Arizona vaccine education course for parents could be revived next school year

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A vaccine education program for parents, canceled by the state of Arizona in August, could be revived.

The Arizona Department of Health Services confirmed it is working to develop a redesigned program to address falling immunization coverage among schoolchildren in the state.

The revamped immunization education program is expected to launch in the 2019-2020 academic year, the state health department said in a statement.

The Maricopa County Health Department is partnering with the state to recruit schools for the pilot program, and so far feedback from schools has been positive, county health officials said.

Original course lasted one school year

The online pilot vaccine education course was active in 16 Maricopa County schools last academic year. It was created in response to a rising number of Arizona children skipping school-required immunizations against diseases such as measles, mumps and whooping cough.

State health officials say a redesigned pilot program will ideally include more schools — 125 statewide, which should allow them to better determine whether the course is an effective strategy for increasing vaccination rates than the first pilot did.

The Arizona Department of Health Services canceled the optional vaccine education course the day before the Governor’s Regulatory Review Council, GRRC, was scheduled to vote on a separate set of health department rules concerning vaccinations and six days after the council questioned state health officials about the course. It had received negative feedback from parents, including some who don’t vaccinate their children.

While the pilot course was not part of the rules under consideration by the GRRC on Aug. 7, parents, individuals and families nonetheless reached out to the council to indicate their displeasure with it.

The parents were under the impression that the course was going to become mandatory. Many parents said they objected to being forced to watch a 60- to 90-minute science-based educational video. Nearly all were critical of additional steps associated with getting non-medical exemptions to vaccine requirements, whether that required watching a video or something else.

The state health department canceled the course Aug. 6. The department’s vaccination rules were approved by the GRRC the next day.

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After The Arizona Republic published a story on Oct. 18 about the course’s cancellation, members of Arizona’s Senate and House Democratic caucuses, the Pima County Medical Society and a group of 133 female physicians from across the country wrote letters to Gov. Doug Ducey asking that the course be reinstated in the interest of public health.

“Universal vaccination of school children to preserve ‘herd immunity’ to infections diseases is broadly supported within the community of public health professionals,” the letter from the Senate and House Democratic caucuses says. “We should be expanding the pilot rather than eliminating it altogether.”

Asked to comment, a Ducey spokesman referred to recent statements the governor has made on school vaccinations, including a video interview he did with The Republicon Oct. 25. He said that while he’s a big believer in freedom and choice, “If your kid’s going to be in the public school system in Arizona, they’re going to be vaccinated.”

‘Statistically significant data’

The online vaccine education pilot program was built by several groups in Arizona over several years, including school administrators, physicians, and state and county health officials, with the aim of improving immunization rates.

The Arizona Department of Health Services said when the program relaunches, the larger number of participating schools should provide the state with “statistically significant data to determine if this strategy will increase vaccine rates to protect children throughout Arizona.”

The health department is working with focus groups, interested parties and schools on the program, officials said.

State health department director Dr. Cara Christ wrote a blog item on Oct. 23 that said the first pilot course did not yield anticipated results in eight of the schools.

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“This very small test did not show any significant change in vaccine exemptions in the eight participating elementary schools, the only school types for which ADHS has data,” she wrote. “This data, combined with partner feedback and a review of rules/statutes, resulted in our decision to discontinue and re-evaluate the pilot program.”

An Oct. 30 policy update from the Arizona Public Health Association executive director Will Humble said the pilot never was designed as a formal study and therefore it was not possible to draw any conclusions about whether it was effective.

Not only did the pilot last just one academic year at a small number of schools, the schools that did participate did so voluntarily, he wrote, calling the course a “promising intervention.”

Immunization rates fall; concern rises

The bottom line, some Arizona public health officials say, is that despite Arizona’s work to date on improving immunization rates among schoolchildren, vaccination rates continue to decline.

“Additional interventions are clearly needed. Perhaps the educational modules will help,” Humble wrote. “But it may be that the only real solution is to look to other states that have eliminated the personal exemption. California provides a promising case study.”

Arizona is one of 18 states that allows “personal belief” exemptions that permit parents to exempt their children from school-required immunizations.

California used to allow such exemptions, too. But a law that took effect in 2016 mandates all California children attending school or childcare facilities be fully immunized unless they have a signed medical exemption from a physician.

After the California law went into effect, immunization rates went up, though a recent  study published in the journal Pediatrics showed that when personal belief exemptions disappeared, the number of medical exemptions rose slightly.

Vaccine exemption ‘hot spot’

State health data for the 2017-2018 academic year shows that for a second year in a row, the percentage of Arizona students exempt from one or more vaccines increased across all age categories.

When too many kids skip getting vaccinated, schools and communities lose what’s known as “herd immunity.” Without herd immunity, disease spreads more easily. Babies too young to be immunized and people with compromised immune systems — those with chronic diseases or undergoing chemotherapy for cancer, for example — are most vulnerable to the loss of the collective protection of the herd.

Kindergartners in Maricopa County as a whole were below herd immunity for measles during the last academic year.

 A study published in the medical journal PLOS Medicine in June found that as a social movement of public health vaccine opposition has been growing in the United States, measles outbreaks also have increased. The study identified Phoenix as a “hot spot” area in the U.S. for its large number of parents who seek non-medical vaccine exemptions for their school-age children.

The public health message that local, state and national public health agencies consistently convey about immunizations is that childhood vaccinations are far safer than the diseases they prevent.

“The Arizona Partnership for Immunization acknowledges the need for vaccine education as a strategy to protect our community immunity. We never doubted that the Arizona Department of Health Services would continue to search for effective ways to provide that education,” said Debbie McCune Davis, executive director of the immunization partnership, which helped develop the online course.

“We support their efforts and will continue to work with our community partners to provide medically valid information and create sound public policy around the use of vaccines as a public health strategy.”

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