New rule, broad outreach could increase vaccinations

BY COLLIN KRIZMANICH
Capital News Service
LANSING — The percentage of parents who opt their children out of vaccinations in Michigan is more than three times the national average, but the numbers vary greatly depending on where you’re looking.
Waiver rates range from less than 1 percent in Branch County to nearly 20 percent in Cheboygan County. Michigan parents have a lot of leeway: The state is one of 20 that allows waivers not only for religious beliefs, but also on philosophical grounds.
Officials are hoping fewer parents will follow through on waiver requests under a rule that took effect this year requiring parents requesting a vaccination waiver to meet with a local health official before the waiver is granted.

At this meeting, parents are presented with information to learn about the risks of not vaccinating, and the benefits of vaccination.
Counties that have already adopted a similar waiver education policy say it’s effective.
“We’ve been doing it for the last four years in all of our school districts,” said Kim Wilhelm, prevention services director at Branch-Hillsdale-St. Joseph Community Health Agency.
Wilhelm said that prior to the waiver education requirements, the school districts had between a 7 percent and 9 percent waiver rate. After implementing the education requirement, the waiver rate dropped below 2 percent in public schools, she said.
These numbers are well below Michigan’s average of 5.9 percent and closer to the national median waiver rate of 1.8 percent for kindergarteners in 2014, according to the U.S. Centers for Disease Control and Prevention.
Some counties in Michigan have especially high levels of children with waivers. In Leelanau County, nearly one out of five kindergarten students received a vaccination waiver, more than 10 times higher than the national average.
“I’m very concerned about the number of waivers we’re seeing,” said Michelle Klein, the director of personal health at the Benzie-Leelanau District Health Department.
With such a high number of unvaccinated individuals, Leelanau and surrounding counties had an outbreak of measles in December 2014. Until this outbreak, Klein said the area hadn’t had a single case in the 17 years she had been working for the health department.
Klein worried that unless the state addresses the high number of waivers, once-defeated diseases will continue to spread.
Educating the public is the primary method the Health Department uses to encourage vaccinations, Klein said. This includes sending letters home to parents through the school system, posting on their Facebook page, and speaking with individuals personally, although the high number of waivers suggests these approaches alone aren’t as effective as officials would hope.
Kent County, whose kindergarten waiver rate is around 3 percent, also focuses on education, but uses a broader approach.
“One of the reasons our exemptions are low is because of our educational outreach with doctors’ offices and health care providers,” said Lisa LaPlante, community liaison and communications director for the Kent County Health Department.
LaPlante said that the county is staying in contact with doctors and healthcare providers, meeting two or three times a year.
These educational avenues also include using the Maternal Infant Health Program and the Women, Infants & Children program, state administered programs to aid new mothers, as an opportunity to educate parents on the importance of vaccines.
“Here in west Michigan we don’t operate in silos,” LaPlante said. “We have a great network of partnerships between the health care providers, educators, daycares and others.”
LaPlante believes that her network aids in the education of the public on vaccination, which leads to a greater number of children receiving the proper vaccinations.
A close relationship with health providers and doctors who immunize has also played a part in decreasing the waiver rate, said Wilhelm of the Branch-Hillsdale-St. Joseph Community Health Agency. Similar to Kent County, officials schedule regular meetings with health providers to educate them on new state recommendations and requirements regarding vaccinations, Wilhelm said.
Other counties struggling to bring down the waiver rates should try to find out why individuals are opposed to vaccinations, Wilhelm said.
“You’ve got to find your niche of how you can get in and start talking to some of these people opposed to vaccinations.”
Experts agree that it in order to increase vaccination rates, it is important to educate the public using any avenue available.
“We need to involve our public health partners and make sure they have the same messages,” said Matthew Seeger, a professor of communication at Wayne State University, who studies health and risk communication and serves as dean of the College of Fine, Performing and Communication Arts. “We must be consistent with messages and make sure they’re out there with some level of frequency a lot of different places.”
Seeger said explaining the social consequences of not being vaccinated is also important.
“There are children who cannot be vaccinated because of various medical conditions like leukemia,” Seeger said. “By vaccinating your children you not only protect your child, but also protect others that may not be able to receive vaccinations.”