SALT LAKE CITY – When school began last fall in the midst of the COVID-19 pandemic, Amy Frank opted for an at-home school option for her kindergartner, through the Canyons School District.
She also elected to wait on her son's one outstanding vaccine, a final Hepatitis B shot.
"I wasn't going to risk it," she said. "I know that doctors are being safe – but every time you go to the doctor, you risk picking up something and it didn't feel like the reward was worth the risk."
Though Frank plans to have him up-to-date before his return to in-person school, her son's school district called and said the boy needed that final vaccine to be enrolled, regardless of whether he was attending in-person or not.
"That was when I opted to get the exemption form done for him," Frank said. "When he goes back to school, if I'm comfortable sending him to school, then I'll be comfortable taking him into a doctor's office. And that's really what it comes down to is, until that point, we'll be at home."
Dr. Daniel Chappell, a family physician, noticed the effects of this approach last spring at his Farmington practice when COVID-19 first hit.
"I have seen a decline," he said. "Probably up to 30% of patients haven't come in for their shots."
Chappell said parents should know that clinics have protocols in place to keep all patients safe and that they should not fear or delay visits due to concern of encountering patients with COVID-19. At Ogden Clinic where he works, all patients with COVID-19 symptoms are seen remotely or in the parking lot, where doctors and nurses are fully protected in the appropriate gear.
"(Potential COVID-19 patients) don't even come up into the clinic space itself," he said. "We reserved the clinic space for the babies and the well-child checks … so it's a very safe environment to bring your child to get vaccinated at a clinic or hospital."
He believes the greater threat is falling behind on vaccines.
Data, driven by age & location shows troubling trends
Utah's vaccination rates for school-age children are tracked at kindergarten and seventh grade, as is recommended by the Centers for Disease Control and Prevention, or CDC. But immunization exemptions, required for students who are not adequately immunized for school entry, can be obtained by completing an online course.
Data on immunization and exemption rates is gathered annually by the Utah Department of Health. The most recent data shows the number of Utah schools where zero kindergartners attending had all required shots is on the rise. That figure shot up from two schools in the 2018-2019 school year, to 34 schools in 2019-2020. And the number of Utah schools where all seventh graders had all required shots has declined from 19% two years ago, to 13% last year.
However, the KSL Investigators found the trends for vaccination and exemption rates for immunizations have been all over the map in the Beehive State – with some years showing spikes in exemption rates, and certain regions consistently outpacing others for their rate of students with exemptions.
For example, the number of exemptions for seventh graders in Utah County rose in 2019, from around 5% in 2018 to over 9% in 2019. And kindergartners in the Southwest Utah and Summit County health departments consistently have the highest exemption rates – almost twice the number for total kindergartners in the state.
So, what's driving that trend?
"I don't even know how to answer that," Rich Lakin, immunization director with the Utah Department of Health, said, ruminating it could be misinformation, the anti-vaccination movement or the belief that the illnesses vaccines prevent are no longer a threat.
"We don't really know why there's certain areas that have a higher exemption rate as compared to others," he said.
There was a plan to take a closer look at some of these trends in 2020, which was postponed in the wave of urgency that accompanied COVID-19. But that wasn't the most concerning impact of the pandemic when it comes to student vaccinations.
"As we know, 2020 was a crazy year. And, basically, what happened is that a lot of schools were impacted, a lot of physicians were impacted, public health was impacted because we really had to put resources toward COVID," Lakin said. "There were those that did not go in for well-child checkups, and that's mostly when you get your vaccines."
"So, we anticipate that there would be a decline in vaccines being up to date for the kindergarten and seventh grade," he added.
An analysis of Utah Department of Health data showed that, across the state last year, 12% of kindergarten schools had exemption rates of 10% or higher. For seventh-grade schools, that number was 17%.
While location and age group drove some data, the type of school also played a part in exemption rates. The Utah Department of Health data showed exemption rates in seventh grade were significantly higher at charter schools, with rates over 11%, compared to 5.9% for district schools and 4.7% for private schools.
