Hesitancy regarding the COVID-19 vaccine rollout last year coincided with an increasing number of parents filing moral or religious exemptions to their children entering kindergarten with established, required vaccines against diseases like measles and polio, a Dayton Daily News investigation found.
At 14 elementary schools in the region, at least 10% of kindergarteners’ parents or guardians opted them out of getting required vaccines due to religious or moral objections during the 2021-2022 school year, according to new data from the Ohio Department of Health analyzed by the Dayton Daily News.
The increases exceed state averages, and are more than those districts saw prior to the pandemic.
How many kids have vaccine exemptions at your kid’s school? Search the data
“Vaccine hesitancy has been on the rise since even before COVID, and I think it’s even worse now,” said Dr. Sara Paton, an associate professor of epidemiology at Wright State University’s Boonshoft School of Medicine.
Heidi Shaw, president of the Ohio Association of School Nurses, said she has seen more vaccine hesitancy from parents and guardians.
“When this occurs, I like to make sure that I have established a safe space for families to share their worries while also making sure I am providing them with the most factual information,” Shaw said. “I have found that a lot of the concern is rooted in misinformation.”
The Dayton Daily News reached out to local schools, health departments, and other experts about the trend of vaccine hesitancy, potential consequences such as the resurgence of once-rare diseases, and how school districts can communicate with families about vaccines.
Schools where at least 10% of parents exempted their kindergarteners from vaccines on moral or religious grounds include three each in Montgomery and Clark counties; two each in Miami and Darke counties; and one each in Butler, Champaign, Greene and Preble counties.
There were only five schools over that threshold the year before.
Statewide, the percentage of students with moral or religious exemptions climbed from 2.4% to 3.2%.
“I think it’s very concerning,” said Megan Setser, a mom from Huber Heights who is in favor of vaccines.
Setser said her opinion on vaccines did not changed due to COVID, but other parents interviewed said the pandemic did have an impact on their opinion about vaccines.
‘Growing national trend’
The COVID-19 vaccine is not legally required to attend school. Ohio law requires students entering kindergarten to be vaccinated against diphtheria, tetanus and pertussis, polio, measles, mumps, rubella, hepatitis B, and chickenpox. Most of these involve multiple doses. There are additional booster and vaccination requirements for grades 7 and 12.
The law permits religious, moral, and/or medical exemptions to these requirements. Parents or guardians have to submit written statements that the student will not be immunized for religious or reason of conscience exemptions. If it is a medical exemption, a physician also needs to provide certification of that decision.
The two elementary schools with the largest increase in students whose parents filed moral or religious exemptions are in the Springfield City School District.
At Perrin Woods Elementary School, 17.5% of kindergartners had moral exemptions in the 2021-2022 school year, up from 3.8% the prior school year. At Fulton Elementary School, 11.3% of kindergarteners had moral exemptions in the 2021-2022 school year. The school had no exemptions in the 2020-2021 school year and wasn’t above 5% in the three years before that.
“There has been a growing national trend of vaccine distrust that resulted from the rollout of the COVID-19 vaccines. More and more parents are directly correlating their beliefs about COVID-19 vaccines with routine childhood vaccinations, such as polio or rubella,” said Springfield schools spokeswoman Jenna Leinasars. “It is evident that Springfield is following this wider trend.”
The district reached out to families through letters and phone calls regarding the required vaccinations, she said. The district also offered vaccination appointments at its school-based health care center at the School of Innovation every Tuesday during summer break.
The percentage of kindergarteners statewide with all required vaccines actually increased last year by less than 1% to 88.2%. The Dayton Daily News reported earlier this year that vaccination rates dropped in 2020-2021, largely because of access issues and school staffing shortages during the height of the pandemic.
This means as schools and health care workers address the problem of parents unable to get their kids vaccinated, they are faced with a growing number unwilling to get them vaccinated.
“Absolutely we have concerns regarding this,” said Charles Patterson, health commissioner with the Clark County Combined Health District.
“We have seen an uptick in pertussis, mumps, measles, and other vaccine-preventable diseases across Ohio. Now, there is even more concern as polio has been found in New York state, which is not that far from Ohio,” he said. “Many people have never experienced or seen the devastating effects of some of these vaccine-preventable diseases and therefore don’t always make a well informed decision about the possible consequences of declining to have their children vaccinated.”
Other area schools
At Mayfield Elementary in Middletown, the percentage of students who were opted out of getting the required vaccinations due to religious and/or moral objections was 10.5% for the 2021-2022 school year. There were none the year before and no more than 4% any year back through 2017-2018.
A Middletown district spokesperson said that since the beginning of the pandemic the district has seen an increase in immunization exemptions overall, not just at Mayfield Elementary.
