The Hawaii Department of Health has given the state’s schools two weeks to report the number of students exempted from statewide vaccination requirements because as many as 40 percent of schools may not have done so for this academic year.

The crackdown was disclosed by DOH officials in an interview with Civil Beat on Monday. Hawaii’s 393 public, private and religious schools were all required to file vaccination exemption waivers at the beginning of the school year in August.

The Health Department said “more than 60 percent, but less than 70 percent” of schools are currently in compliance. The department blamed its own staff shortages for the failure to enforce regulations that require filing of reports on the number of students who are unvaccinated.

The health department did not identify to Civil Beat which schools have failed to provide the required information.

Worries about vaccination rates have taken on new urgency nationwide with recent measles outbreaks in Washington state, Texas and New York and growing anti-vaccination sentiment among some of the public.

Measles Mumps Rubella Vaccine Vials With Syringe Over Turquoise Background
DOH says reporting of vaccination rates by schools — both public and private — has been delayed and inconsistent. Getty Images/iStockphoto

Disclosure of the reporting shortfall in Hawaii and the requirement that schools correct their reporting deficiencies within two weeks came from Ronald Balajadia, immunization branch chief in the health department’s Disease Outbreak Control Division.

Balajadia said getting schools to comply with the regulations is a chronic problem and the health department has been struggling with personnel shortages that have hamstrung vaccination exemption data collection for “four or five years.”

In a statement, Janice Okubo, a health department spokeswoman, said, “The Department of Health attempts to collect reports from schools on student health and immunization requirements (including religious and medical exemptions). However, reporting from schools has been delayed and inconsistent.”

“DOH staff are actively working with schools to improve reporting toward eventually determining and presenting county-level exemption rates for the 2018–19 school year forward. Without high reporting compliance, data are incomplete and calculations using these data may be inaccurate. Therefore, DOH relies on the Centers for Disease Control and Prevention’s methodology to determine exemption rates for the State.”

According to statistics published by CDC, Hawaii has the 15th highest rate among states for non-vaccination of kindergartners due to either medical excuses from children’s doctors or filings from parents who raised religious objections.

According to Balajadia, the surveys used in the CDC reports require health department staff members to choose 40 schools at random for in-person visits, with the teams reviewing the records of 30 students  at each school. The CDC then uses statistical models to project non-vaccination rates to the state as a whole.

Growing Concerns

Public health experts fear an increase in vaccination exemptions will place all students and families at risk of contracting infectious diseases ranging from measles to mumps.

For many years, anti-vaccination activists have contended that vaccination is medically risky — especially that such shots can cause autism, an assertion that has been repeatedly debunked.

The exemption rate for Hawaii is listed among those CDC figures as 3.1 percent — just below Nevada’s rate of 3.2 percent and substantially lower than the 7.6 percent of students in Oregon schools whose parents filed waivers of vaccination requirements there. Alaska showed a 7 percent exemption rate and Idaho recorded 7.1 percent.

At the other end of the national spectrum, just .1 percent of students in Mississippi were the subject of vaccination waivers, along with .7 percent in California and .9 percent in Indiana, among other high-ranking states.

According to the CDC, there have been a total of 159 cases of measles since the beginning of 2019. The Washington Post recently reported that the percentage of kindergartners nationwide with exemptions from at least some vaccines has grown gradually in the last three years to a median of 2.2 percent.

In response to those figures and the recent outbreaks, legislatures in several states are considering rules that would tighten down eligibility for waivers.

Declining Vaccination Rates

Acknowledgment of the health department ‘s failure to obtain current data on student vaccination waivers comes less than a month after the department’s director, Bruce Anderson, published a newspaper op-ed piece emphasizing the critical importance of high vaccination rates to public health.

Bruce Anderson, director of the Hawaii Department of Health. Nathan Eagle/Civil Beat

Anderson argued that: “Decreasing vaccination rates have become both a national and international concern. Alongside issues including the Ebola disease and climate change is vaccine hesitancy — the reluctance or refusal to vaccinate despite the availability of effective and safe vaccines.”

His commentary focused on a series of public forums on “dangers of immunizations.” Those forums prompted an outcry from public health officials throughout the state, including Dr. Janet Berreman, the DOH district health officer for Kauai County.

Berreman is scheduled to make a presentation on the importance of measles vaccinations at a program in Lihue on March 11 organized by the Hawaii Alliance for Science.

In his commentary, Anderson observed that “Hawaii has a history of devastating illness and death among Native Hawaiians who had little or no natural immunity to many common diseases, most of which today can easily be prevented with safe and routine vaccinations.”

“Vaccines are the most effective and safe means of preventing contagious diseases.”

The Department of Education directly supervises all 292 public and charter schools in Hawaii.  There are also 101 parochial and private schools, represented by the Hawaii Association of Independent Schools.

That organization’s executive director, Philip Bossert, said, “Each school reports its vaccination data directly to DOH. Most of our schools have reported their data to DOH, but a few have not and we are working with DOH to try to get them to do so.”

Staff turnover at the health department, Balajadia said, has made it difficult to keep waiver report filings current. For the current school year, he said, a new staff member was chosen to oversee the process.

He said the department hopes that person can quickly get up to speed and rectify Hawaii’s reporting deficit.

As things stand, however, he said, a parent who wants to know the vaccination rate of students at their child’s school or any other school can’t get that data.

“We are unable to provide that information,” he said.

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