Arizona sees dramatic drop in kindergarten classes protected from measles. See how your school rates

Measles is a highly infectious disease that can immensely harm children — and the risk to kindergartners in Arizona is escalating .

Over the past decade, the number of schools whose kindergarteners are protected from an outbreak has dropped by half. Now, only one in three schools in the state has "herd immunity," or enough vaccinated children to stop the disease from spreading.

And among charter schools, the rate was even lower: Only 17% of those schools reached herd immunity last school year. At private schools, about 33% schools reached the benchmark; public district schools were the highest, but still just at 35%.

The problem isn't isolated to the Grand Canyon State: Kindergarten vaccination rates are down nationwide, but the rate here has even fallen below the national average. Misinformation campaigns stoking fear about vaccines during the COVID-19 pandemic contributed to some of the widespread decline, but two factors specific to Arizona could explain why the state lags.

First: Arizona parents can easily opt out of vaccines for their children if they sign an exemption form acknowledging the risk of doing so. Only 15 other states allow vaccine exemptions for personal beliefs.

But many Arizona schools also don’t bother to make parents sign exemption forms . The Arizona Department of Health Services has no authority to penalize schools for breaking the law.

The Arizona Republic reported about the noncompliance more than 10 years ago, and the issue has grown worse, according to a Republic analysis of the most recent data.

The second factor: Until last month, the state health department managed a free-vaccine program in a way that drove out healthcare providers — making it more difficult for uninsured families and those who depend on Medicaid to get their kids vaccinated, said Will Humble, director of the Arizona Public Health Association and a former director of the state health department.

The Arizona Department of Health Services recently announced changes in hopes of bringing back fed-up doctors. But regaining their trust may prove difficult.

Kids are now getting vaccinated for the 2024-2025 academic year as they start school over the next few weeks, so the results of the state's efforts aren't yet known.

“The office in Arizona is almost impossible to deal with,” one healthcare provider said during a recent study designed to determine why vaccination rates were falling, particularly among publicly insured kids.

“They start from the assumption that pediatricians and pediatric offices are guilty of fraud.”

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Rates fall dramatically at schools that once were leaders

Among the schools that previously achieved herd immunity, Glendale Landmark School in the southern part of that city experienced the steepest vaccination rate decline in the state. The school went from having every kid vaccinated in 2015 to just 46% of kindergartners vaccinated last school year.

Just half of the kids who enrolled at Cottonwood Elementary in Casa Grande last year were vaccinated, a major departure from its typical rates from the mid-90% to the high-90s.

And Black Mountain Elementary School in Mohave County steadily declined, from 96% to 60%.

All of these schools are located in high poverty areas, meaning 20% of the people living in their surrounding census tracts live in poverty.

About 70 other schools in high poverty areas that used to reach herd immunity no longer did in the last school year, according to a Republic analysis.

The Republic’s analysis includes kindergartens with 20 or more students, as the state redacts key information about smaller schools.

Experts say a federal program for free immunization called Vaccines for Children historically kept rates high among publicly insured and uninsured children. The program eliminated barriers that might deter parents who rely on Medicaid from getting their kids vaccinated.

And schools in high-poverty areas still tend to reach herd immunity more frequently than schools in more economically secure areas, according to The Republic's analysis.

But the number of provider locations in Arizona offering free vaccines through the government program shrunk by half over the past decade, leaving just 10 for every 10,000 kids who need them in Maricopa County. The national average is 24 providers per 10,000 kids, according to the study on falling rates.

This is despite an increase in the population eligible to receive the free vaccines.

The limited access left parents with logistical headaches that may have prevented them from getting their kids vaccinated, including being sent to crowded health departments to get shots.

"Plus, now we're talking about somebody who maybe lives in, say, Casa Grande or Queen Creek, and we're asking them to drive into Phoenix. Even if the county has an office closer to them, it's still a burden, because it means taking their kids out of school," one provider said during the vaccine study.

It is not clear what areas are lacking providers; the state health department didn't respond to a request for a list of addresses for participating doctors. The Arizona Partnership for Immunization, a statewide coalition that promotes childhood vaccines, didn't provide a list, either.

Such a list does not appear readily accessible online, which could make it even more difficult for parents to figure out where take their kids.

