Why did more Utah kindergarteners get vaccine exemptions last year?

Vaccine exemptions for Utah kindergartners were up last school year, but a top state immunization official says he doesn’t believe parents are more reluctant to get their children the shots required to enter school despite the politics surrounding COVID-19.

“You’re really not seeing the sky is falling. Because it’s not,” Rich Lakin, immunization director for the Utah Department of Health and Human Services, said, describing the waivers for the list of required vaccines that does not include COVID-19 as “in no way” indicating parents are opposed to getting their children vaccinated.

“Some of these, we know that they are claimed just so they can get their kids in school. They’re not against vaccinations. They just don’t have the time to get to their physician,” Lakin said. “They just need to get their kid enrolled in school. So the easiest process is just to hurry and claim an exemption and get their child enrolled.”

That reason became more prevalent because of the pandemic, when many people postponed routine medical care for themselves and their families, he said. With schools shifting to online learning, Lakin said parents likely felt there was little reason to worry about getting the shots.

For him, the real test of whether there’s an ongoing issue with Utah kids getting their needed vaccines before starting kindergarten will come this school year. Although the COVID-19 pandemic isn’t over, much has returned to normal for many students and their parents.

“It will probably give us a better reflection of what our exemption rates are going to be like — are they going to increase? Are they going to decrease? But again, they haven’t really increased significantly,” Lakin said. “From my perspective, the bottom line is, from 2020 to 2021, school years were extremely abnormal.”

The pandemic is to blame for “some disturbance in how it reflected on the school vaccination data that we received. That was a very troubling time that the whole country, the whole world went through, and Utah went through,” he said. “We do look forward to collecting new data in the new school year.”

‘That is scary’

Dr. David Cope, a family medicine doctor in Bountiful, was alarmed by the latest increase because of the potential impact on what’s known as herd immunity, ensuring enough people are vaccinated against a disease to prevent it from spreading.

“Oh, that is scary,” Cope said after reviewing the numbers Laking provided for the 2021-2022 school year. “The rate required for herd immunity varies for each vaccine, but there are several of these that are approaching those minimal levels.”

But Cope also said he believes vaccinations are headed back up as parents return to routines like regular well-child visits, where they can get their questions answered about the various required vaccines and be counseled about the need to stay up to date on their children’s shots.

During the worst of the pandemic, “it was very difficult and those numbers were pretty astounding,” he said of the drop he saw in routine checkups for children. “That took a while to rebound,” the doctor said. “It’s just happening now.”

The doctor agreed that because of COVID-19, parents “just didn’t see the need, didn’t have the motivation or momentum” to get their children the required shots to enter school, noting that “getting exemptions is easier than ever” and can be done from a phone.

Cope does believe the political backlash against COVID-19 vaccines has had an impact on how parents view all vaccines. But he said they’ll still get their children the required vaccinations if they have the opportunity to sit down and talk over their concerns with a trusted expert.

What happened last school year

What the numbers show is that statewide, kindergarten exemptions rose less than one percentage point from the previous school year, from 5% of students to just under 6%. That’s only slightly more than the pre-pandemic 2018-2019 school year, he pointed out.

But some parts of the state saw bigger jumps in kindergarten exemptions, according to a breakout of state data by local health departments. The biggest percentage of exemptions in the past school year, just over 12%, are in Southwest Utah Public Health Department, which serves Washington, Beaver, Iron, Garfield and Kane counties.

Kindergarten exemptions in the region, which includes St. George, had hovered close to 10% in the 2018-2019 and 2019-2020 school years before dropping down to just over 8% in the 2020-2021 school year. Tooele County experienced a similarly sized surge, from 3% in the 2020-2021 school year to nearly 7% this past school year.

Exemptions are higher in some of the more conservative parts of the state, where fewer Utahns, including school-age children, have gotten their COVID-19 shots, but Laking said he doesn’t see a connection to the politics surrounding COVID-19 vaccinations, which are not required to attend school in Utah.

“We don’t see that as a political issue,” Lakin said of the exemption increases. “COVID is a different disease. You can’t really compare that with the rest of the vaccine-preventable diseases,” he said, since many parents don’t feel their children face the same risk from the coronavirus that they do from other childhood diseases.

COVID-19 does hit older adults and the medically frail the hardest, but it remains a risk to children.

There have been seven deaths and more than 1,200 hospitalizations of children 1 to 14 years old in Utah from the coronavirus since the pandemic began in March 2020, according to the most recent information from the state. Another 453 infants under 1 year old in Utah have also required hospitalization for COVID-19.

And although COVID-19 vaccines are now available for infants as young as 6 months old, the ability of the coronavirus to mutate into ever more transmissible strains means immunity from previous infections or vaccines may not be as protective.

Boosting herd immunity

The vaccines required for school, however, not only keep kids from catching diseases but also can stop their spread once there’s a high enough level of immunity. Lakin said public health officials shoot for a 94% vaccination rate because that’s the minimum for keeping the most contagious disease, measles, from spreading.

But for the 2021-22 school year, half of the state’s 14 local health departments were above 6% for exemptions for the the list of needed vaccines for kindergarteners — measles, mumps, rubella, diphtheria, tetanus, whooping cough, hepatitis A and B, chickenpox and polio.

Lakin said the vaccine exemption rate needs a boost to keep those diseases from returning, especially as diseases like polio are once again spreading in the United States after the nation’s first case in nearly a decade turned up in an unvaccinated adult near New York City.

“It’s important that the Utah Department of Health and Human Services and the immunization program, that we should continue to find new and improved ways to communicate with parents and really stress the importance of vaccinating their students,” he said, adding, “We want to make sure everybody is vaccinated and protected.”

Given the size of the increases in vaccination exemptions in some parts of the state last school year, Utah may have avoided an increase in preventable childhood diseases because many people were still taking pandemic precautions, Lakin said.

If places in the state continue to fall short of herd immunity, outbreaks may now be more likely, he said.

“We’re coming down off the pandemic, where people are socializing more and getting closer together, and traveling more. So the potential is there, yes,” Lakin said, unlike last school year, when more Utahns were wearing masks and social distancing.

Ben B. Braun, Deseret News

Opening a ‘Pandora’s box’

Parents do require more reassurance about vaccines because of what they’ve heard about the COVID-19 shots, Cope said.

“I’ve spent more time talking about things with parents,” the doctor said. “It’s been an interesting time, where they were worried about COVID vaccine, and how they extrapolate those concerns and fears to the other vaccines that have been around for a while.”

Most parents, he said, “realize after a discussion that that’s OK and they go ahead and get them. I haven’t had people say, ‘No, I’m not going to get them.’ I think there’s been quite a bit of that for the COVID vaccine itself. But for the other ones … the numbers in my practice have not gone down significantly.”

So what is it about the COVID-19 vaccine that makes parents question shots that children have been getting for years?

“You’ve opened a Pandora’s box. I spend a lot of my time talking about that with parents and why they’re fearful. I think the politics play into it and it’s on both sides,” Cope said, among both conservatives and liberals, and Republicans and Democrats.

Parents “feel like they’re being told to do something and don’t want to do something just because they’re told to,” he said, comparing the reaction to the COVID-19 vaccine to what happened when an HPV vaccine was introduced for young people.

The COVID-19 vaccine is also “new and it’s novel. It’s the same thing we went through when the Gardasil vaccine came out years ago. For a while, it was really dissed on and a lot of hesitancy for. it. Now, it’s much better accepted,” Cope said

Something new does spark discussions about vaccines in general, he said, but in his experience, parents are willing to go ahead and let their children get the necessary shots for school once they “realize, ‘That’s OK. We’ve done it before.’”