Ohio school vaccination levels vary amid scant oversight

The school year has begun, and for Ohio children, that means getting immunizations up-to-date within the 14-day window required by state law.

But data from 2015 shows that large segments of students at hundreds of schools in Ohio fell short of immunization requirements required by state law – and there is little state officials can do about it. That’s because while nearly 2 million Ohio students are required to have certain immunizations to prevent deadly outbreaks of diseases such as measles, the implementation and enforcement of state vaccination laws is largely at the discretion of the more than 1,000 different school districts in Ohio.

“The Ohio Department of Health has no authority, unless there is an outbreak,” said Spokeswoman Melanie Amato. The state does require schools to report immunization data by Oct. 15 of each year on new students, but it does not check back to ensure students ultimately complied with state law or were kept out of class by schools if immunizations weren’t received. “We just get the numbers from the schools, so we do not follow up,” she said.

The patchwork of vaccination compliance levels seen across the state has some schools with nearly every new student properly vaccinated, while others reported nearly all new students starting school without the right vaccinations, according to 2015 data on 7,298 schools in the state. On average, 8.5 percent of new students in Ohio didn’t have complete vaccinations by mid-October of 2015. Data is not available to show how many of those students ultimately completed vaccinations.

Of the 35,038 students with incomplete vaccinations state wide in the 2015 report, 8,738 didn’t have vaccination records filed at their schools – a status that would put students still attending class in violation of Ohio law, according to the Ohio Department of Heath. Ohio had 7,031 students with vaccine requirement exemptions based on religious objections. Exemptions are not included in the figures of students with incomplete vaccinations.

Ohio law states that pupils in schools overseen by the state may not remain in school for more than 14 days unless immunized, or in the process of being immunized, against certain childhood diseases. Students can be “in process” if they have received an initial dose of certain vaccines with the expectation that follow-up doses will be administered once a medically required dosing interval passes. Students also are required to have immunization records on file with school administrators showing the statuses of required vaccinations.

In Fairfield County, 5.4 percent of new students entering schools had incomplete vaccinations in 2015. The highest level seen was at Fairfield Union Rushville Middle School, where 50.9 percent of incoming students had incomplete immunizations as of the 2015 report. If Ohio does have a problem with vaccination levels, it will take better data to figure out a course of action, said State Rep. Dan Ramos, D-Lorain, who introduced a bill in May that would require schools to report a summary of vaccination levels for all students – instead of just incoming pupils – each year. The bill was introduced just before the legislature took a break over the summer, and is unlikely to make much progress this session but may be reintroduced next year, Ramos said.

Poor parents juggling multiple jobs, for instance, might not put a priority on vaccinations if not spurred by a school to do so, Ramos said. But if schools can’t be held accountable for vaccination efforts then some students could suffer, he said.

“It looks like there are holes and that people are falling through the cracks,” he said. “We do need to improve on the reporting side.”

It’s not clear why some schools see very high levels of students who have incomplete vaccinations or missing records, but Ohio’s allowance of immunization exemptions for religious or philosophical reasons could contribute to a culture of lax policies at some schools, said Ross County Health Commissioner Timothy Angel.

“It used to be that school districts would not let a child into school without completed vaccines,” he said. “I think we’re kind of straying away from that a little more.”

Some of the highest levels of incomplete immunizations in schools are in poor urban or rural areas. There is no data available on how often schools keep children out of class because of incomplete vaccinations. But some schools may be hesitant to send children home over vaccinations, Ramos said.

“They are trying to get kids in the door, and every day that some of these kids come to school is damn near a miracle to begin with,” Ramos said. “They’re not looking for ways to kick them out.”

But keeping kids in school with incomplete or skipped vaccinations will lead to more outbreaks of diseases that can be lethal, said Angel, who holds a Ph.D in biomedicine and said he counts vaccinations among his life’s passions.

“As long as we allow exemptions and these loopholes, we’re going to continue to see those vaccination numbers decline,” he said. “That’s why we see a rise in whooping cough, measles and all of these other childhood diseases.”

Ohio has seen several outbreaks of such diseases in recent years, including a whooping cough outbreak in Marion in June and a mumps outbreak that affected hundreds at Ohio State University in 2014.

The best path toward higher levels of immunization is for the Ohio legislature to eliminate religious or philosophical vaccination requirement exemptions, he said. Such a move would also signal to schools and others that vaccines are to be taken seriously, Angel said.

“Exemptions open the door for a lenient mindset,” he said.

But making changes to vaccination policy is tough, said Ohio Sen. Cliff Hite, R-Findlay, who sponsored Senate Bill 121, which starting this year requires seventh- and 12th-graders to receive a meningitis vaccine. Hite said he had to allow religious or philosophical objections to vaccinations to get his bill through.

“That puts people in jeopardy,” he said of the exemptions.

Work on measures to improve reporting and school accountability would be worth pursuing, Hite said.

It’s not clear, however, what the outlook for such a measure would be, said Ramos, who expects his bill to receive at least one hearing before the end of the year.

“My hope is that this is the beginning of the conversation on this,” Ramos said. “We can’t solve the problem if we don’t know what the problem is.”