Here’s another troubling pandemic surge.
Idaho’s school immunization opt-outs rose sharply.
Idaho recommends a series of vaccinations from kindergarten through 12th grade. But none of them are required. Parents can ask for an exemption simply by turning in a note to their child’s school.
And this has nothing to do with the COVID-19 vaccines — not directly, anyway. Here, we’re talking about parents who opted their kids out of other childhood immunizations: for diseases such as measles, polio, whooping cough and chicken pox. The state has been recommending most of these vaccines for years, long before the pandemic.
It’s been a tough sell for years. Idaho’s immunization rates have long been among the lowest in the nation. But when the opt-out rates surged over the past two years, that means the immunization rates fell even further.
This could have serious implications for parents and students, if an outbreak occurs later this school year. And for school administrators who have spent more than two years juggling in-person learning against a global public health crisis, and are no doubt yearning for a more back-to-normal 2022-23.
What happened over the past two years?
While sketchy, the state’s numbers are nonetheless eye-opening.
In 2019-20, just before the pandemic, 86.5% of the state’s kindergarten, first and seventh grade students were immunized. That percentage actually increased a bit the following year, but in 2021-22, the immunization rate dropped to 80.2%.
This declining rate puts Idaho barely above the 80% threshold believed to offer “herd immunity” against polio, a childhood disease that had appeared all but extinguished until July, when New York health officials reported the nation’s first case in almost a decade. Idaho’s current immunization rate also falls way below the 95% threshold needed to ward off a measles outbreak.
The immunization rate is even worse for 12th graders. The state recommends a meningococcal vaccine, but in 2021-22, only 55.4% of 12th graders were immunized.
Before the pandemic, immunization opt-outs covered 7.9% of kindergarten, first and seventh grade students. After surging in 2020-21, the opt-out rate came in at 9.7% last school year. But that improvement is of little comfort to Sarah Leeds, manager of the Department of Health and Welfare’s Idaho Immunization Program. “We still believe that 9.7% is too high.”
Other students fell through the cracks in increasing numbers. Before the pandemic, the state had incomplete immunization records for about 3,200 kindergarten, first and seventh grade students. That number has nearly doubled, topping 6,300 last year. These children are attending school, but school administrators have no way of knowing if they’re immunized or not, and more likely to contract or spread a contagious disease.
Several factors could have contributed to these trends, Leeds said. Hunkering at home during the pandemic and school shutdowns, parents could have simply fallen behind on other child immunizations. An influx of newcomers might have been a factor, creating even more gaps in Idaho’s immunization database. Parents might have opted out on immunizations, which they can do by sending a note to their child’s school, because it was easier than making a vaccination appointment or corralling immunization records.
And while the state’s immunization guidelines are silent on the COVID-19 vaccine, the COVID controversy probably was a factor as well. As skeptics questioned the safety and effectiveness of the COVID vaccines — despite strong evidence that the vaccines reduce rates of death and serious disease — this skepticism extended to other, established vaccines.
“I don’t think it helped, by any means,” Leeds said.
What we don’t know
Normally, the state’s childhood immunization database is exhaustive: breaking down vaccination numbers by district, school and grade level, and pinpointing counties with high opt-out rates. These detailed breakdowns have generally shown higher opt-out rates in North Idaho and parts of central Idaho and lower rates in eastern Idaho.
But due to staffing shortages, the Department of Health and Welfare has not drilled down into last school year’s numbers, so it doesn’t have school-level data, Leeds said.
And it will be a while before this year’s immunization numbers come into focus at the state or local level. School-level data is collected on Nov. 1.
While local data is hard to come by, two of Idaho’s largest school districts say more of their parents are opting out of immunizations and more parents aren’t bothering to turn in complete health records.
West Ada health services supervisor Tracey Garner says it comes down to a long list of factors. Some parents don’t trust the medical community. Others can’t schedule their kids in for a well-child checkup, an immunization requirement. Newcomers don’t always know Idaho’s immunization guidelines; for example, California transplants were never asked to immunize their kids for hepatitis A, but that vaccine is on Idaho’s list of recommended immunizations.
In Coeur d’Alene — in the middle of North Idaho’s opt-out ground zero — those numbers are climbing. And when parents don’t turn in their kids’ immunization data, or formally ask for an exemption, school nurses try to fill in the holes in the data. They email, call and text parents for records, often to no avail.
“Our greatest challenge has always been obtaining immunization records in our district,” said Leanne Bullamore, the district’s health services director.
‘By and large, most Idahoans believe in vaccines’
Public schools are required to accept all students, regardless of immunization status. That would only change during a disease outbreak. At that point, schools can close their doors to students who aren’t immunized.
Ultimately, state officials and local school administrators can do little more than encourage parents to get their kids immunized--not just to curb the spread of infectious disease, but to ensure that their children can attend school without interruption.
In Boise, that means immunization drives. The district held a back-to-school immunization clinic in August, in partnership with Central District Health. And even though the influenza shot isn’t on the state’s list of recommended vaccines, the district will offer flu vaccine clinics at 27 schools.
At the state level, Health and Welfare is trying to make it easier for parents to track immunization data.
A smartphone app, Docket, will allow parents to access their kids’ immunization registry, and email the information to schools. The hope is that school nurses and principals will have a more complete picture of immunization status, while parents can schedule vaccinations that might otherwise be forgotten.
While trying to streamline the process, Health and Welfare is also trying to instill a sense of urgency. The department will step up its efforts to promote the importance of vaccinations.
“By and large, most Idahoans believe in vaccines,” Leeds said. “We’re trying to really kind of encourage that that is the social norm. The minority I think is very vocal.”
Based on the past two years of immunization numbers, however, that vocal minority has grown.