Expert: High Arizona vaccine exemption rate in kindergarten 'just a disaster waiting to happen'
According to the CDC, the national rate of vaccine exemptions among kindergarteners is at 3%, the highest ever. CDC data also shows exemptions in Arizona trending higher, even before the pandemic.
Just over 7% of Arizona’s kindergarteners were exempted from commonly required vaccines in the most recent school year. Former public health official and current consultant Dr. Bob England said Arizona has trended higher for years, even before vaccine hesitancy brought on by the pandemic.
“This is a continuing trend,” said England. “We’ve been losing about one half of one percent of coverage for many vaccines each year, year after year. And there are many reasons for that.”
Herd immunity: What is it, and why does it matter?
Gaging the situation isn’t easy, he said, because “it varies wildly around the state,” making it hard to pin down an ideal "herd immunity" level.
Herd immunity is the idea of building resistance to the spread of disease within a population through pre-existing immunity, usually through previous infection or vaccination.
“Immunizations, if you think about it, are therefore a communal good,” said England. “It matters to you whether your neighbor is vaccinated, and whether your neighbors’ kids are vaccinated, and the other students at your kids’ school are vaccinated.”
According to England, determining exactly where the ideal threshold to achieve herd immunity is, is difficult.
“But we are well under it,” he said. “We’re under 90% statewide and under 50% coverage in certain schools. And that’s just a disaster waiting to happen, whereas other schools have 100% coverage.”
The federal Vaccines for Children (VFC) program provides free immunizations to qualifying children.
“There are fewer than half as many locations to get VFC vaccines now than there were 10 years ago in the state,” England said. “And our state in particular is having trouble. We have about a quarter of the number of VFC providers per eligible child as the national average.”
Fewer locations also means longer waits for parents that do make it in. England said that, combined with confusion about navigating the health care system, could lead some parents to look at exempting their children.
“A lot of parents, we think, are making the choice to exempt their children from the vaccine requirement because it's just easier,” he said. “All they have to do is sign a form.”
Arizona is one of 15 states that allows exemptions based on personal belief.
Dr. Eugene Livar is the assistant director for public health preparedness at the Arizona Department of Health Services (ADHS). Access to certain vaccine providers, he said, may vary by location or county.
“I think DHS can be at the center of moving forward and seeing what we can do to help mitigate those gaps and mitigate those issues that are presenting across the state,” said Livar. “It’s probably going to vary by location and area from one to another. But I think that we could likely identify some solutions and some next steps to open up and ease access to the VFC program.”
A robust vaccination infrastructure across the state is key, said Livar, and securing it will require a flexible approach.
“Those needs that arise, those resources that are needed, those lean-ins needed from a state standpoint are going to be different,” he said.
Approaching solutions on a community-by-community basis is important to secure “a threshold of coverage that would provide protection” or herd immunity.
“What we often use as our indicator, kind of the canary in the coal mine, if you will,” said Livar, “is our measles, mumps, and rubella, or MMR, coverage rates. We would love to see those at 95% or higher. If you look at kindergarten rates, they were just under 90% this last year as reported.”
Livar added that among 6th graders, there was greater than 95% coverage.
Still, according to England, Arizona has the fourth lowest rate in the country of immunization against MMR for kindergarteners.
The fight against misinformation
While ease of access plays a contributing role, so does misinformation.
“The No. 1 source of information that parents say they trust about whether to vaccinate their kids is their health care provider,” said England. “But the health care provider has them in front of them for what, a few minutes, every six months? Maybe a few minutes a year?”
By contrast, the barrage of misinformation parents receive on the internet is constant.
“You have higher exemption rates in communities like east Mesa and north Scottsdale, where people have higher incomes and higher levels of education than you do on average,” he said. “And that’s a reflection of true vaccine hesitancy because of all the competing narratives out there and social media algorithms.”
England said that while it’s understandable for parents to be confused, getting the right information to them is that much more important.
“Nobody wants to hurt other people on purpose, but vaccines are the one health decision that impacts not just yourself,” said England. “If you choose not to get your high blood pressure screened or treated, or you don't take care of your diabetes, you're only hurting yourself. If you don’t get vaccinated, you’re not just risking your own health. You’re risking being a vector of disease to other people around you.”
At the state Health Department, Livar said it’s their responsibility to “provide resources, education and awareness to help make sure that parents and families have all of the information available to them to be able to make decisions.”
'Make it easy to understand'
“Some of the landscape has changed on how you want to communicate those items and how you want to get that information out,” said Livar. “We can't have the same approach that we had pre-pandemic.”
Pre-pandemic breakthroughs of diseases like measles prove that point, he said, especially because they showed up in unvaccinated or under-vaccinated families and communities.
“The old style of messaging just wasn’t working,” Livar said, “and that’s just one of the things we need to work through.”
Thinking about what information will resonate with people, and delivering it in a lighter, more relatable way is one promising approach.
“Not everybody has time to read a 90 page paper or 200 page research document,” said Livar. “That's our job. What can we do to break that down and make it easy to understand and bring the most important points forward?”
England also called attention to the ease of exempting a child from getting commonly required vaccines in Arizona, compared to other states: “Making it easier to ignore those requirements is a policy choice, a political choice.”
“There's real vaccine hesitancy that we can talk about forever, that has been increasing over time,” he said. “But that’s a big part of the problem, are the system issues that we have more control over.”