KALAHEO, Kauai — Fred Birkett, principal of the Alakai O Kauai Charter School, which has 130 students, knows there is a new list on which his school is ranked No. 1 in the state, but he wishes it wasn’t.

It’s a ranking of Hawaii’s 36 charter schools, showing the percentage of students whose parents have obtained exemptions — almost all of them based on religious beliefs — allowing their kids to not be vaccinated against common childhood diseases.

Until a few weeks ago when the Department of Health released school-by-school information at Civil Beat’s request, Birkett wasn’t aware that Alakai O Kauai had the highest exemption rate at 40%.

“I don’t want to be No. 1 on that list,” said Birkett, the principal since January. “I’m new on the job. We hope to improve. This is something we’ve been working on. I’ve said (to state health officials), ‘Come on in. Take a look at it.’”

Janet Berreman is the state’s district health officer on Kauai, which in general has disturbingly high rates of nonvaccination. Two of its five charter schools are among the worst in the state.

It will be Berreman’s job to try to persuade families and school administrators to vaccinate. The health department has begun to deploy response teams to schools with unusually high rates.

Kanuikapono Public Charter School & Learning Center is one of the schools with a worrisome rate of unvaccinated students.

Allan Parachini/Civil Beat

At Kanuikapono Public Charter School & Learning Center in Anahola on Kauai’s east side, 32.9% of the 207 students are unvaccinated. And on the Big Island, 37.4% of the 222 students at Kona Pacific Public Charter School have not had their shots.

Statewide, charter schools have far higher rates of unvaccinated students than other public schools or private schools, according to the health department data gathered in March, with a few schools not yet reporting their information.

All told, 8.1% of charter school kids have such waivers — up from 4% in the 2013-14 school year. During that time, total charter school enrollment has increased modestly. There were 9,813 kids in charter schools six years ago compared to 11,034 this school year, based on the 35 that reported their data to the health department. Only Kamalani Academy in Wahiawa failed to do so.

That statewide exemption rate is three times higher than private schools, where 2.7% of students are unvaccinated, and more than four times the proportion of other public schools, where 1.4% are unvaccinated.

Nearly 900 of the 11,034 students in Hawaii charter schools lack protection against such diseases as measles, mumps and whooping cough because, in nearly all cases, their families claim a religious exemption — the only path to rejecting the shots other than rare medical exemptions.

Nineteen of Hawaii’s 36 charter schools show nonimmunization rates of 5% or more, the level many health authorities consider high enough to be of concern. Immunization, experts say, is all about achieving a critical mass for a concept known as “herd immunity.”

Together the charter schools with rates of 10% or more have 4,353 students.

Anti-Vaccine Dogma

Administrators and board members at some of those schools cite concerns that vaccinations may be dangerous based on misinformation such as the erroneous belief that vaccines cause autism.

At Kanuikapono, office staff said anti-vaccine dogma is so strong that some parents even remove their children from classes on days when voluntary flu immunizations are offered. But the 32.9% nonvaccination rate has administrators vowing to step in.

“I just think it’s the lifestyle on Kauai,” said board member Shane Cobb-Adams. “The governing board has been talking. Because of our high rate (of nonvaccination), we have been looking into starting a vaccination campaign this summer and into the beginning of the next school year.

Some parents even remove their children from classes on days when voluntary flu immunizations are offered.

“We’re developing a survey to get some information on the reasoning behind it,” Cobb-Adams said. “We’re not really sure why we have a lot of parents who won’t vaccinate their kids.”

The school has 207 students, according to DOH figures.

Cobb-Adams said a first step will be a campaign to emphasize the importance of vaccination of kindergarten students.

Officials at a third charter school with an extremely high nonvaccination rate, Kona Pacific Public Charter School on Hawaii Island, did not respond to requests for comment. A total of 37.4% of the school’s 222 students have exemptions from the shots.

At Myron B. Thompson Academy on Oahu, principal Diana Oshiro said administrators had become aware of the school’s 17.5% nonvaccination rate and were troubled. However, Oshiro said, the school has an unusual type of “blended” curriculum in which much of its instruction is online and students may physically appear on campus only on occasion.

“I expect that contributes to it,” Oshiro said. “Many of them always submit paperwork (vaccine waivers), and we just pretty much honor that request.”

Berreman said that one reason charter schools may stand out in terms of lack of vaccination exemptions is that public health resources routinely available on traditional school campuses may not be available at charters.

“The relationship is different,” she said. “We are available as a resource, but it’s reactive, not proactive.”

Charter schools generally have more latitude in self-governance than traditional schools, she said.

Smaller Enrollments Decrease Public Risk

Dr. Sarah Y. Park, the state’s chief epidemiologist, however, counseled against using any specific percentage of nonimmunization as an alarm.

“We tend not to focus on a specific percentage or only one aspect and instead consider the school and particular community as a whole,” she said.

The reason high proportions of unvaccinated children are dangerous, Berreman said, is that one unimmunized child with measles can infect as many as 12 to 18 other kids. This creates particular risk if a large number of other children at the same school are unvaccinated.

Dept of Health's Dr Sarah Park State Epidemiologist speaks at press conference announcing source of Hepatitis A outbreak as scallops served at Genki Sushi. 16 aug 2016

Dr. Sarah Park, the state’s chief epidemiologist, noted that while vaccination exemption rates are higher on average at charter schools, their smaller enrollments diminish the overall health risk.

Cory Lum/Civil Beat

Park questioned whether charter school vaccination waivers affect enough students to constitute a particular risk. Examining charter schools in isolation, she said, “would likely provide a skewed perspective from multiple points, especially since the charter schools tend to include comparatively small numbers.

“Five percent of a school of 20 can have very different potential impact compared with 5% of a school of 1,000,” she said.

While charter schools do account for a relatively small total enrollment — 5.6% of school-age children statewide — they contribute 23% of the religious waivers withholding vaccination protection. Private schools, by contrast, make up 21.6% of school enrollment but represent just 15.7% of exemptions.

Only five of the 36 charter schools have enrollments below 100, while seven have more than 500 students each, and one — the Hawaii Technology Academy on Oahu — has more than 1,000. Ten percent of its students are unvaccinated, according to DOH figures.

But just as there are wide disparities among public schools in terms of vaccination rates, there are some charter schools with no students who lack vaccinations. On Kauai, for example, while two of five charter schools rank among the highest in terms of nonimmunization, the remaining three show rates of zero to 1.3% unvaccinated.

Statewide, eight charter schools have low rates of nonimmunization — zero to 2.2%.

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