In the Weber-Morgan health district, three seventh-grade schools had double-digit exemption rates – all private or charter schools. Sixteen of the 18 schools in the Utah County health district with double-digit exemption rates in seventh grade were charter or private schools, including Canyon Grove Academy, a charter school in Pleasant Grove with 92.3% of students with exemptions. A notable exception to charter or private schools accounting for schools' highest number of exemptions in Utah County: American Fork Junior High, where 34% of seventh graders have exemptions.
These numbers matter because Lakin said you need certain immunization rates to achieve herd immunity and prevent outbreaks.
"For measles, you got to have a 95% herd immunity. It's extremely contagious," he explained. "So, if you have a rate that is lower than 95%, that means we can have measles cases start to pop up again."
Angela and Isaac Jacob, parents of seven, were the first to express their gratitude for vaccines.
"They've helped eradicate terrible diseases," Isaac Jacob said. "But we also feel like it's an important decision, you know, anything that you're going to put into your body, you want to know what you're doing, and you want to research it."
The Jacobs said they took a less traditional approach to vaccinations after their oldest child was born when the timeline their physician laid out felt rushed and rigid for the family.
"I felt a little bit uncomfortable about that, just recognizing how precious these babies are," Angela Jacob explained. "They're already adjusting to so much in life anyway."
Instead of vaccinating on the standard timeline, they prefer to have their children vaccinated over a longer period of time. They said they have their children caught up on all shots by age 5 or 6.
"I thought that a middle-of-the-road approach would be the wisest course for our family to mitigate the risks of vaccines, but also to navigate to prevent the risk of disease," said Angela.
The Orem mother also said she would regularly consult with her children's doctors and nurses to discuss the vaccines and the diseases they were preventing, and then use that information to guide which vaccines she had her children receive at a particular time.
"Sometimes that would change the order that I did them in," she said. "I would order them according to what I felt was the greatest risk."
The parents said they only needed a kindergarten vaccine exemption once when there was a mix-up obtaining medical records from out of state.
Easing access to exemptions
Lakin said the exemption process in Utah became easier a few years back when the process moved to an online module as part of a recent state law.
"It's a fairly easy process to do that," Lakin said. "It only takes 20 minutes and you can do it on your phone. So, pretty easy process to do it here in Utah."
Those seeking an exemption for their child must select whether the reason is medical, religious or personal. And data from the Utah Department of Health shows the overwhelming majority of exemptions in the state had "personal" cited as the reason in more than 90% of the total exemptions for both kindergartners and seventh graders in 2019.
At Granite Elementary in Sandy, the school's student vaccine exemption rate jumped 8% in a single school year from 4.35% in 2018-2019 to 12.5% exempted in 2019-2020.
Christie Taylor, whose children attend a public school in the Canyons School District, has questions about this.
"I want to know, are you just not vaccinating? Or is there a reason?" she said, noting that she's not reticent about vaccines. "I'm the mom that wants my kids vaccinated. I want them vaccinated on time."
This school year, she went to great lengths to ensure that her children were, in fact, vaccinated. Taylor said that when she missed the virtual orientation for her soon-to-be kindergartner, she also missed the vaccination reminder.
After school started in the fall of 2020, her daughter's school called to tell her the necessary vaccinations needed to be completed within two weeks. Initially surprised her daughter wasn't current on her vaccinations, she thought it would be a relatively easy fix.
"I called her pediatrician," Taylor said. "We couldn't get in. There were no appointments."
Not knowing exemptions were an option and faced with the "daunting" notion of homeschooling while awaiting an appointment, Taylor said she was told she could try the health department. That route was quicker but was not an ideal experience for her daughter.
"I just felt it was kind of a traumatic experience for her," she said. "I thought she was really brave going down there."
Still, Taylor believes in the benefits of vaccinating and wants to ensure her family stays adequately immunized.
"We really are taking the risk to get our kids vaccinated to protect the other kids so that those kids can choose not to get vaccinated," she said.
Until more parents take that approach, state health department officials will be watching the data and bracing themselves for the future.
"I'm anticipating that there's going to be more outbreaks," Lakin said. "There's a very good chance that we're going to be busy two to five years from now, ensuring the safety of our students."
Editor's note: Christie Taylor is an employee of Bonneville International, which owns KSL-TV.