By Cecilia Chan, GSN Staff Wrier
As the new school year gets into full swing across the East Valley, the Arizona Department of Health Services offers this eye-opening report: Parents are increasingly choosing to forgo vaccinating their children.
Immunization rates among children in the state have dropped from 2012 to 2017 for a number of infectious diseases – including polio, measles, chickenpox and whooping cough, according to the department’s annual report this month. The report covers the 2017-18 academic year for preschool, kindergarten and sixth grade and is based on self-reporting data.
“The health department is concerned about the rising exemptions and reduced coverage,” said Jessica Rigler, the department’s branch chief of public health preparedness. “As the trend continues, we are going to see a continued risk to students, their families and citizens of Arizona for preventable diseases.”
In 2017, the immunization rate was such that in an event of an outbreak, over 5,000 kindergartners would be at risk for measles, state health officials said.
Arizona allows parents to exempt their children for three reasons – medical, personal and religious. However, students in grades K-12 can’t use religious beliefs as an exemption and child care centers, preschool and Head Start can’t use personal-belief exemptions.
Data showed the non-medical exemptions continued to rise in Arizona, with the highest rates reported in public charter schools, followed by private and then public schools.
In 2017, non-medical exemptions increased to 4.3 percent from 3.9 percent the year prior for preschool, jumped to 5.4 percent from 4.9 percent for kindergarten and rose to 5.4 percent from 5.1 percent for sixth grade.
The numbers are somewhat misleading, contended Melissa O’Connor at Montessori Children’s Centre.
The Mesa private school, with an enrollment of 41 kindergartners in 2017, reported 51 percent of those students were exempted from the polio vaccine; 51 percent from diphtheria; 54 percent from the measles, mumps and rubella vaccine, 41 percent from hepatitis B and 41 percent from chickenpox.
“A lot of our parents for the exemptions are on a slower path,” explained O’Connor, who oversees the school’s immunization records. “They are getting their kids immunized but just at a slower rate. That is what I am finding with a lot of my parents, not so much that they are completely exempting their kids.”
So, by the time she has to file the report with the state in October, not all of the kindergarteners have had their immunization yet, she said. Parents in Arizona must show proof of all required immunizations or a valid exemption before their children are allowed into the classroom.
“We don’t have breakouts here of measles, polio or any of that,” said O’Connor, who has been with the school for 17 years. “Our kids are very healthy here. A majority of our kids are immunized but they are taking a slower route.”
Rigler said the data doesn’t show what percentage of students reported as exempted later get vaccinated.
“There are some students marked as exempted from vaccination, but their parents are still intending to vaccinate them,” Rigler said. “The data we provide is just a snapshot in time. We ask every school every year to report for all kindergarteners currently enrolled, all sixth-graders currently enrolled and childcare facilities of students in a certain age range at that point in time during the beginning part of the school year.”
The data, she said, gives the understanding that, for example, if an outbreak of measles were to occur at that particular point in time, the 5,000 kindergartners in 2017 who were not vaccinated against measles would be susceptible to the highly contagious disease.
“Schoolchildren are a marker for us as vaccination coverage,” Rigler said. “I think it demonstrates our coverage level for vaccination is not as high as it should be to protect the community against preventable outbreaks.”
Will Humble, former Department of Health Services director and now executive director for the advocacy group Arizona Public Health Association, also expressed concern with the trend of dropping vaccination.
“When we took a deeper dive into the data, this trend continues to be in the high-income parts of the state,” he said. “It’s the higher-income parents that are the ones contributing to the higher-exemption rate, the unvaccinated kids. The problem areas are in Prescott, Sedona, some of the places in Mesa, north Scottsdale – those higher-income places.”
Another problem is the uneven distribution in the state, with far more exemptions found in charter schools than public schools, he added.
“The same parent who chooses a charter school over public is more likely to challenge a pediatrician about vaccines,” said Humble.
A study performed by the state health department and the University of Arizona several years ago identified parents in the top 20 percent of income earners as less likely to vaccinate their children but why is difficult to say, Rigler said.
“Some of the things we know is there is a lot of access for care for lower-income communities and more trust in health-care providers,” she said. “Whereas with higher income, which correlates with higher education, we often see people do their own research and not look at all the credible sources or listen to what their pediatricians tell them.”
Dr. Chinwe Egbo, medical director for Banner Children’s Urgent Care centers, has seen an increase of parents questioning the safety of vaccination.
She said a number of parents see the growing autism rate in the country and persist in believing there is a link between that and vaccination.
In 1998, British Dr. Andrew Wakefield published a study claiming the measles-mumps-rubella vaccine could lead to autism. His paper was later discredited and retracted and his license to practice medicine yanked.
