Last week, the Arizona Republic published a startling report on vaccination rates for measles around the state. According to their findings, only about one-third of schools in Arizona have what’s known as “herd immunity” — defined as at least 95% of the student population being vaccinated against the disease.
It wasn’t always like this. The Republic reports that the vaccination rate for Arizona students has dropped by about half over the last decade, and reporter Caitlin McGlade, who wrote the piece, says there are two big reasons for the decline.
For one thing, Arizona allows parents to opt out of vaccinating their kids based on “personal beliefs.” While religious exemptions are somewhat common in other states, our state is one of only 16 that broadens that standard to include non-religious exemptions. But as McGlade told The Show recently, that’s not the only explanation.
Full conversation
CAITLIN MCGLADE: Another thing that is specific to Arizona is that the State Health Department managed its free vaccine program in a way that drove out health-care providers. So it's harder for uninsured families and those who depend on Medicaid to get their kids vaccinated.
SAM DINGMAN: So this if I'm not mistaken is the Vaccines for Children program. And this is a federal program, but it's obviously managed in our state by the health department. Why has it not been working as well as intended?
MCGLADE: So several years ago, state health officials began forcing pediatricians to pay to replace vaccines they received for the program if they didn't use them before they expired. And that was very costly for the providers participating in the program. Providers also complained to researchers that the state's attempts at accountability weren't always accurate.
So there's this one instance that the state Health Department announced it would charge 500 providers a total of $6 million for 86,000 doses that they said were unaccounted for, but actually, like 40% of the providers were able to prove they didn't owe anything. So there was just this constant mistrust going on for many years.
Some providers told researchers that they were bullied, they were treated like they were guilty anytime the state came in and it just became very difficult for, for them to participate. So the number of provider locations offering these free vaccines has basically shrunk in half over the past decade.
DINGMAN: Wow. And was this fraught relationship between the providers and the health department, was that the case over the entire history of the Vaccines For Children program or, or did something change in this recent 10-year period?
MCGLADE: There was like a government accountability report from the feds that came out that encouraged states to cut down on vaccine waste. And, it's my understanding from my sources that Arizona reacted to that report by basically cracking down. The [Gov. Doug] Ducey administration kind of came down and said, well, we're going to really, really hold these doctors accountable and count every last vaccine. And the doctors were not happy about being that regulated.
DINGMAN: Yes, which in turn has led to the decline in providers participating in the program, as you just mentioned. Is there a correlation between that and the fact that the drop -offs in vaccination rates are particularly steep in high poverty areas?
MCGLADE: Yes. So that was one of the things that really surprised me when I started crunching the numbers for the most recent school year. Glendale Landmark School in the southern part of that city, experienced a really steep decline. The school went from having 100% of the kids vaccinated in 2015 to just 46% of kindergartners vaccinated last year.
DINGMAN: And the thought it seems from what I gather in the piece is that there just are fewer vaccination sites available to the parents in these poorer areas to get their kids vaccinated.
MCGLADE: Right. Right. That's what my sources say. That's what the researchers found when the county had a study done on declining vaccination rates. I would have loved to have done a further analysis and identified areas that, that have like a desert of, of vaccination providers. But the state health department didn't give me a list when I asked for it. It also does not appear to be readily available online. So I'm not sure how parents are supposed to even find where to get free vaccines for their kids if they're uninsured or have, are on Medicaid.
DINGMAN: And I suppose that the rationale that the administrators of the Vaccines for Children program in Arizona would give in terms of cracking down on this alleged waste in the program is saving money. But as you report, it's actually much more expensive to treat a measles outbreak than to pay for vaccines.
MCGLADE: Right. Right. Bob England, who was the director of Maricopa County Health Department and also was there at the time when the state really started cracking down. He pointed to a number of different studies showing how expensive me outbreaks are.
One of them he pointed to was in Clark County, Washington, 72 people got the measles between December 2018 and April 2019. And the overall societal cost was about $3.4 million, and that's like $47,000 per sick person.
DINGMAN: And that's for just 72 cases.
MCGLADE: Correct.
DINGMAN: There also seems to be from your reporting some skepticism about vaccines in general that is intensifying this situation. Tell us, tell us about what you found there.
MCGLADE: Correct. So there is a nationwide decline in vaccination rates for the measles, for a lot of vaccines. And there are a lot of researchers studying this and like why this could be. And we're definitely seeing that some of our local health department folks, or our state health department folks, have told me that, yes, they are seeing, you know, basically since the pandemic, an increased mistrust in all vaccines. There's a lot of stuff out there on Facebook, these posts that look like news articles, they sort of masquerade as news articles and they say a bunch of stuff that isn't true. But people spread them widely or like them and, and they were more likely to get a lot of likes if they mimic the styles of news or scientific reports. So this vaccine hesitancy from COVID-19 from people not wanting to get the COVID-19 vaccine because they were afraid of it. That sort of spilled over into other routine vaccines.
DINGMAN: Gotcha. And is there any sense that the health department is doing anything to push back against the misinformation about the vaccines?
MCGLADE: I asked about this and the, the person who was the assistant director of public health preparedness told me they, you know, they arm the schools with as much information as they can. They do try to dispel this. He did also say that, that, you know, they do have to be sensitive to the fact that in Arizona law protects parents’ right to choose whether or not to get their kids vaccinated. So I think some public health officials have to tread fairly lightly on that because of the law.
DINGMAN: Gotcha. And just so folks know in case they're in that cohort of people who tend to think of measles as something from a more bygone era. What can happen when someone gets measles? What, what is it, what does it do to you?
MCGLADE: It used to like kill a lot of kids. The vaccine was first invented in 1963. Almost all children caught the measles before they turn 15 back then. Like before the vaccine. And up to 4 million people in the U.S. would get it every year and 400 or 500 of them died, 48,000 were hospitalized, 1,000 suffered brain swelling, things of that nature.
