Each year, thousands of children become ill from diseases that could have been prevented by basic immunizations. When a child catches measles or whooping cough, there is an obvious threat to the child’s health. But how does illness affect that child’s education, or our education system and society at large?
Vaccines and our schools
“The immunization rates for Michigan are not where we would like them,” says Bob Swanson, division of immunization director for the Michigan Department of Health and Human Services (MDHHS). “Our goal is to have immunization rates to at least 80 percent.”
Michigan’s vaccination rate for 19- to 35-month-old children is 70 percent, according to the National Immunization Survey. Michigan is ranked 24th in the country based on NIS data.
The MDHHS reports that, for the last two years, Michigan has had the fourth highest vaccination waiver rate in the country for children enrolled in kindergarten — behind only Oregon, Idaho and Vermont. Vaccination waivers allow parents to opt out of having their child vaccinated, but allow unvaccinated children to remain in school.
States with high vaccine waiver rates are on federal and state officials’ radars because outbreaks of diseases are more likely to occur in communities with groups of unvaccinated children or adults.
2014 research shows about 700 Michigan elementary schools have kindergarten waiver rates above 7 percent. This percentage is the benchmark above which health officials say communities are at risk of an outbreak of whooping cough or measles, the most contagious vaccine-preventable diseases.
“Outbreaks of disease in schools can impact the educational system. We hear frequently of schools that will close down due to high absenteeism due to influenza outbreaks. These could be prevented if we had higher coverage levels with flu vaccine,” says Swanson.
Absences and school closures prevent students from learning, putting them further behind national and international peers in educational attainment. An analysis of a national sample of chronically absent kindergarten students revealed lower academic performance when they reached first grade, and time and time again research supports that when students miss school, particularly for long periods of time, they fall behind.
If just one unvaccinated student falls ill with a preventable disease, that child’s education is put in jeopardy, and if he or she infects multiple students or causes a school closure, everyone suffers.
Vaccines and health care costs
The costs associated with choosing not to vaccinate can be monetary as well.
“It is estimated that one dollar spent on pediatric immunizations saves five dollars on treatment of the disease,” says Meghan Swain, executive director of the Michigan Association for Local Public Health (MALPH).
The costs continue to mount when considering lost days from work for parents, lost days from school, the potential for lifelong impacts from diseases, the cost to the public health system for disease investigation and containment and the cost of illness for other exposed members of the community.
The social impact of outbreaks
Swain also warns of the social impacts of outbreaks.
“When there was a pertussis outbreak in counties in northwest Michigan this past winter, schools had to close,” she says. “People did not want to even take their immunized children to the area for fear of an unwanted exposure. Social events and family gatherings were cancelled. And there are definite emotional feelings between families who choose to immunize their children and those who choose not to. Anything that endangers one’s children becomes very personal very quickly.”
In Michigan, there are certain exemptions that allow parents to have vaccinations waived. Of the 6,184 kindergarten-only immunization waivers in 2014, more than 50 percent cited philosophical reasons for the waiver. Religious reasons are cited in 22 percent of waivers, and medical reasons make up 6 percent of waivers.
“Parents can obtain a medical exemption form from their school or child care center, and it must be signed by a physician stating the medical reason why a vaccine cannot be administered,” explains Swanson. “Nonmedical waivers, attributed to religious or philosophical reasons, can be obtained from the local health department.”
As of January 1, 2015, parents who request to waive vaccinations for their children due to nonmedical reasons have to take an additional step. Under a new rule approved by the Michigan Legislature’s Joint Committee on Administrative Rules, any parent or guardian who wants to claim a nonmedical waiver will need to receive education regarding the benefits of vaccination and the risks of disease from a local health department before obtaining the certified nonmedical waiver form.
There are several medical reasons for not vaccinating, although these exemptions are rare, making up only a small portion of those who don’t vaccinate. Allergies, a weak immune system and certain diseases can all prevent a child from being vaccinated. While they cannot be vaccinated themselves, these children rely on their peers to be vaccinated to help protect against the spread of life-threatening diseases.
Most parents with young children in the U.S. have never seen the devastating effects that diseases like polio, measles or whooping cough can have on a family or community. Many think of these as diseases of the past, but as recent outbreaks are showing, they not only still exist, they are quickly on the rise.
According to the Centers for Disease Control, the annual number of people reported to have measles in the U.S. jumped from 37 people in 2004 to 644 people in 2014, a staggering 1,640 percent increase. In 2012, whooping cough affected more than 48,000 people domestically, resulting in 16 infant deaths.
Barriers to vaccinating
Despite jarring outbreak statistics, there are still barriers to improving vaccination rates.
“The cost of vaccinations is a barrier that has recently emerged,” says Peter Pratt, Public Sector Consultants president. Pratt oversees the firm’s health division. “In some cases, insurance is not covering the cost of vaccinations and costs continue to rise.”
There are efforts to help combat the cost of vaccinations for children who aren’t covered. The American Academy of Pediatrics offers free vaccines for children that are Medicaid-eligible, uninsured, underinsured or American Indian or Alaska Native through the Vaccines for Children program.
“One of the most significant barriers to vaccinations is misinformation,” says Pratt. “People need accurate information on the benefits of vaccination and the minor side effects of vaccines. The much more serious risks associated with vaccine-preventable diseases need to become the focus of the conversation, not just in the doctor’s office, but also in our schools, childcare settings and communities.”
Educating parents
To increase immunization education, Dr. Rose Ramirez, family physician and president-elect of the Michigan State Medical Society, suggests requiring vaccination education sessions for parents enrolling their children in school.
“Many times, parents decide to vaccinate their children once they are educated on the potential risks of vaccine-preventable diseases,” says Ramirez.
Besides a few minor common side effects, such as a sore arm or a low-grade fever, research does not point to any health implications of vaccination, according to the CDC. Scientists have consistently debunked the many myths about vaccines being harmful or causing autism, and studies have shown serious side effects to be very rare.
According to infectious disease specialist Dr. Anthony Ognjan, children who don’t receive recommended vaccines are at risk for severe diseases.
“Vaccines give parents the safe, proven power to protect their children from 14 serious diseases before the age of two,” says Ognjan. “When older children are not vaccinated, they are at increased risk for disease.”
Yet, a study of more than 11,000 parents showed nearly 40 percent of parents of children aged 24 to 35 months delayed or refused vaccinations because they “perceived fewer benefits with vaccines.”
What now?
It’s clear there are health, education and social impacts of choosing not to vaccinate, but the numbers of unvaccinated children continue to rise.
A new MALPH project, funded by the Michigan Health Endowment Fund, will work to address those rising numbers.
The goals of the project are to identify and implement new funding models for sustainable immunization action, strengthen collaborative immunization promotion activities, and create systems change that can be replicated throughout Michigan — ultimately leading to higher immunization rates. MALPH intends to pilot the project in two regions, one rural and one urban, and then disseminate successful approaches to other local health jurisdictions in the state.
PSC will be conducting an evaluation of the project to determine the approaches that are most successful and whether immunization rates increase. Jane Powers, vice president in PSC’s health division, is leading the evaluation effort.
“Vaccination is one of the most important methods we have for protecting the health of our children,” Powers says. “This new project has exciting potential to improve immunization rates in Michigan, and we are glad to be a part of it.”