At a time when state vaccination rates are declining and measles has reached epidemic proportions around the globe, 27 elementary schools in Scottsdale are at risk for an outbreak.
Using data from the Arizona Department of Health Services, the Scottsdale Progress found that those 27 schools have less than 95 percent of their kindergartners vaccinated for the Measles Mumps Rubella.
The Centers for Disease Control and Prevention says coverage rates below that level no longer protect those who can’t be vaccinated – such as babies, people with certain medical conditions and pregnant women.
The top five most at-risk schools include Pima Elementary, with a 61 percent coverage rate. It’s followed by Mission Montessori Academy, 64 percent; Scottsdale Country Day School, 67 percent; Laguna Elementary, 79 percent; and International School of Arizona, 82 percent.
Will Humble, executive director of the Arizona Public Health Association, who has been studying vaccination rates in Arizona since he was the head of the state health department in 2009, said the statistics illustrate a common theme.
“There are a couple of trends we’ve seen in Arizona over the years,” said Humble. “One in general is that it’s the higher income families with higher educational levels – both parents have college degrees and an income of over $100,000 – that are the ones we see choosing not to vaccinate. Not because of bad access to care but just because they decided not to.”
Humble no longer works with the department, and continues to research and lobby for pro-vaccine legislation through the APHA.
Exemptions are expanding
More parents nationwide are opting out of state-required vaccines for non-medical reasons.
In Arizona, kindergarten exemptions for personal reasons increased from 5.4 percent in 2017 to 5.9 percent in 2018, according to the ADHS. Arizona is one of 17 states in the country that allow personal belief exemptions.
Parents or guardians can exempt their children for personal reasons as long as they submit a statement saying they are aware of the potential risks and benefits of immunizations, as well as the potential risks of non-immunization. Children in childcare can be exempt for religious reasons.
Schools are also required to submit their vaccination data to the state health department every November. While the schools don’t post their data on their own websites, it can be found through the ADHS website.
“I think the answer is to get rid of the personal exemption,” said Humble. “Maybe a compromise instead of all or nothing – what if we said we’re getting rid of the personal belief exemption only for the MMR vaccine? That might be a reasonable compromise.”
Maricopa County is among the 60 percent of Arizona counties at risk for a measles outbreak.
Haley Elementary School in Chandler has a 92 percent coverage rate for the MMR vaccine. Although the rate is below the threshold, Principal Pam Nephew said she considers the school to be pro-vaccine.
“We just want to keep everybody healthy here. There are some people who come in with religious or medical reasons and all they have to do is fill out that form and there’s no accountability,” said Nephew. “Anybody can fill it out. That’s the struggle we have as a school.”
“If there were to be an outbreak,” she added, “those children would need to be out of school. That’s basic protocol for any school. That’s difficult because then the kids are going to be missing information.”
The school’s coverage increased by one percent from last year, though, going against the statewide trend.
Mesa’s homeschool Eagleridge Enrichment Program has one of the highest numbers of unvaccinated kindergartners. More than half of the public school’s 77 kindergartners are exempt.
Because the students only meet for class one-to-three times per week, Principal Aimee De La Torre said she isn’t concerned.
“I respect the decision they’re [the parents] making. They’ve made the choice to homeschool, which allows more flexibility in all areas of a child’s life,” she said. “We have not had any major scares or anything.”
Measles makes a comeback
Measles is currently at the center of the vaccine controversy, with more than 650 cases of the disease popping up in the United States since the beginning of 2019 -- including in Arizona. This is the highest number of confirmed cases since it was declared eliminated in 2000, according to the CDC.
The disease is highly contagious and early symptoms can include high fever (104-degree range), cough, runny nose and watery eyes, followed by a rash three days later.
Those affected can suffer from some serious complications, such as brain trauma, and once in a while, death.
The CDC estimates that:
1 in 20 children with measles will get pneumonia, the most common cause of death from measles in young children.
About 1 child of every 1,000 with measles will suffer swelling of the brain, potentially leading to seizures, intellectual disability or hearing loss.
For every 1,000 children who get measles, one or two will die from it.
Humble said he believes the rise in MMR exemptions can be attributed to a myriad of factors.
Although the World Health Organization recently named “vaccine hesitancy” as one of this year’s biggest global health threats, anti-vaxxers are continuing to run rampant on social media, he said.
“The social media revolution and the internet made it so much easier for people with inaccurate and misleading information to have a voice and confuse people,” he said. “Vaccine-skeptical and anti-vaccine parents can share misleading information and then grow their cohort of anti-vaxx people.”
The fuel for misinformation stems from a debunked 1998 study that linked immunizations to autism, he explained.
In places like Sedona, where vaccine exemptions are particularly high, Humble attributes anti-vaxx attitudes to liberalism and higher education.
“It’s this kind of left-wing enclave up there where people are considering their carbon footprint, but won’t vaccinate their kids,” he said, adding:
“Vaccines are a social contract you have with your community, and that vaccine you provide for your kid benefits all of the kids in that community – especially kids with special needs and those who can’t get vaccinated.”
The health expert also mentioned that today’s generation of younger parents weren’t confronted by measles in the same way that older generations were, so they might not fully understand the seriousness of the disease.
What’s being done
Despite the growing anti-vaccination movement and several bills in the Legislature that would enable even more exemptions, Gov. Doug Ducey has made it clear he wants a pro-vaccination state.
In February, Ducey promised he wouldn’t sign several controversial bills that would make it easier for parents or guardians to receive exemptions for their children.
The bills, which were proposed by Rep. Nancy Barto, R-Phoenix, seek to expand exemptions while eliminating the requirement that parents sign a state form. They would also require doctors to offer tests determining if a child is already immune.
Although the House Health and Human Services committee advanced the bills, state Rep. Kelli Butler, D-Phoenix, who has been a strong supporter for educational vaccine resources, said she doesn’t believe the legislation will get too far.
“I feel very strongly they [the bills] would create more vaccine hesitancy and that they would result in less people getting vaccinations,” she said. “I think from a public health standpoint, we need to be making a case that vaccines are important and safe. The more places parents can find that information [vaccine data], the better.”
Last year, Butler introduced a bill seeking to require schools to post their vaccination data online themselves, but it didn’t catch wind.
The representative said she felt frustrated with the outcome because she believes vaccines should be bipartisan, and is considering re-introducing HB 2352 next year.
ADHS will be conducting a pilot program next school year in an effort to educate parents seeking personal belief exemptions through an online course.
The Immunization Education Course will require parents at participating schools to read through a series of slides before answering questions regarding vaccination data. Upon completion, they will be able to access the exemption form.
Mesa Public Schools will be in the pool of participants, according to Health Services Director Nadine Miller.
“Vaccines are very safe and have been around for a long time, but parents questioning them need to have good information to go to,” she said. “Not only is an outbreak devastating to the kids, but think of the resources of our medical facilities and the parents that have to go to work – where do you put your kids now?”
The program will enable ADHS to collect data that can help determine strategies to increase vaccine rates across the state.