“Even though it was debunked and there is no clinical evidence and studies to prove that, we still have parents who are concerned and don’t want to take the risk,” Egbo said. “And sometimes we get parents who want to spread out the vaccination and get it later.”
Those parents worry about the level of mercury or elements in the vaccine, she said.
By age 2, children should have received vaccines against 14 diseases, according to the immunization schedule approved by the U.S. Centers for Disease Control and Prevention.
But a majority of parents who don’t vaccinate do so because they say they want to raise their children healthy, through a “natural” route, the doctor said.
“That is what we are getting a lot more now than in the past,” she said. “Those are the ones we can’t get to vaccinate.”
She said the parents of today were vaccinated as children, which stopped many of the diseases. And, because they don’t see the diseases anymore, they don’t feel the need for vaccination, she added.
Although some anti-vaccine parents rely on herd immunity – if enough people are vaccinated, it is unlikely anyone will get sick and infect anyone else – to protect their children, there is still an increased risk for unvaccinated children of catching diseases, Egbo said.
Arizona is not alone in seeing a steady increase in non-medical exemptions. Twelve of 18 states with this exemption have seen an increase of parents seeking waivers since 2009, according to a study published this year by PLOS Medicine.
The study’s researchers found several major cities, including the Phoenix metropolitan area, stood out for their “very large numbers of non-medical exemptions,” and the high numbers suggest that outbreaks of vaccine-preventable diseases could either originate from or spread rapidly throughout the populations of unimmunized children.
“The fact that the largest count of vaccine-exempt pediatric populations originate in large cities with busy international airports may further contribute to this risk,” the report said.
To date, the only infectious disease that has been eradicated is smallpox, with polio next on the list.
Humble said that in his last year as the state health director, in 2015, the department overhauled the exemption sheet. Instead of a blanket form, parents are now required to check off and initial each individual vaccine they are seeking an exemption.
“What we were trying to do is build more transparency in the system,” he said. “In other words, make it clear to the parents, that by signing the exemptions and not vaccinating, what it means to risk their kids and the risks to their classmates.”
Among the groups of people who are most at risk from those who are unvaccinated are infants and children simply too young to be vaccinated.
Humble added the Arizona Partnership for Immunizations is working with school administrators to help parents overcome barriers that might prevent them from getting their children vaccinated and by reducing so-called convenience exemptions, in which parents sign a waiver because they can’t get their children immunized in time to meet school requirements.
Rigler said the state is doing more education and outreach with school nurses, healthcare providers and schools, which are often the frontline for parents when registering their children.
“One of the things we know is conversation with a trusted individual has a lot of impact on decision-making,” Rigler said. “We are educating them about vaccination and safety so they are equipped to have that conversation with parents.”
She said a one-on-one between a pediatrician and parent carries more weight than hearing a message from a health department.
The state also is working with county health departments. The state health department last year launched an online pilot program in which parents seeking personal-belief exemptions must first take an immunization education course, which takes between 25 to 90 minutes to complete, depending on how many exemptions they are seeking.
The program was launched at 17 public schools in Glendale, Mesa and Paradise Valley.
Rigler said plans are to expand the program to schools in other counties.
“I have no beef with the religious exemption if it’s true or medical exemptions,” Humble said. “It’s the personal exemption I have a problem with and I didn’t use to with all the interventions.”
But the interventions are not working as immunization levels continue to drop in Arizona, he said.
Whether Arizona will go the way of California, Mississippi and West Virginia (which don’t allow religious and personal exemptions) and allow only for medical exemptions is entirely in the hands of state lawmakers, who generally frown on laws that they consider nanny-state issues, Humble said.
Two years after California removed personal and religious exemptions, vaccination rates have risen in that state, especially in high-income enclaves like Marin County, which had the highest personal-exemption rates, Humble said.
The Golden State’s law was spurred by a 2014 measles outbreak at Disneyland that spread to multiple states, including Arizona. Federal health officials suspected a foreign visitor or an American coming home with the virus was the culprit and the reason why the disease spread was due to the low-vaccination rates. A majority of the people who came down with measles were unvaccinated, according to the CDC.
The news was shocking considering the United States in 2000 declared measles eliminated in the country.
Humble doesn’t expect to see any changes in the state’s vaccination policy until it hits the pocketbook for charter schools.
(Kimberly Carrillo/GSN Photographer)
By the time a child is 2, he or she should have had 14 vaccinations against dangerous contagious diseases. But more parents are keeping their kids away from the shots, swayed by discredited claims they cause autism.