There is not yet a Covid-19 vaccine for children under 12. But public awareness of the importance of vaccination has cast the Outer Cape’s low childhood immunization rates in a new light.
Two bills pending in the Mass. legislature — one co-sponsored by Rep. Sarah Peake of Provincetown, the other by Sen. Julian Cyr of Truro — aim to address the issue by making it much tougher to get exemptions from vaccine requirements.
To be admitted to kindergarten, children must be immunized against hepatitis B, MMR (measles, mumps, rubella), DTap (diptheria, tetanus, pertussis), polio, and varicella (chicken pox). There are two routes around that mandate: a medical exemption via a doctor’s note, or a religious exemption that simply requires the guardian to submit a form.
For the last school year, 95.1 percent of kindergartners statewide had received the full series of immunizations; 1.1 percent of children statewide had vaccine exemptions. But Barnstable County’s exemption rate is higher: 2.6 percent, almost all for religious reasons.
Eastham and Wellfleet have had even higher exemption rates in recent years: in Eastham, 5.9 percent in 2019-2020, and in Wellfleet 12.5 percent, in a study conducted from 2016 to 2018.
The two bills address exemptions in different ways. The bill filed by Haverhill Democrat Andy Vargas and co-sponsored by Peake would eliminate the religious exemption. More than 75 percent of the exemptions statewide are for religious reasons.
“There’s no major religion that has prohibitions against protecting kids with vaccination,” said Peake, noting that Wellfleet’s exemption percentage is “at the top of the list.”
Several other states have eliminated nonmedical exemptions, including Connecticut, New York, and Maine.
The second bill, filed by Sen. Becca Rausch and Rep. Paul Donato and cosponsored by Cyr, would move the exemption approval process from local jurisdictions to the state Dept. of Public Health, which would follow a list of qualifying conditions.
Data on exemptions is self-reported by school districts, resulting in gaps. In 2019-2020, 520 kindergartens statewide failed to report immunization data to the state, according to Rausch’s website. There is also no current requirement for parents to be notified if a school falls below herd immunity against a preventable disease.
Cyr pointed to the comparatively low rate of immunization against measles in Wellfleet and some schools on the islands. “Having a measles outbreak is possible, given the vaccine rate,” he said. Cyr’s district includes Nantucket and Dukes counties, where exemption rates for the current year were 7.3 and 8.5, respectively.
“It’s really about getting better information on why families are opting out,” he said. “At the end of the day, it’s about safety in schools.”
In 2019, Outer Cape Health Services launched a research project to understand the reasons why increasing numbers of parents were rejecting vaccines, focusing on birth to age three. But the pandemic delayed the work. “By the time the nine-month project was coming to a close in spring 2020, the pandemic and lockdown prohibited our family outreach,” said Gretchen Eckel, OCHS director for child health services, in an email. That outreach has now resumed.
“Vaccinating our youth can be the single most important preventive medicine strategy pediatric providers have to make a lifelong impact on a child’s health,” Eckel said.
OCHS spokesman Gerard Desautels said only 41 percent of current three-year-old patients from the four Outer Cape towns are up to date on required vaccinations.
Vaccination data for Truro Central School are not available from the state, nor are Provincetown’s, Eastham’s, or Wellfleet’s for 2020-2021. But based on other sources, rates in Truro and Provincetown appear to be higher than in Wellfleet and Eastham.
According to the state’s 2019-2020 data, only 88 percent of Eastham kindergartners had received the full series of required vaccinations. The Wellfleet study found that only 77 percent of its kindergartners were fully immunized.
Truro Supt. Stephanie Costigan said every entering kindergartner in 2020 was fully vaccinated, and there were no exemptions.
Provincetown Supt. Suzanne Scallion also reported that 100 percent of kindergartners were vaccinated and there were no exemptions. Scallion attributed it to outreach. “Our nurse works with families who need assistance with appointments or translation,” she said.
School nurses at the Eastham and Wellfleet elementary schools were not available to provide data for this story.
The proposed bills have generated pushback. The Independent attempted to contact Cape Cod parents who who signed a petition against the Rausch bill, but none responded. Lynn Smith of West Dennis, who said her two daughters have never been vaccinated, was reached through an the group Health Choice 4 Action Massachusetts. She got a religious exemption for her children and is opposed to both bills.
Part of her objection is political. “I don’t think politicians should interfere with a parent’s choice,” she said. Smith also said she thought the push to reach herd immunity via vaccination was “a false argument meant to make people compliant.”
Smith believes herd immunity should be achieved through exposure: “If you are exposed to live virus, you would have a broader natural immunity,” she said. But according to the CDC’s FAQ on vaccines for children, “natural immunity usually results in better immunity than vaccination,” the problem is “the risks are much greater.”
Asked about the religious exemption, Smith said her reasoning is based on the fact that some vaccines are made with aborted fetal cell lines. “I’m pro-choice, but I’m not comfortable with aborted fetal cell lines being injected into my daughters,” she said.
According to the Children’s Hospital of Philadelphia’s Vaccine Education Center, while fetal cells dating to tissue collected in the 1960s is used to grow the viruses used in the MMR vaccine, the vaccines do not contain these cells.
Retired pediatrician Pamela Zuckerman said she had crossed paths with numerous parents skeptical of vaccines during her career, but one case has stayed with her: a four-year-old girl whose parents refused the MMR vaccine. The child got the measles, and pneumonia followed. “I have memories of doing her vent care,” Zuckerman recalled. “The downside is terrible if your child gets sick.”
Cyr is optimistic that people will come around on vaccines. Covid-19, he said, has been a game changer, with the governor issuing vaccination mandates for state employees and businesses following suit.
“If you want to live in a society that isn’t continually plagued with preventable disease, vaccination is the means,” he said.
