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Health director: Arizona kids vax policy not working


PHOENIX — An increasing number of vaccine deniers, coupled with one of the easiest opt-out provisions in the nation, has left Arizona with close to one out of every 10 kindergartners unprotected against key childhood diseases.

That’s causing concerns from the state’s top health official.

“The measles MMR vaccine is highly effective,” said Don Herrington, interim director of the state Department of Health Services.

The same vaccine, properly administered, also protects against mumps and rubella. And he said a high vaccination rate is the best way to prevent an outbreak among those who can’ be vaccinated due to medical or religious reasons, or simply because they’re too young.

Yet during the last school year, the most recent data available, only 90.6% of Arizona kindergartners actually got the MMR vaccine, Herrington said, “well short of the 95% threshold considered necessary to prevent localized outbreaks.”

The result are those outbreaks, like three new cases of measles earlier this month in Maricopa County, including an adult and two minors, all unvaccinated. One had to be hospitalized.

And Herrington said these are not innocuous diseases

“Measles, in particular, you can have loss of hearing,” he told Capitol Media Services.

“It can affect their intellectual development,” Herrington continued. “You can have brain swelling. It's killed people.”

But of particular concern are the increasing number of parents who are claiming a “personal exemption” from the requirement that children attending school be vaccinated against not just measles, mumps and rubella but a host of other diseases. More to the point, they need not provide any reason at all.

The result is that 6.6% of kindergartners in school statewide have a personal exemption for one or more vaccines.

And that only paints part of the picture.

The opt-out rate exceeds 10% in Mohave County and 11% in Gila County. And close to one child out of every seven in Yavapai County has a personal exemption for one or more mandated vaccines.

“It’s insidious,” said Will Humble, the executive director of the Arizona Public Health Association of the decline in childhood immunizations in the state, with the rate dropping about a half percent a year for the past decade.

“That might not sound like a lot,” he said. “But if you start looking at a 10-year period, now you're looking at a loss of 5%.”

Hence, the 90.6% coverage rate -- and that trend line moving ever lower.

Herrington said there’s only so much he can do.

According to the National Conference of State Legislatures, Arizona is one of only 14 states that has a personal exemption. And Gov. Doug Ducey, who has seen the personal opt-out rate for kindergarten-required vaccinations rise from 1.4% in 2000 to 6.6% now, has shown no interest in asking lawmakers to eliminate that privilege.

That's not a new attitude for the lame-duck governor.

“Ultimately, decisions are going to be left to parents,” he said in 2019 when the opt-out rate hit 5.4%.

That was after California, facing a measles outbreak at Disneyland, eliminated the personal exemption. And the same week that Ducey declared his support for parental opt out, Washington Gov. Jay Inslee signed legislation saying parents could not use personal or philosophical exemptions and still send their children to school.

Ducey press aide CJ. Karamargin said Wednesday the governor's attitudes have not changed since then.

But Humble said Herrington’s agency is not entirely powerless even if Arizona keeps it personal exemption.

He pointed out the department worked directly with state Sen. Heather Carter to create a pilot program in 2018 to provide educational materials to parents seeking to opt out of one or more vaccines. The idea was to show the benefits outweigh any risks.

But the effort was scrapped after complaints from some parents who feared they would have to take the course to get the personal exemption, something that was not true.

Humble, who was health director before Ducey took office, said the agency should revisit the plan.

All that is based on his view that there's a direct link between vaccine acceptance and education and the related issue of income, one he said was borne out by a study the University of Arizona did for the health department a year ago.

“The lower income families, when their pediatrician says something, they believe it. It’s ‘the doctor recommended this, so this is what I’m going to do,’” Humble said.

And those with higher income and more education?

“You get people who think they know more than the doctor knows,” he said. “So I guess it's hubris when you think you're smarter than you really are about things and question the physician's recommendations and therefore decide on your own not to vaccinate, either based on what your friends are saying in the friend group or what you’re reading on Facebook or whatever those sources of bad information are.”

Herrington, however, said he's not prepared to have that fight again.

“I think it really was like a line in the sand for some people,” he said of the reaction to the 2018 pilot program. “We meant it to be very informative ... so that we could inform people of the drastic consequences of not being vaccinated.”

But he said that’s not the way it came across.

“I think some folks felt that we were trying to scare people, which, of course, we weren't,” Herrington said. So rather than push ahead, he said, “We just rethought it and discontinued it.”

What's left in his toolbox, he said, are press releases, blog posts and media interviews, all with the goal of explaining to people about the benefits of the MMR vaccine -- and why it's not like others that some see no reason to take.

“People read that COVID vaccines might prevent half of cases,'' Herrington said. “Flu might prevent 60%.”

“But that measles, mumps and rubella vaccine, if you get both doses in the right sequence, timing I mean, it's 97% effective,” he said. “And I think that's going to have to be a lot of our messaging is that don’t associate all vaccines with that of the flu vaccine or with the COVID vaccine.”