Arizona Faces Challenges to Vaccine Policy in 2020

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Written by: Debbie McCune Davis, TAPI Executive Director, and Jennifer Tinney, TAPI Program Director

As 2019 comes to an end, it is clear that the conversation about vaccines and vaccine policy is far from over. This year began with the World Health Organization (WHO) declaring vaccine hesitancy as one of the greatest threats to the health of children. As the year continued, the evidence in support of this warning came clearer as the number of measles cases in the U.S. and around the world continues to climb to levels not seen in three decades.

Arizona trends seem to align with the concerns of WHO. Our medical community noticed an increasing number of parents raising concerns about vaccines. Our hospitals report a rising number of parents refusing the birth dose of Hep B. Our TIPS trainers traveling the state hear from local practices that concerns about vaccines and autism are still the most common question raised by parents. These beliefs lead to vaccine hesitancy and create challenges for physicians. Do these questioning parents understand the value of vaccines as a preventive health strategy?

This trend is reflected in the numbers too. Arizona Department of Health Services tracks the number of children exempted from vaccines in childcare, kindergarten and 6th grade in Arizona schools.  Only 66% of Arizona’s infants and toddlers have the recommended vaccines they need (Fig 1) and the numbers of exemptions have increased year over year (Fig 2), eroding the level of community immunity in many of our classrooms. The statewide number sits at 93.3% suggesting that herd immunity in many of our classrooms is at risk.

Figure 1

Figure 2

Who is at risk of this trend? In the short term, very young children yet unimmunized, children with fragile immune systems and those who cannot be vaccinated. In the long term, the broader community as pockets of unimmunized persons become vulnerable to diseases.

This is what has happened in Samoa as measles spreads rapidly in a community that has low vaccine acceptance. An incident of human error two years ago resulted in the death of two infants raising doubts about the safety of vaccines. The government responded by suspending the vaccine program while it investigates the incident. Though the investigation showed an improper additive mixed into the vaccines caused the deaths, distrust in vaccines continued.

As vaccine hesitancy goes up and herd immunity goes down we need to do everything we can to protect the most vulnerable with particular attention to pockets of at risk in communities, our youngest and most susceptible patients.

Diseases as common as yearly influenza are still a threat to our kids.  This year’s flu season has 300% more cases than this time last year with B as the predominant strain.  We have already had our first pediatric death for the 2019/2020 season and the CDC is reporting 1/3 of flu-related hospitalizations are in pregnant women   We know pregnant moms, babies and toddlers can have severe complication from flu that leaves them vulnerable, yet we only protect 55% of kids under 18 with a vaccine and less than half of women are offered a flu shot during pregnancy.

Individuals with developmental disabilities have a higher rate, overall, from complications of the many diseases that we now have vaccines for. The influenza vaccine is probably the most important vaccine that they can receive, with the complications of pneumonia and organ shutdown being major issues. Unfortunately, these individual’s immunization rates are less than the general population. Part of this problem is perceived pain hypersensitivity and anxiety, especially with individuals with Autism Spectrum Disorder. Using a variety of distraction techniques and local skin creams such as EMLA Cream have been found to be successful in giving a vaccine. 

– AD Jacobson, MD, Past Board Chair TAPI

It’s difficult to overestimate the importance of community/herd immunity when considering the overall health of Arizonans.  While the benefits of vaccines far outweigh the risks, we must remember that risks do exist, and as such, there will always be those who cannot, or do not, vaccinate.  Given that, we must rely on herd immunity to protect the larger population- especially infants who are too young to fully vaccinate, those with a medical contraindication to vaccination, non-responders, and those who choose not to vaccinate.  It is that last group that we can impact with positive, scientifically accurate information.  This year’s measles outbreaks in the US of 1,276 cases, and the ongoing outbreak in Samoa with 4,693 cases, give us an indication of what to expect if we are not vigilant in our efforts to be advocates of education about the value of immunization, and the risk of complacency on the topic.

– Andrea Houfek, MD, Board Chair, TAPI

Vaccinate with confidence!  Study after study showcases that vaccine confidence is tied to a strong provider recommendation.  Your patients trust you and follow your advice.  Use of presumptive language when talking about vaccines increases patients’ confidence in vaccines and the likelihood of follow-through – “You’re due for your flu and Tdap vaccine today”.  Recommend, administer and recall to protect your patients from preventable diseases.

Your recommendations carry weight in other areas as well.  Our Arizona Legislature convenes for the 2020 session on January 13th. We have seen the anti-vaccine advocates at the Capitol, at the Arizona State Fair and at the airings of VAXXED II. They have champions at the legislature in Representatives Nancy Barto, Frank Carroll, and Kelly Townsend, and have worked through the interim to build larger networks of concerned parents. This week Rep. John Fillmore introduced a bill to strip away school vaccine requirements replacing them with recommendations for vaccines as parental options. TAPI will work to respond with a unified voice of opposition from the medical and public health communities and will value the expertise you bring to those conversations.

Visit for AZ specific patient and staff materials, plus links to CDC, IAC, and CHOP recommendations and resources.

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