How vulnerable are northern Michigan schools to the spread of diseases like measles, mumps, and whooping cough? With immunization rates trending downward statewide, Michigan’s health leaders are worried about the potential for an outbreak-ridden school year – and are pleading with parents to get their kids vaccinated to minimize risks.

Last month, Bridge Michigan reported that “the number of Michigan kindergartners attending school where vaccination rates were less than 90 percent has more than doubled between 2015 and 2022.” Health experts generally recommend 90 percent as the proportion of a school’s student body that should be vaccinated to minimize the spread of disease.

Since 1978, Michigan law has enforced high immunization rates in schools by requiring that every student submit an up-to-date immunization record prior to both kindergarten and 7th grade, as well as before enrolling in a new district. For kindergartners, the state requires vaccinations against diphtheria, tetanus, pertussis (whooping cough), polio, measles, mumps, rubella, and hepatitis B, as well as either immunization for or history of chickenpox. For 7th graders, the list expands to include meningitis.

But immunization law in Michigan and many other states leaves room for parents to seek vaccine waivers for their children on medical, religious, or philosophical grounds. Such waivers allow students to attend school without ever being immunized against some or all of the diseases on the required vaccine list.

Those waivers are on the rise: Per the CDC, the nationwide median rate of kindergartners with vaccine exemptions jumped from 1.4 percent in 2012 to 2.7 percent in 2022. Michigan has actually bucked the national trend, with 4.5 percent of kindergartners getting exemptions last year, compared to 5.5 percent in 2012. Still, Michigan’s waiver rate is one of the highest in the country – and, according to Bridge, has created a situation where some 37,000 of the 112,300 kindergartners in the state last year “were in buildings with vaccination rates less than the threshold generally accepted to avoid the spread of infectious diseases.” For comparison, in 2015, just 16,000 kindergarten students in Michigan were in below-threshold classrooms.

How is Grand Traverse County doing, specifically? Based on state data from the 2022-23 school year (the most recent data available), 14 elementary schools in the county have kindergarten immunization rates below 90 percent: Blair Elementary, Buckley Community School, Central Grade School, Courtade, Grand Traverse Academy, Immaculate Conception, Kingsley Area Elementary, New Horizons, Old Mission, TCAPS Montessori, Traverse City Christian, Trinity Lutheran, St. Mary’s of Hannah, and Woodland School. Last year’s kindergarten immunization rates at those schools ranged from 58.3 percent to 89.5 percent.

Nationally and in Michigan, the trends of rising immunization waivers and dipping vaccine rates in schools have corresponded with a spike in infectious disease outbreaks. In 2019, nearly 1,300 cases of measles were reported in the United States, the highest number since 1992; per the CDC, “the majority of cases were among people who were not vaccinated against measles.” Then, earlier this year, a measles outbreak in Columbus, Ohio “sickened 85 children,” according to the American Academy of Pediatrics, 94 percent of whom had never received the measles, mumps, and rubella vaccine. No children died in the outbreak, but 36 were hospitalized.

During a press conference in August, Dr. Natasha Bagdasarian, chief medical executive for the Michigan Department of Health and Human Services, pointed to the Columbus outbreak as a warning of what could happen in Michigan communities if vaccine rates continue to fall.

“We’re seeing some of the lowest vaccination rates in more than a decade, which puts our schools and communities at risk,” Bagdasarian said. “We also know that families are traveling more, both out-of-state and internationally. All it takes is one case to spark an outbreak that could affect an entire community.”

Falling immunization rates are often linked with a rise in vaccine hesitancy among parents – a trend that has accelerated significantly during the COVID-19 pandemic. But anti-vaccine sentiments aren’t the only factor driving an increase in waivers. Dr. Najibah Rehman, who serves as medical director for the Grand Traverse County Health Department (GTCHD), says “children falling behind on age-recommended vaccines” became more common during COVID-19, sometimes simply due to parents skipping routine doctor’s office trips to avoid pandemic risks. And Ginger Smith, communications director for Traverse City Area Public Schools (TCAPS), lists “access to affordable health care, lack of availability of appointments, and lack of convenience for working parents” as reasons that some students aren’t vaccinated, along with medical, religious, or philosophical reasons.

While Rehman confirms that Grand Traverse County “saw an increase in waivers” during the pandemic, she notes that the county still “performed well in Michigan for vaccination” in several key groups, ranking fifth of Michigan’s 83 counties in vaccination rates for young children (those between the ages of 19 months and 3 years), and 13th for school-aged kids (3-17 years old).

Still, state health leaders growing increasingly concerned about disease outbreaks raises a question: If one or more local schools were to face an outbreak of a vaccine-preventable disease, what would happen?

One potential answer is a total school closure – something that happened at Grand Traverse Academy in 2014 when a whooping cough outbreak sickened at least 11 GTA students and prompted the school to shut down for four days.

An outbreak could also lead to unvaccinated students being excluded temporarily from all in-person school activities. Despite legal challenges, courts have historically upheld the authority of schools or health departments to exercise such measures as a matter of public health.

When asked what GTCHD’s protocol would be in the event of local school outbreaks – and whether excluding unvaccinated kids from school would be on the table – Dr. Rehman says the department doesn’t have a one-size-fits-all approach.

“We work very closely with our schools, as they report communicable illnesses to us every week,” Rehman tells The Ticker. “If there were concerns about an outbreak, we would continue to work with the schools, parents, et cetera to investigate the illness, as different diseases require their own specific responses. In instances where the disease is vaccine-preventable, we would review the vaccination status of exposed contacts and offer vaccines and/or medication as appropriate, if [the families] are willing to [consider those options].”