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A Case for Immunizations

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The resurgence of preventable childhood diseases, especially measles and pertussis, creates dilemmas for families and for school boards. Arizona is among the minority of states that allow "personal belief" exemptions from immunization, and rising exemption rates have contributed to recent outbreaks. Pertussis flared up twice in the Vail district last year, causing the county to send non-immunized children home for weeks. Over 28,000 persons caught pertussis last year, nationwide, more than in the entire decade of the 1970s. A recent measles outbreak in Disneyland made headlines, and Tucson had a major outbreak in 2008. Though only occasionally fatal, these diseases are serious and frequently cause hospitalization. 

Even immunized children lack perfect protection and children with certain medical conditions risk serious illness if exposed to vaccine-preventable diseases. One of us has a patient, a little girl with leukemia, who is home schooled to reduce the risk of such infections.

Families thus have good reasons to care about immunization rates, and we believe that the Tucson Unified School District's website should show the percentage of students fully immunized for each of its elementary schools. This proposal would preserve existing rights to personal exemptions and use only data that the state already collects. Students' privacy would remain protected, because two different federal laws, FERPA and HIPAA, block disclosure of individual students' immunization status (except during outbreaks). 

Our idea is not new. The nonprofit Arizona Partnership for Immunization has long advocated for legislation requiring all schools to disclose their immunization rates, and the Arizona chapter of the American Academy of Pediatrics recently joined that effort. If TUSD showed leadership on this issue, then others might follow. District leaders have resisted such changes. Superintendent H.T. Sanchez said (Arizona Daily Star, "Proposal would post immunization rates...", 9/17): "it's a slippery slope ...Are we going to have separate water fountains? One for immunized children and one for non-immunized children? We've been there as a nation and we've moved beyond that." 

The allusion to racial segregation is unfortunate and misplaced. Federal law clearly prohibits "separate water fountains." We propose only that TUSD publish aggregate data, which would not identify individual students. 

A TUSD board member raised a different objection (in the Star article): "I understand it is a public record so a parent can come and ask for that information, but when we're trying to increase enrollment why would we be advertising that?" 

That comment places TUSD's institutional interests above those of its stakeholders and exemplifies the "information game": If you know what information is available, your rights under the public records law, and whom to ask, and if you are willing to wait indefinitely for your answer, then TUSD will eventually provide it. (Even TUSD board members sometimes wait many months for answers.) This institutional culture is neither helpful nor transparent. 

The irony, in this case, is that TUSD's high immunization rates are good news. Most TUSD schools have kindergarten immunization rates over 95 percent, sufficient to create the "herd immunity" that can protect the few children not immunized. For 19 TUSD schools, the rate is 100 percent.

In contrast, the Arizona Republic reported that last year, statewide, only one-third of children in charter school kindergartens were in schools with immunization rates over 95 percent. TUSD also has higher immunization rates than most of the adjoining public districts. Why hide this information?

After pediatricians testified at the last TUSD board meeting, the district posted a temporary link to a state website that provides complex spreadsheets from which it is possible to calculate any school's full immunization rate. We believe that access to this information should be easier, permanent, updated annually, and enshrined in policy. The policy proposal comes back to the board on Oct. 20.  Superintendent Sanchez said that "to label schools immunized vs. those that aren't ... it's not a welcoming practice." We disagree. Information is power. Helping parents to get information easily respects their judgment and helps them to choose the best school for their family's unique needs.

Mark Stegeman is a member of the TUSD governing board.

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