Given a recent rise in the rate of students who are exempt from vaccinations, Arizona public health officials are issuing a back-to-school reminder about the benefits of immunizations.
Health officials are also stressing that free vaccine clinics are available to local families.
“It isn’t just about meeting a school requirement. Immunization is one of the most fundamental steps we can take to protect the health of our children,” Richard May, manager for the Pima County Health Department’s clinical services division, said in a news release.
The Pima County Health Department will have expanded immunization clinic hours through Aug. 24.
“Vaccinating your child can save their life and the lives of others you care about,” said Heidi Pottinger, director of clinical investigations with health promotion sciences at the University of Arizona’s Mel and Enid Zuckerman College of Public health.
“Overall it’s the safest way to protect your child from serious illness — and that is based off of numerous scientific, evidence-based studies. The benefits of vaccinating your child are going to greatly outweigh any minimal risk associated with the vaccine.”
Maintaining high immunization rates is, “critical” to prevent outbreaks of dangerous vaccine-preventable disease in Arizona communities, Arizona Department of Health Services Director Dr. Cara Christ wrote in a recent blog post.
“Based on data from this school year, in the event of a statewide measles outbreak, over 5,000 Arizona kindergartners would be at risk of contracting measles,” she wrote.
State health data for the 2017-18 academic year shows that for a second year in a row, the percentage of Arizona students exempt from one or more vaccines increased across all age categories.
Exemption rates were much higher in charter schools, the data shows. University of Arizona researchers have found that parents who sign “personal belief” waivers exempting their children from vaccines tend to be white, college-educated and higher income.
A recent study by Pottinger and other researchers at the UA’s Mel and Enid Zuckerman College of Public Health also found in their study that parents who exempt their children from vaccines are not typically doing it because of convenience, but because of true personal beliefs.
Distrust of doctors
Researchers found factors are at play in the decision to exempt children from vaccines include a distrust of physicians and information about vaccines.
The parents who chose exemption were also more likely to visit a naturopath, and to have a perception that vaccine-preventable diseases are not severe, the study found. Some also believe that it’s better for their child to develop immunity through illness rather than vaccination.
“When parents are saying things to us like it’s better for my child to get immunity through active infection, that is very dangerous,” Pottinger said.
“Vaccine-preventable diseases can be very severe — they can cause brain damage, paralysis, and death. Vaccinating with a weakened, inactivated, or targeted version of the disease is going to be far safer for the child.
And it’s not just about your child. There are infants, kids with cancer, children in our communities who can’t be immunized and are vulnerable to these diseases.”
While the numbers of vaccine-exempt students in Arizona remains small, the increase in exemption rates led to a decrease in vaccination coverage rates for all three age groups the state uses to gauge vaccine rates, Christ wrote.
In Pima County, vaccine coverage is better than the state average in every category — child care, kindergarten and sixth grade. Still, the rates of non-medical vaccine exemptions locally showed slight increases over the 2016-17 school year for all three groups.
Nearly three percent of Pima County kindergarten students, or 2.7 percent, had non-medical vaccine exemptions last school year, for example. In Coconino County, the rate was 10.3 percent and in Maricopa County, the rate was 5.9 percent, the state data shows.
“We always rock in the vaccine coverage area in part because we’ve worked really hard with the school districts,” said Dr. Francisco Garcia, who is Pima County’s assistant county administrator for health services.
“The only real holes in our (vaccine) coverage are charter and private schools. We don’t have a good mechanism to provide the support and technical assistance to improve their compliance . . . A charter school won’t necessarily have a school health aide, for example and it can be really complicated to make sure kids are getting their forms in.”
Rise in exemptions
Though Pima County fares well compared with other counties, there’s always reason for concern, said Pottinger, of the UA’s public health college.
“The reason is that the immunity threshold needed to contain the spread of certain preventable diseases is so high,” she said.
“We have to have a really high vaccination rate in order to protect our neighbors — people who can’t be vaccinated — and people travel. It’s important to never let our guard down. The total number of medical and non-medical exemptions combined could be enough to allow the spread of serious diseases”
Statewide, overall vaccine exemptions rose from 3.9 percent to 4.3 percent at the child care level and from 4.9 percent to 5.4 percent for kindergarten students.
For sixth grade students, the exemption rates rose from 5.1 percent to 5.4 percent last school year, the state data shows.
“A continuing rise in exemptions is concerning, and public health is acting to curb this trend,” Christ wrote in her blog post.
“Arizona law requires that all children attending school or child care must obtain certain vaccines, unless they are exempted by a doctor for medical purposes, or by a parent for personal reasons”
Arizona is one of 18 states that allow parents to exempt their children from vaccines based on personal beliefs. A study published in the journal PLOS Medicine in June found that since 2009, non-medical vaccine exemptions rose in Arizona and most other states that allow such exemptions for religious, personal or philosophical beliefs.
The study by researchers from Baylor University in Texas notes that some European countries have improved their vaccination coverage by making vaccines mandatory, or else imposing fines on parents who refuse to vaccinate their children.
“Our concern is that the rising non-medical exemptions linked to the anti-vaccine movement in the U.S. will stimulate other countries to follow a similar path,” the Baylor researchers wrote.
“It would be especially worrisome if the very large low- and middle-income countries—such as Brazil, Russia, India, and China or Bangladesh, Indonesia, Nigeria, and Pakistan—reduce their vaccine coverage. In such a case, we could experience massive epidemics of childhood infections that may threaten achievement of United Nations global goals.”
California in 2016 passed a law that mandates vaccinations for all private and public schoolchildren with the exception of kids who have a doctor-certified medical exemption. Exemptions for personal beliefs are not allowed.
The percentage of preschoolers statewide with non-medical vaccine exemptions quadrupled between 2000 and 2014.
And as personal exemptions have increased in Arizona, so have reported cases of vaccine-preventable disease — reported cases quadrupled between 2008 and 2013, UA researchers found. Cases of whooping cough increased sixfold during that time, their study said.
The UA study said Arizona could consider more stringent requirements for personal belief exemptions and/or imposing processing fees to reduce high numbers.
“The bottom line is that vaccination interventions are among the safest kinds of things that we do for children,” Garcia said. “Nothing is 100 percent perfect. But the downside of not vaccinating can be life-threatening and that is what I focus on.”
Garcia also noted that parents who don’t vaccinate their children in Pima County put their children at other risks. He cited a recent whooping cough outbreak in a local school district that resulted in a prohibition on unvaccinated children attending school for a period of time.
“I got a ton of calls from parents who were pretty angry,” he said. “All of a sudden it became not just an ethical/moral issue but a convenience issue. I have to do that if children are unvaccinated. There are real consequences if you don’t vaccinate your kid.”