify an exemption for vaccines that change annually (for example, seasonal influenza variants). The chairman said the change was intended to ensure the Department of Public Health can keep its current childhood vaccination schedule and still assess risk and benefit before mandating a newly developed vaccine.

Amendment 2: pharmacist refusal during emergencies Amendment 2 addresses when a pharmacist may refuse to fill or refill a prescription. The amendment preserves a pharmacist's right to refuse in non-emergency circumstances but narrows the exception during a declared public-health emergency: a pharmacist may not deny a prescription for the off-label use of any drug approved by the Food and Drug Administration (FDA) that is prescribed to treat an infectious disease or life-threatening illness during a public-health or state emergency declared by the governor. The Committee chairman summarized the provision: "This amendment gives pharmacists the right to refuse to fill any medication except FDA approved drugs that the physician and patient want to try for a disease or illness for which there is a public health emergency."

Senators debated whether that change addresses testimony from pharmacists who said they need discretion when they believe a drug would harm a patient. The Senator from Williamsburg pressed whether the provision would require a pharmacist to fill a prescription that the pharmacist believed would do more harm than good; the chairman responded, "Only if it was FDA approved and only if we're under a state of a health emergency by the governor."

A later amendment presented on behalf of Senator Garrett requires that, when a pharmacist refuses to fill a prescription, the pharmacist make a documented attempt to contact the prescribing physician; that amendment also describes limited exceptions. Senators suggested details on referral procedures and regulatory implementation could be handled in agency regulation or worked out in full committee.

Amendment 3: definition of "department" Amendment 3 removed the phrase "or any person authorized to act on behalf of the department" from the bill's definition of the Department of Public Health. The chairman said the clause could be read as delegating broad authority to nonemployees and that striking it aligns the bill with existing statutory practice.

Amendment 4: narrowing the grounds for declaring a public-health emergency Amendment 4 restructured the bill's language so that a governor's declaration for a "widespread illness" must be tied to an illness or agent that poses a substantial risk of significant human fatalities or permanent or long-term disability. The chairman said the change "just clears it up" so the term "widespread illness" cannot be the sole basis for declaring a state of emergency. The Senator from Williamsburg cautioned the change should not "tie the governor's hands" in the event of an unforeseen pandemic; the chairman and other senators said the amendment preserves emergency authority in cases involving substantial mortality or long-term disability.

Amendment 5: quarantine and isolation time limits Amendment 5 sets a release rule for asymptomatic quarantined individuals: a person in quarantine without symptoms "must be released from quarantine after 21 days or at the end of the incubation period for the disease, whichever is sooner." Proponents said the amendment places a clear time limit on quarantine and noted that current law includes no fixed limit. Opponents raised concern that a novel disease with a longer incubation period could require a longer quarantine. Senators noted an existing statutory mechanism (section 44-4-540(C)(5)(D) in the bill's draft) that can allow the Department to seek continuation of isolation or quarantine beyond the initial period in extraordinary circumstances and that such extensions would be subject to judicial review.

Public testimony and expert remarks

After the committee votes, Doctor Robert Jackson of Spartanburg, who testified at earlier meetings, addressed the committee. Jackson, who said he prescribed ivermectin to some patients during the COVID-19 pandemic, framed his remarks around patient autonomy and informed consent. "My patients value the ability to say no to a vaccine," said Doctor Robert Jackson, identifying himself as a physician practicing in Spartanburg. Jackson said his practice attracted patients who objected to vaccine mandates; in exchanges during the meeting he stated, "I don't believe [the COVID vaccines] saved lives," and criticized mandates and employer-enforced vaccination policies. Other senators questioned Jackson on scientific consensus and effectiveness; Jackson said he did not know how many peers agreed with his view.

Votes and next steps

The subcommittee adopted Amendments 1 through 5 and approved a motion to report the bill favorably as amended to the full committee. A single senator recorded opposition to Amendment 5 (Senator from Williamsburg); no other recorded opposition was announced during the meeting. The chairman moved the bill to full committee; members signaled the earliest likely floor consideration would be at the next available full committee meeting.

Why it matters

SB54 revises how the state defines emergency authority and how medical decisions intersect with pharmacists and public-health orders. The amendments change statutory language that affects DPH discretion, pharmacists' refusal rights and obligations during emergencies, and the duration of quarantine orders. Those changes will affect patients, pharmacies, long-term-care facilities and the state's emergency response framework if the bill advances.

What remains unresolved

Senators asked staff to clarify implementation details: how pharmacists will identify alternative fill options, how regulatory language will align with statutory duties, and how courts would handle continuation requests in extraordinary circumstances. The committee deferred further technical work and regulatory detail to the full committee and agency rulemaking discussions.

Votes at a glance: SB54 (as amended) - Amendment 1 (remove "novel vaccine"): adopted - Amendment 2 (pharmacist refusal exception during declared emergency for FDA-approved drugs used off-label): adopted - Amendment 3 (remove "any person authorized to act on behalf of the department" from definition of department): adopted - Amendment 4 (clarify "widespread illness" must be associated with substantial risk of fatalities or long-term disability): adopted - Amendment 5 (release asymptomatic quarantined individual after 21 days or end of incubation period, whichever is sooner): adopted (one recorded no) - Final: Favorable report to full committee as amended: adopted