Lawmakers seek changes as school vaccination rates remain low

Melissa Cantrell, a registered nurse with Public Health Dayton & Montgomery County, administers routine immunizations for school to Amandeep Chahal (right) and his brother Harpreet, both juniors at Wayne High School. LISA POWELL / STAFF
Melissa Cantrell, a registered nurse with Public Health Dayton & Montgomery County, administers routine immunizations for school to Amandeep Chahal (right) and his brother Harpreet, both juniors at Wayne High School. LISA POWELL / STAFF

Some parents object to plan that calls for a doctor’s sign off before a parent can opt out.

Ohio lawmakers are considering changes to standardize the way schools collect data on student vaccinations — including requiring that a doctor sign off when a parent wants to opt out — as many schools still struggle to meet state standards for immunizations.

Medical professionals backing the effort say Ohio needs a more streamlined process to ensure health professionals and parents have accurate data on vaccination rates.

But the proposal is already drawing criticism from some parents, who want to protect their ability to choose not to vaccinate without interference from a doctor.

“A person who has a religious exemption, why would they have to go through a doctor?” said Tracy Longman, of Franklin, who advocates against mandatory vaccines.

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Since 2015, this newspaper has exclusively obtained and made publicly available vaccination data on every school in Ohio, including how many students are fully vaccinated against specific diseases.

Schools are required to report that information for all students in kindergarten, seventh and twelfth grades, and for students who enter a new school.

Health officials in some cases said they couldn’t get the same school-level data from the Ohio Department of Health that the newspaper received and they’ve advocated for more transparency.

“You guys were sharing good data that the rest of us couldn’t see,” said Melissa Wervey Arnold, president of the Ohio Chapter of the American Academy of Pediatrics. The data that has been shared is still problematic, she said, because it is self-reported from schools, and many schools collect student vaccination records differently.

“Individual school data is all over the map, and we’re not sure if it’s reliable,” Wervey Arnold said. “We don’t actually know if parents are opting out.”

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House Bill 559, which the AAP is supporting, would create a standardized form that every school in Ohio would use to collect vaccine information from each student at the required grade levels. A health care professional — whether a physician, nurse practitioner or health department nurse — would complete the form to show what vaccines the child has received.

Parents wishing to opt their child out of certain vaccines would still be able to do so for religious or personal beliefs, but they would need a health care professional to fill out the same form, acknowledging that they had a conversation prior to opting out.

The bill also calls for the school-level data collected by the Ohio Department of Health each year to be published online, so that public health officials, stakeholders and parents can know the opt-out rate by school building.

“Currently, the rates of unvaccinated children are unknown, and this prevents public health officials from knowing critical data in case of a disease outbreak,” the Immunization Advocacy Network of Ohio said in a statement. “It also prevents parents of children who cannot be vaccinated because of allergies or other compromised medical issues, from knowing the potential for exposure.”

The network said the bill, sponsored by State Reps. Anne Gonzales, R-Westerville, and Al Landis, R-Dover, calls for a streamlined process that does not prevent parents from opting out, nor does it disclose individual student vaccine status or private information.

SEARCH: How many kids are vaccinated at your child’s school?

“Ohio’s children’s hospitals fully support House Bill 559, as it provides a mechanism to capture accurate, verified data on immunization rates,” said Sarah Kincaid, director of public policy for the Ohio Children’s Hospital Association.

Wervey Arnold said doctors will provide information to parents, but will not pressure them.

Parents want freedom to choose

Advocates for parental choice when it comes to vaccines have concerns about requiring a signed form from a doctor.

Longman said she went along with all the recommended vaccinations when her now 21-year-old daughter was a student, but later began researching the pharmaceutical industry when her mother got cancer.

“It just kind of led me to looking at the vaccine debate,” she said. “I was shocked.”

One of her concerns is that doctors willing to check the opt-out box for families will feel pressured by the medical community to stop doing so.

“It puts doctors who want to honor a patient’s decision… it puts a target on their back,” Longman said. She pointed to California, which in 2016 outlawed personal belief exemptions and only allows students to forgo vaccines if there is a medical necessity.

California doctors were assured by lawmakers that they’d be able to use their discretion in granting medical exemptions, but some have felt pressured to deny such exemptions to families, Longman said.

Longman said she just wants parents in Ohio to have a choice as to whether to vaccinate and for that choice to be unfettered by intervention from the medical community.

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“People aren’t getting both sides, the good and the bad,” she said. “The vaccine compensation program has paid out over $4 billion dollars… that’s a lot of injured people and deaths.”

The National Vaccine Injury Compensation Program allows individuals to file a petition for compensation if they or a loved one suffered injury or death from an adverse reaction to a vaccine.

To date, total compensation paid over the life of the program is approximately $3.8 billion. For every 1 million doses of vaccine that are distributed in the U.S., approximately one individual is compensated for an injury or death, according to VICP and CDC data.

Local schools fall short of standards

Health officials say when large numbers of people start forgoing vaccines, it puts an entire community at risk because some individuals can’t get vaccinated. Very young children and people with immune disorders rely on an immunized public to create a buffer between them and sick people, which doctors call “herd immunity.”

The percentage of the public that needs to be immune for the safety net to work varies based on the disease, but in general, health officials put it above 90 percent.

Each year of this newspaper’s examination, hundreds of Ohio schools have fallen short of that target. By law, students without records of vaccination or an opt-out are supposed to be excluded from school, but that rarely if ever happens.

Those who opt out aren’t the big driver of low vaccination rates, the data shows, but rather those who have incomplete records or fail to turn in anything to their schools.

Cincinnati City Schools remained the worst district in the state this school year with 24 school buildings where more than half the incoming kindergartners had incomplete immunization records.

Clark Preparatory Academy in Springfield had the highest incomplete rate of any school in the Dayton-Springfield region with 53 percent of incoming kindergartners incomplete. School administrators did not return a call for comment by deadline.

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Russia Elementary School in Shelby County had the highest opt-out rate of any school in the region this year at 31 percent.

Russia Local School Superintendent Steve Rose said he is aware of the high opt-out rate and said there have been some complaints from other parents worried about an outbreak.

“I respect parents and the choices they make,” he said.

Some districts have turned around high opt-out rates from past years.

Mills Lawn Elementary in Yellow Springs had a kindergarten opt-out rate of about 30 percent during the 2014-15 school year, the highest of any school in the state. The district since has engaged parents in conversations on the topic, and this year's rate dropped to 19 percent.

“We tried to intentionally make some time to have some discussions with our community and our families,” Superintendent Mario Basora said. “We make sure we get feedback one way or another so we know where folks are.”

From 2015: Epidemic fears follow parents’ refusal to vaccinate

From 2016: Low vaccination rates in schools concern health officials

From 2017: Ohio struggling to get students vaccinated