New data showing the percentage of Oklahoma kindergarteners who are up to date on all required vaccines is missing about 7,870 students because their schools did not submit the information.
Each year the State Department of Health conducts a survey of vaccination coverage and exemption rates for children enrolled in public and private kindergarten programs. It uses the data to develop public health policy.
Participation in this year’s survey was down by 70 schools, with four in five schools responding.
“Our numbers would have been considerably lower if not for the State Department of Education encouraging schools to participate,” said Kellie Clark, the health department’s immunization nurse manager.
“We had been trending up in participation, but considering the challenges related to the pandemic we feel good about the numbers.”
When schools shut down in March, the survey was not their priority, she said.
While the survey is voluntary for schools, the health department is required to submit the results to the Centers for Disease Control and Prevention for inclusion in the national kindergarten survey report.
Approximately 55,350 Oklahoma children were enrolled in kindergarten in 2019-20. The state report released Oct. 6 represents 88% of those who were in public schools and 53% of those in private schools.
“We’ve really been working on private school participation,” Clark said. “Schools may be less likely to report if they have a higher number of exemptions. That would be our concern with the private schools.”
Oklahoma requires kindergarteners to be immunized against 10 diseases unless parents get an exemption based on medical, religious or personal grounds. The number of approved vaccine exemptions doubled from 2,417 in 2014 to 5,082 in 2019, according to state data. Most were for non-medical reasons.
Medical vs. Personal Exemptions
Oklahoma is one of 15 states that allow parents to cite personal reasons to exempt their children from immunizations.
“We have an extremely liberal exemption policy in Oklahoma,” Clark said. “To us (health department officials) the only valid exemption is a medical exemption.”
Private schools participating in the survey reported an exemption rate of 5.3%, up from 4.7% last year. Only 0.3% were medical exemptions. The rate reported by public schools was unchanged at 2.6%, with only 0.1% for medical reasons.
Both public and private schools reported 91% of their kindergartners were fully vaccinated.
Parents of children who cannot receive vaccines for medical reasons depend on classmates to be immunized to protect their children from diseases.
Since 2016, Catholic schools in the Archdiocese of Oklahoma City have required new students be fully immunized or have a medical exemption from their doctor.
The decision was made to provide a safe environment for students who cannot receive vaccines due to allergies, cancer treatment, immunosuppressive drugs or other medical reasons, as well as teachers who are pregnant, said Allyson Helm, associate superintendent for accreditation and school operations.
“We feel like it’s really important to protect those who are compromised, those that are vulnerable,” Helm said.
Families who object to vaccines for personal reasons still complain about the policy four years after it was enacted, she said.
A statewide telephone poll conducted by WPA Intelligence last October shows 96% of Oklahomans think vaccines are effective in preventing disease and 85% think the benefits outweigh risks. Those in the minority make themselves heard, Clark said.
Opponents of mandatory vaccination have successfully fought off efforts in the Legislature and state government to tighten exemptions.
In March, health officials opened public comments on a new rule requiring parents to first view an instructional video on benefits and risks of immunizations before receiving a non-medical exemption. Clark said they were swarmed with opposition from “anti-vaxxers,” including many from outside Oklahoma.
The rule was set to go into effect Sept. 11 but has been delayed for one year due to the pandemic. “The video is done,” Clark said. “We are hopeful that come September we will be right back to it.”
Oklahomans for Health and Parental Rights, a political action committee that promotes vaccination choice, strongly opposed the requirement, calling it forced vaccine propaganda.
The PAC this month released its endorsement of 34 candidates for seats in the Oklahoma Legislature, based on their responses to a survey that included multiple questions about vaccination choice, as well as the voting record of incumbents.
Immunizations Down as School Resumes
The concern for the current school year is more serious than missing data. Childhood vaccination rates are down nationwide.
The CDC reports the number of routine measles vaccines administered to U.S. school-aged children dropped dramatically following the March 13 declaration of a national emergency. An average of 2,600 measles vaccines were given each of the first 10 weeks of the year, but the average dropped to 280 for the five weeks after the declaration.
Immunizing children, even as the pandemic continues, is critical to protect them and their communities against increased risks for outbreaks of vaccine-preventable diseases, the CDC noted in the report.
The Oklahoma City-County Health Department reports a significant decline in children getting their back-to-school vaccines this summer. The agency administered immunizations to only 782 children from June 1 to Sept. 7. The number was 3,091 — four times higher — for the same period in 2019.
State health officials are urging schools to “be flexible and be supportive” while ensuring students are compliant.
Clark said there was a lot of confusion early on about mandatory vaccines for virtual learners, but the requirement is the same for all students.
“Enforcing that requirement continues to be somewhat challenging for the schools,” Clark said. “I am hoping we do not see a significant decrease in our immunization rates this year.”
Central Oak Elementary Principal Kim Templeman said she will make compliance a priority. The 2019-20 survey shows 61.3% of the school’s kindergartners were fully immunized and no exemptions were on file.
“I was not aware that our percentage was that low last year,” Templeman said. “But it won’t be this year.”
School officials will reach out one-on-one to parents about the reasons for immunization and to make sure they know the dates when the Caring Van will be at the school to provide free vaccines, she said.
Central Oak is the only elementary school for the Crooked Oak district in southeast Oklahoma City. This year 82 kindergartners are enrolled with about 30 percent in the virtual learning option.
Oklahoma City Public Schools has 2,485 kindergartners — about 500 fewer than last year — enrolled in 33 elementary schools.
Some children do “fall through the cracks” despite a good health services team, Director of Health Services Anika Wilson said.
Ten schools did not respond to the 2019-20 survey, even though they had the previous year. Wilson said the reasons likely are disruptions from COVID-19 or buildings without a dedicated school nurse on site.
Most district schools participating in the survey the past two years reported immunization coverage of higher than 90%.
Kindergartners returned for in-person learning last week. Wilson said staff used the opportunity to talk to parents dropping off students about vaccinations.
And starting this year, school nurses are making home visits to increase compliance. “We have captured quite a few families,” Wilson said.
By law children cannot attend school unless they are vaccinated or have an exemption on file.
“Putting a child out of school is the last resort,” Wilson said. “When it happens, we continue to reach out to that family. Usually we find there is a litany of other things going on.”
Views Oklahoma’s 2019-20 kindergarten immunization survey spreadsheet here. The survey results for each county and individual schools are available on this map.
Some rates on the spreadsheet may not match those on the map. In Oklahoma County, for example, the spreadsheet says 2.6% had exemptions on file but the map says 2.1%.
Health officials say that is because the data submitted to the Centers for Disease Control and Prevention includes charter schools, but those schools are not included on the interactive map. Additionally, the county rates on the spreadsheet are aligned with county assignments listed on the official State Department of Education directory published each year. For some schools, the map may assign a different county based on the physical location of the school.
When looking at the rates keep in mind the number of students included in the sample, officials say. Since Oklahoma has many small rural schools, even a small cluster of unimmunized children or exemptions can make a significant difference in the rates for that school or even county.
