The number of Granite State students up to date on the many vaccines the state mandates for school attendance is going in the wrong direction, health experts say. The trend is also happening nationwide, the Centers for Disease Control and Prevention reported earlier this month.
Experts say even a small drop in vaccination rates, which New Hampshire has seen, increases the risk of the spread of communicable diseases in a school and beyond. For measles specifically, the CDC said the nation’s 93.5% vaccination rate among kindergarteners still puts 250,000 of their peers at risk of being infected.
Vaccine skepticism, which has hampered uptake of the COVID-19 vaccine, plays a role, but is not the driver, health experts have said. Nor did religious exemptions, which so dominated legislative debates last session that lawmakers made it easier for parents to obtain an exemption.
Religious exemptions for all students have dropped since the 2019-20 school year, when 2.5% of parents requested one, to 1% this year, according to the Department of Health and Human Services. (The COVID-19 vaccine fueled the change in exemption requests, but is not required to attend schools and daycares.)
Dr. Erik Shessler, chairman of general pediatrics and associate medical director of Dartmouth Health Children’s and vice president of the New Hampshire chapter of the American Academy of Pediatrics, says two other culprits are responsible for the drop in vaccination rates. : Staffing shortages and the pandemic have made it harder for children to get their annual physical exam, where providers update vaccines and check a child’s overall mental and physical health. And some families don’t prioritize postponing those missed visits.
“One of the things we’ve had to do in the state and across the country is a bit of that cheerleader again, saying, ‘No, not having your regular physique is a big deal,'” Shessler said. “Like any type of pandemic or disaster, people expected the sky to fall, and when the sky didn’t fall it was, ‘Well, I’m going to get back to that, but not right away. I’ll get there when I get there.’ “
Shessler and other public health experts are urging parents to reschedule missed appointments as soon as possible. But they warn it won’t immediately reverse falling vaccination rates as providers face rising flu and RSV cases while trying to reschedule adults and children who have delayed care during the pandemic. .
“We’re behind and so you add their delay plus our delay, and you end up falling behind with vaccines,” Shessler said.
State law requires children to have several vaccinations to attend a private or public school or daycare: diphtheria, mumps, pertussis, polio, rubella, measles, and tetanus. The Department of Health and Human Services, which can also prescribe vaccines, requires vaccinations against hepatitis B and chickenpox, as well as a vaccine that protects against meningitis, epiglottitis and pneumonia.
The department would lose its authority to mandate vaccines under Bill 557, which would only allow lawmakers to make changes. Sponsor representative Jim Kofalt of Wilton said that although the department has been “very limited” in adding new vaccines, he is concerned that a future health and human services commissioner will add all recommended vaccines. by the CDC or the COVID-19 vaccine.
“It should be something the Legislative Assembly decides and not who runs the agency,” he said.
Laura Montenegro, spokeswoman for Health and Human Services, said the percentage of students in public and private schools who are up to date on mandatory vaccines has risen from 95 to 93 percent. Vaccination rates have tended to be 2 to 4 percent lower among private school students, according to department records. Private school students also have higher rates of religious exemptions. Last school year, the most recent period available, 4% of students were exempted from mandatory vaccinations for religious reasons, double the number of public school students.
Outside the world of public health, a two percentage point drop may seem minor, especially when rates remain above 90%. But for some vaccines, a drop below a rate in the high 80s risks that herd immunity, public health experts say, is needed to prevent an outbreak.
“We don’t want to lose our fantastic immunization rates in the state and now all of a sudden we have to deal with outbreaks of measles or whooping cough and getting a lot of babies into the hospital,” said Shessler.
Measles was declared “eliminated” in the United States in 2000 thanks to high vaccination rates, according to the CDC. This is no longer true.
In 2019, 1,274 cases were reported. The number dropped during the pandemic, when people masked up and social distancing, but rose again, from 49 in 2021 to 121 cases last year. A November measles outbreak in Ohio infected 85 college students, 72 of whom had not received the combined mumps-measles-rubella vaccine.
“It’s about putting the community into perspective,” said Ryan Tannian, chief of the Department of Health and Human Services’ Office of Infectious Disease Control. “We have seen examples across the country where there have been outbreaks of vaccine-preventable diseases. And, you know, our goal is to keep kids in school and not have to close a school because of a vaccine-preventable disease.
Tannian said schools across the state had to close due to outbreaks of the flu, a disease with no required vaccine in New Hampshire. It has not reported disease outbreaks with mandatory vaccines, he said.
Like Shessler, Tannian said declining childhood immunization rates have expanded the department’s immunization reach beyond helping communities by making vaccines readily available at local schools or clinics.
“We’re trying to make sure people choose to have their children vaccinated,” Tannian said. “And then, in the meantime, we want to make sure that anyone who may have missed, or didn’t have access, or couldn’t get those routine vaccines catches up and gets up to speed.”
Henniker’s Hali Wilkins is not among those who missed the chance to have her 3-year-old daughter, Jovie, vaccinated. She and her husband chose not to vaccinate her.
Wilkins’ opposition to all vaccines began with a miscarriage that had nothing to do with vaccines. Instead, Wilkins began to question all medical recommendations, including vaccination, after concluding that an internal ultrasound had killed her baby several weeks into her pregnancy.
Prior to her second pregnancy with Jovie, Wilkins and her husband, Cody, discussed postponing recommended childhood vaccines. They finally decided to give up all vaccinations. She has shared her research with others through Facebook groups and her business, Jovial Birth and Postpartum Services, which focuses on natural childbirth and care.
“The day I had (my daughter) I just looked at her and thought, ‘Whoa, I could never let anyone inject her with anything if I risked hurting her or kill her,” Wilkins said. “So I was like, let’s sit down and watch each blow and what it’s supposed to, in quotes, protect against.”
None, they decided, were worth the risk for Jovie and their second baby on the way.
Shessler and Tannian said it’s impossible to know how many parents choose not to vaccinate their children because of vaccine-related health issues or religious objections.
“There is a large population that does all the vaccines that we could give. There’s a small, noisy population that doesn’t do any of the vaccines,” Shessler said. “And then there’s a big chunk in the middle where you’ll hear the term ‘vaccination hesitancy’. We’re trying to move people from one side of that spectrum to the other to improve their vaccination confidence. And have a reliable source for this information is extremely important.
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