Martha’s Vineyard schoolchildren continue to lag well behind state vaccination rates, according to Massachusetts Department of Public Health (DPH) figures. According to state and federal public health experts, the failure of Island parents to vaccinate their children against a list of communicable diseases puts their children and the community at risk.
According to the most recent data submitted to The Times from Island school nurses, 94 percent of students are up-to-date on their vaccinations. But because of the complicated calculations that come with vaccinated vs. unvaccinated populations at schools across the Island, there is a starker picture behind those numbers. The vaccination rates of individual schools average out to just 87 percent compliance, with most schools reporting rates of above 94 percent, and two schools — Chilmark and West Tisbury — reporting much lower rates. The Charter School did not report its vaccination rate.
Children are required by state law to be vaccinated against 14 communicable diseases in order to attend public school, with a total of seven vaccinations by the time they reach seventh grade. The law allows only for a medical or religious exemption from the vaccination requirement; philosophical exemptions are not allowed. The majority of Island parents who have failed to vaccinate their children claim a religious exemption.
Dukes County, with the highest exemption rate for vaccinations in Massachusetts, is close to six times the state average — 8.2 percent of kindergartners were exempt, and therefore either unvaccinated or partially vaccinated, during the 2015–16 school year, according to DPH. Average statewide exemptions for vaccinations of kindergartners were roughly 1.4 percent that same year.
The numbers show that efforts by school officials to see that most of the children in their care are immunized according to state requirements have been mostly successful, but not entirely. A variety of exceptions to the immunization rules make the record keeping and the effort to keep the school population healthy complicated.
Matt D’Andrea, superintendent of schools, told The Times in a phone conversation on Wednesday that the high rate of exemptions is “a concern for the school district,” but that the school does not question religious exemptions.
“We don’t question them,” Mr. D’Andrea said. “We respect the parents’ right to take religious exemptions. It’s their right. It’s based on their religion to take that exemption, so we respect that.”
Mr. D’Andrea said the schools want to do what’s best for families, and be respectful of their decisions around health and religion. “But as a school administrator, you want to do what’s best for the students and you want to keep them safe, and sometimes it’s a fine line that you walk,” he said. “It’s really important we all work together to do what’s best for the kids.”
School nurses weigh in
The Times met recently with some of the Island’s school nurses, and they pointed out that they only have vaccination data for preschoolers, kindergartners, and seventh graders, as required by the state.
The Martha’s Vineyard Public Charter School “respectfully declined” to provide current vaccination rates to The Times, and because they reported having fewer than 30 kindergarten students, their most current information is not available at DPH.
Children are allowed medical or religious exemptions from vaccines, and parents have to sign a document that explains that if there’s an outbreak, their child will be excluded from school if they don’t have certain vaccinations.
A medical exemption is allowed if a physician submits documentation that states that a vaccination is medically contraindicated for a student. According to the most recent data provided by school nurses, 19 Island students are medically exempt from vaccinations, accounting for less than 1 percent of the total student population.
A religious exemption is permitted if a parent or guardian submits a written statement saying that vaccinations conflict with their “sincere religious beliefs,” according to the DPH. Philosophical exemptions, based on a parent or guardian’s personal beliefs, are not allowed in Massachusetts.
There are 120 students on-Island who are religiously exempt from vaccines — roughly 6 percent of the Vineyard’s student population.
“There’s a high religious exemption because we cannot have philosophical exemptions,” Linda Leonard, Martha’s Vineyard Regional High School (MVRHS) nurse, said. “And we cannot ask about religion.”
An exemption does not necessarily mean a student has no immunization, the nurses said. Often, children with exemptions are missing only one or two vaccinations.
The Chilmark School has the highest rate of exemptions, with 50 percent of their students exempt from vaccines — 21 of the 42 students enrolled — all on the basis of religious exemption. Six students are unvaccinated, while 15 are partially vaccinated. Susan Stevens, principal of the Chilmark School, told The Times in a phone conversation on Wednesday that the majority of students who are partially vaccinated are missing only the hepatitis B vaccine.
“I think you have people who are thinking that vaccinations cause a variety of problems in kids, so the religious exemption is a way to get into school,” Ms. Stevens said.