Schools contacted by The Republic did not make officials available for interviews. The Republic also tried to interview parents for this story but even those who were willing to share opinions asked not to be quoted out of fear of public backlash.

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Doctors: 'We were being bullied' by the state

Maricopa County Public Health enlisted The Arizona Partnership for Immunization, to figure out why vaccination rates plummeted. Last school year, 88% of kindergartners were vaccinated against the measles, a six-percentage-point drop over the past decade.

The group hired a third-party research team that found health care providers who said the Arizona Department of Health Services treated them badly. That change in approach came after a federal report in 2012 that recommended states improve oversight over the program and reduce vaccine waste, according to the vaccine study.

Bob England, who was the director of the Maricopa County Department of Health at the time, said every year or two after that the state grew more difficult to work with, eventually to the point that providers quit the program.

State health officials began forcing pediatricians to pay to replace vaccines they received through the program if they didn’t use them before they expired. Providers also dealt with an unwieldy tracking system that ate up hours of staff time. And the state's attempts at accountability weren't always accurate.

One provider told study researchers that the health department announced it would charge 500 providers a total of $6 million for 86,000 doses they said were unaccounted for. But nearly 40% of the providers proved that they didn’t owe anything, the provider said.

“They're not even looking to try and see if these people really owe anything. They're just saying, ‘You're bad, you're guilty,’” they said.

Another said the culture became punitive just prior to the pandemic.

“Almost like we were being bullied, harassed, policed and, ‘You will do this, or we will make you pay.’ And, in my opinion, that got ugly. We didn't feel very supported at all.”

Some states reacted differently to the federal report. California taught providers how to follow rules and also how to drive up vaccination rates. In Texas, state officials visited doctor offices to support and educate staff on the program's policies with no intention of critique, according to the study.

England noted that measles outbreaks are expensive. He pointed to one in Clark County, Washington, where 72 people got the measles between December 2018 and April 2019.

A report published in the journal Pediatrics determined the overall societal cost of that outbreak was $3.4 million, or $47,479 per sick person.

"If you have policies in an attempt to prevent vaccine wastage that will save you tens of thousands of dollars but, because of that, you lose so many providers that you lose herd immunity and risk an outbreak, you're going to pay a lot more than you're trying to save in the first place," England said.

Public health officials make changes to lure doctors back

State public health officials are trying to address the state's "concerning" vaccination rates, said Eugene Livar, assistant director of public health preparedness for the state health department.

While public health officials tread lightly about parental choice, there is one variable they can control: the Vaccines for Children program.

In June, the Department of Health Services announced it would no longer penalize doctors for unused vaccines and would reduce reporting requirements. The state also will allow offices to participate if they're open four consecutive hours on any day but Monday, a departure from a more stringent requirement.

England said he's hopeful the changes will eventually bring vaccination rates up.

"I don't think its going to happen over night," he said. "But if providers who had previously left the program give it another shot, I think they're going to be pleasantly surprised."

Livar said the state health staff "arms" schools with resources about immunization, but it's ultimately up to parents to decide whether to get their kids vaccinated. He noted the "polarization of vaccine attitudes" that came out in the pandemic.

The measles vaccine was first available in the United States in 1963. In the decade prior, almost all children caught measles before they turned 15. Up to 4 million people in the United States contracted the disease every year and 400 to 500 of them died, 48,000 were hospitalized and 1,000 suffered brain swelling, according to the Centers for Disease Control .

This year, more than 160 cases so far were reported in the United States. People were hospitalized about half the time, according to the CDC. The CDC says measles cases are increasing around the world.

Researchers say COVID-19 vaccine hesitancy has spilled over to other routine vaccines, with misinformation running wild on social media.

A study published in the Journal of Medical Internet Research looked at 140 anti-vaccine Facebook posts. Content mimicking the style of news and scientific reports was popular.

"The liking of COVID-19 anti-vaccine posts that employ language features to mimic news or scientific reports is perturbing since a large audience can be reached on social media, potentially exacerbating the spread of misinformation and hampering global efforts to combat the virus," the authors wrote.

Reach Caitlin McGlade at caitlin.mcglade@arizonarepublic.com. Follow her on X @caitmcglade.

This article originally appeared on Arizona Republic: Arizona sees dramatic drop in kindergarten classes protected from measles. See how your school rates