Middletown school officials say this year, Mayfield’s exemption rate has gone down to 5.2% and they noted that number can vary from year to year and month to month as students move to/from different buildings/districts. The district said its nurses work hard to obtain immunization records for students, provide education on the importance and benefits of vaccinating their students, and help families connect with providers of vaccines and overcome obstacles to getting their children immunized.
“Like many other districts, Warren County Health District (WCHD) has experienced hesitancy from parents in deciding to get their child the COVID-19 vaccine,” said Allison Combs, WCHD public information officer. “We are continuing to work in our clinic to get children up to date with the recommended vaccine schedule, which was impacted by the COVID-19 pandemic.”
“Parents are being compliant with the recommended/school required vaccines, but they are more hesitant on the optional recommendations such as hepatitis A, HPV, and meningococcal B,” Combs said.
Kettering City Schools and Valley View Local Schools both had schools with exemption rates over 10%. Kettering schools officials did not respond to requests for comment. Valley View officials declined to comment.
Big increase in rural communities
The seven school districts with district-wide kindergarten vaccine exemption rates over 10% all serve rural areas.
COVID-19 vaccinations have also nationally been lower in rural areas compared to urban areas with 48% in rural areas versus 61% in metropolitan areas, according to the U.S. Department of Agriculture. The Department of Agriculture noted this difference may have left residents in counties with lower vaccination rates more vulnerable to the Delta variant of coronavirus, which emerged in July 2021.
In Miami County, Newton Elementary School saw a decrease in the percentage of students opted out of immunizations, going from 25.5% in the 2020-2021 school year to 19.7% in the 2021-2022 school year. This is still one of the highest in the region.
Covington Elementary School, also in Miami County, has also fluctuated over the past few school years, exceeding 11% in the 2017-2018 school year before going down and then back up again to 10% in the 2021-2022 school year.
David Larson, superintendent of the Miami County Educational Service Center, discussed the balancing act of seeking the required immunizations but also giving parents the space to make decisions for their families.
“It’s an interesting topic for us to engage in as schools because it’s an additional responsibility that we didn’t necessarily sign up for, and so the challenge comes in where we have to police these decisions that parents are making, and then how that impacts our relationships with families,” Larson said.
“I think we have to be very mindful as school leaders that we can enforce regulations that we’re instructed to enforce, but also make sure parents understand that we respect their rights to make decisions about their kids, and for that matter, respect students’ rights to make decisions when they’re at an age that’s appropriate for them to make decisions on any topic.”
Yellow Springs schools has seen vaccine exemption rates fall steadily since the Dayton Daily News reported that its exemption rate was one of the highest in Ohio. It dropped from 19% in the 2017-2018 school year at Mills Lawn, the village’s only elementary school, to zero kindergarteners with moral exemptions last year.
‘Have open dialogue’
Even prior to the pandemic, the World Health Organization listed vaccine hesitancy as one of the top 10 threats to global health in 2019. The WHO noted a 30% increase in measles cases globally and that countries that were close to eliminating the disease have seen a resurgence.
“It has been escalating, it has been going up,” Paton said about vaccine hesitancy. “It’s actually been a really big concern.”
In order to achieve herd immunity, which is the resistance to the spread of contagious diseases due to a pre-existing immunity a portion of a population has, there needs to be higher percentages of the population immunized against diseases that spread more easily. To prevent the spread of polio, Paton said you need around 80% of the population to be immunized against it. For the measles, though, it needs to be around 95%.
“It’s easily transmissible,” Paton said.
Health departments are working with families to fill in vaccination gaps.
“We work closely with all school districts, especially Springfield City, as well as Rocking Horse Community Health Center to ensure that parents that want to have their children vaccinated have a clear avenue to reach those goals,” Patterson said.
“We’re doing outreach for our children who maybe need to get caught up on vaccines,” said Jennifer Wentzel, Montgomery County health commissioner with Public Health - Dayton and Montgomery County. “We have open walk-in hours, and those have been a huge success.”
Health officials and educators recommend districts keep lines of communication open with parents and guardians when it comes to vaccinations.
“What I would recommend is districts have open dialogue with parents, and make sure they are providing opportunity for families to share what their concerns are, share their beliefs,” Larson said. “I think it’s an opportunity for good, meaningful discussion, which I think can build strong relationships with our parents and families and communities.”
Creating environments for positive conversations are important, Larson said, especially when individuals are divided.
“If you look at the last few years, people in general I think have just become very defensive and maybe feel as though their opinions aren’t appreciated or respected,” Larson said. “We can disagree about something or recommend a different direction and still be respectful.”
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