“It absolutely is a concern,” Mr. D’Andrea said when asked about the Chilmark School’s high rates of partially vaccinated students.
When school nurses met with The Times, Janice Brown, school nurse at the Chilmark School and the Charter School, said many Island parents delay vaccination because they believe their children are too young to receive the number of vaccines required by the state. “I think people do what they call a delayed immunization, where they feel that they don’t want to assault their young children with so many immunizations, so they span it out,” Ms. Brown said.
By the time their children reach high school, the parents believe, their bodies have grown enough, and they’re able to handle more vaccines.
The numbers at the high school reflect this — out of 655 students, zero at MVRHS are unvaccinated, and 26 are partially vaccinated.
“So for all of us, what that means is if there is an outbreak, I would target these 26 students that I have — 22 religious, 4 medical — I would target them to what disease is presenting, say [chicken pox], and exclude the ones who don’t meet the criteria for immunization for that disease from school,” Ms. Leonard said.
Kristine Cammorata, West Tisbury School nurse, said she sees a lot of parents withhold the hepatitis B vaccine because since it’s “a blood-borne disease that their child is never going to come in contact with.” In some cases, a student will get one shot in each series, so they have some immunity, but not full protection. “It just seems like that’s what I see a lot of — a lot of picking and choosing,” Ms. Cammorata said.
“And I think also, the fact that we don’t see these diseases happening so much, a lot of the parents think that if a majority get their children immunized, that will protect my nonimmunized child,” Ms. Brown said.
“And that’s the problem that’s happening on this Island, is that the herd effect is starting to wane,” Ms. Leonard said. “Which puts the community at risk,” she added.
“And that puts children with medical exemptions, who truly cannot receive the vaccine, at risk,” Ms. Cammorata said. “They don’t have the community protecting them.”
Herd immunity is a common term for a community’s resistance to the spread of a contagious disease, achieved if a majority of individuals are immune to the disease, typically through vaccination. But is herd mentality starting to jeopardize herd immunity?
There is a tremendous amount of digging and record keeping for school health officials — to let parents know what vaccinations are required and what exceptions are allowed, and to get official reports of vaccinations from physicians’ offices — because there is no central registry on-Island or by the state.
“It comes down to preventable childhood diseases, and we need to support that,” Ms. Leonard said. “We need to make that strong in our message, that we are public health nurses, and these are preventable childhood diseases.”
Understanding the numbers
In a conversation with The Times on Wednesday, Pejman Talebian, director of the DPH immunization program, said 99 percent of individuals are eligible and should be be fully vaccinated.
“We want as many people as possible to be vaccinated, because it will ensure that even though some can’t get vaccinated because of immunodeficiency disorders, they’ll be protected due to this concept called herd immunity,” Dr. Talebian said.
The current statute allows for parents to claim religious exemption, but Dr. Talebian said that in reality, a majority of these are likely philosophical objections. “There are very few true organized religions that have formal objections to vaccines,” Dr. Talebian said.
He said the general rule of thumb at DPH is at least 90 percent of children are fully vaccinated, with the exception of measles, a highly infectious disease where DPH aims to have 95 percent coverage to ensure herd immunity.
Dr. Talebian said the numbers on Martha’s Vineyard are “troubling.” However, because Dukes County has such a small population compared with the rest of the counties in the state, the numbers are hard to compare, and the data can appear skewed.
“It does mean that there is a potential for greater risk of an outbreak of infectious disease in that setting, because you have a higher rate of the population that is unimmunized,” Dr. Talebian said. “That being said, numbers can be deceiving.” Martha’s Vineyard is one of the smallest counties in the state, he said, “so it takes a small handful of children to make the rate look high, but the total number of kids unimmunized is relatively low, so it only takes a few kids to claim exemption to make the overall rate appear high.”
And although Dukes County has a higher rate of exemption than state averages, over the past few years the rate has decreased dramatically. In 2013, the rate of exemption was more than 18 percent.
“We’re hoping our educational efforts are making a difference,” Dr. Talebian said, “but there’s still progress that needs to be made.”