D.C. has still not met its targeted goal for vaccination rates in schools despite significant governmental efforts, including a campaign from the mayor’s office over the summer.
The objective is for the MMR (measles-mumps-rubella) immunization compliance rate to be at least 95 percent. When vaccination coverage drops below 95 percent, the chances of a disease outbreak are more likely. The science and medical community are in agreement on this: Near-universal vaccinations support herd immunity, the idea that when a certain threshold of the community is vaccinated, the spread of a certain disease is limited. Measles, which is highly contagious, needs a higher threshold than other diseases.
According to DC Health data shared with City Desk, as of November 2019, 114 public schools have an average vaccination rate of 90.2 percent; 124 charter schools have an average vaccination rate of 91.2 percent; 52 private schools have an average vaccination rate of 90 percent; and 20 parochial schools have an average vaccination rate of 75 percent.
The rate hasn’t significantly changed since last November. Public, charter, and private school rates were comparable: 91 percent, 90.1 percent, and 90.6 percent, respectively. The vaccination rate at 20 parochial schools, which are supported by a church or parish, actually decreased this year; the compliance rate was 81.3 percent in November 2018.
A national measles outbreak in the spring prompted D.C. leaders to generate more noise about getting kids vaccinated. Last school year, DC Health Director LaQuandra S. Nesbittcalled on school principals to encourage parents to get kids vaccinated. Over the summer, Mayor Muriel Bowser’s office launched its #dontwaitvaccinate campaign, which intended to inform residents about free vaccination services. Bowser even made the issue personal, using her own baby to make the case for vaccines. Despite these efforts, it appears nothing has drastically changed this school year.
While D.C. has not reported a measles case to the CDC in 2019, it’s important to take a preventive approach, particularly in health care, says Anjali Talwalkar, DC Health’s Principal Senior Deputy Director.
“I would like to see this number up,” Talwalkar says, referencing the District’s vaccination rates. “We think about all of the different possibilities, so that informs our approach.”
The possibilities fall into two categories: Kids either aren’t vaccinated or they are but documentation isn’t being submitted to DC Health.
Not being vaccinated can happen for all sorts of reasons, like misinformation around vaccines or lack of access. But as Talwalkar notes, vaccines are free for minors and D.C. has one of the highest health insurance rates in the country. Additionally, immunization compliance rates are similar across the city. People with Medicaid, health insurance designed for low-income people, do not have lower rates.
It’s also just hard to get people to go to the doctor when they aren’t sick.
“I think we see this with a lot of different preventive care and primary care, in the way people live their lives today and how complex everything is and the competing priorities we have,” says Talwalkar. “How do you make it easier to utilize for people or more convenient? Most of our health care centers do provide evening and weekend hours to try to meet that need and help meet people where they are, so that is what we’re hoping is going to make a difference in terms of getting higher utilization.”
Children could also be vaccinated but their information may not have reached DC Health. Information collected on students comes from both providers and schools. There’s at least one immunization point of contact at every school for DC Health. Talwalkar is confident her team’s data is up to date, but there’s always a possibility that something could be missed. A student might transfer from another jurisdiction, for example. This information is critical, particularly if and when there’s an outbreak, so her department can concentrate on supporting the unvaccinated.
“I need that piece of paper,” stresses Talwalkar.
The data piece is very important, says Deputy Mayor for Education Paul Kihn. “The schools themselves have to have up-to-date information.” This doesn’t happen if, for example, a student gets shots at a local pediatrician and a parent does not notify the school. The school needs to have this information to meet compliance.
Overall, Kihn says the city is working to achieve its goal in three ways: educating residents, creating access, and, the big push this year, enforcing compliance. Unless a student obtains a medical or religious exemption, D.C. law requires kids attending a school to be vaccinated. If a student is not in compliance after a 20-day period, they cannot be in the school building.
“After ensuring communication and understanding and the access points and so on, this year, we are focusing on ensuring that all schools understand the requirements of that law, that they got what they need in order to ensure families are compliant,” says Kihn. “We understand there is variability across schools, both in terms of rates of immunization but also in terms of kinds of actions that the schools take.”
Some schools are doing a great job, while others, not so much. There’s a lot of variability across schools, according the data. Gonzaga College High School, a Jesuit all-boys high school in Northwest, has a reported rate of 30.63 percent, for example. But getting uniform compliance across schools presents operational challenges, says Kihn. For one, it requires proper training. There are also needs for flexibility, if, for example, students transfer in mid-year. There are also 152 public school students who have religious exemptions and 32 who have medical exemptions that allow them to be in school without vaccinations, according to a June report in the Washington Post.
“It is actually quite a complicated area. It is not a one-size-fits-all because each school community is unique and in this instance, each child is unique from a compliance perspective,” says Kihn. “What we are focusing on this year is ensuring schools have what they need to address compliance for their own unique communities.”
Ultimately, the health and education departments are working together to try to meet its goal.
“We are certainly in it for the long game and we try to use multiple methods, recognizing that it isn’t going to be a single a single strategy that’s going to get us to where we want to be,” says Talwalkar.