Immunization has been a hot topic in Vermont over the last few years, with health officials trying to improve vaccination rates amidst a growing movement of parents who are choosing not to have their children vaccinated for "philosophical" reasons.

We have written before about this philosophical exemption allowed in Vermont and how falling vaccination rates put children and whole communities at risk for outbreaks of some of the deadliest childhood diseases, such as whooping cough/pertussis, polio and measles. Given the seriousness of this health risk, however, the message bears repeating.

Measles, which public health officials thought had been eliminated in 2000, has come back with a vengeance all across the United States. And, according to the Centers for Disease Control and Prevention, from January through April this year cases of whooping cough were up 24 percent from the same period last year.

Recently, Vermont dropped down from being the healthiest state in the country, to number two. In February, Vermont Health Commissioner Harry Chen cited the state's immunization rate as one reason for the state's decline. Vermont has the second highest Opt Out rate in the country -- second only to Oregon. Vermont numbers show that a third of the state's public schools have immunization rates too low to ensure the public health of all their students. Nearly half the private schools in the state are too low.


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"Vaccination needs a critical mass to effectively confer 'herd immunity' on a population," Helena Rho, a former assistant professor of pediatrics, wrote for the Valley News. "When vaccine rates fall below 90 percent, diseases spread readily enough to endanger people who can't be vaccinated because of illness or because they are too young. In parts of Vermont, the vaccination rate is only 60 percent."

Improving Vermont's immunization rate is one of Chen's main initiatives in his department's budget plan. According to the commissioner, every $1 spent on childhood vaccines saves $16.50 in future health care costs. An estimated 75 percent of U.S. health spending is on preventable chronic conditions such as obesity, heart disease and diabetes, but only three cents of every $1 spent on health care goes toward public health and prevention.

Throughout all of this discussion about improving vaccination rates and the debate over the philosophical exemption, what hasn't been getting much attention is the part of state law that requires all schools, childcare and preschool facilities to report immunization data to the Department of Health. Public and private schools alike have done a good job of meeting that reporting requirement, but according to the DOH, childcare and preschool facilities have not.

Immunization reporting for all children enrolled in licensed or registered childcare has been required in Vermont for the last three years. Yet, in 2011 and 2012, fewer than 55 percent of facilities complied with the reporting requirement.

Why is this important? Because it's the only way the state can tell which communities are at risk for the spread of certain diseases that often spread through populations of young children. Furthermore, someone wanting to put their child into a preschool or childcare facility has no idea of the risk level.

According to a 2013 annual report from the DOH, the cornerstone of a successful immunization program are effective parental education, universal access to vaccines, collaboration with health care providers, and a fully operational immunization registry. Fortunately, the Health Department is working with the Department of Children and Families to increase reporting by childcare facilities to better assess coverage rates and identify ways to ensure children have been vaccinated.

In the meantime, parents would be wise to find out the vaccination reporting practices of the preschool or child care facility they send their young ones to. Perhaps the added influence from the parents, as well as from the state, will help boost the state's immunization registry.