Gov. Jared Polis has signed an executive order aiming to increase vaccination rates in the state.
“We all know why we are here and what the problem is,” Polis said Thursday during a press conference at an urgent care center for children in downtown Denver.
According to the Centers for Disease Control and Prevention, Colorado has the lowest kindergarten vaccination rate in the country among the 49 states that report measles, mumps and rubella (MMR) immunization. Polis said in recent years vaccination rates have dropped for MMR, hepatitis B, polio and chicken pox.
“With most of the vaccinations that are recommended nationally, Colorado is moving the wrong direction,” he said.
Among other things, the order requires the Colorado Department of Public Health and Environment to identify the cause of low immunization rates in certain communities, start an annual outreach campaign to “address vaccine hesitancy” and study the effectiveness of local vaccine drives and immunization clinics based at schools, community centers or mobile units. It also directs state health agencies to come up with policies that will improve access to vaccines among those covered by Medicaid, and improve data on vaccination in underserved communities.
“We really view this as the third way between the government forcing people to get shots, which is counterproductive, and simply allowing these rates to go down, which is counterproductive to the public health and will result in people dying,” Polis said.
The Mountain West News Bureau found that there are hundreds of kindergarten classes and schools that are vulnerable to an outbreak of the measles because of their low immunization rates.
“The experts describe it as if it’s a puddle of gasoline waiting for a match to be thrown on,” State Rep. Kyle Mullica said at the press conference. “This is a step in the right direction.”
As KUNC has reported, Mullica received death threats earlier this year after he wrote a bill that would have required parents to fill out a standardized form and visit a public health office to opt their children out of vaccines for non-medical reasons.
Suzana Deng was present for some of the debate around that bill, which included a number of vehemently anti-vaccine voices.
“They would say, ‘You need to stop the government from interfering in our lives,’ that the vaccines are full of poison,” said Deng, who recently completed a master’s degree in Strategic Leadership in Healthcare Organizations, in addition to a public policy fellowship with pediatrician and State Rep. Yadira Caraveo.
“I was also very surprised by the way some people were equating the bill with the government coming to get [their] information,” she said. “I remember one witness talking about how this was the same thing that was done to the Jews in Germany. It was kind of shocking.”
Deng trained as a medical doctor in Sudan before moving to Colorado 20 years ago. She said one night during her pediatrics rotation at a hospital near Khartoum showed her firsthand the tragedy that can come from a lack of immunization, in this case the meningococcal vaccine.
“There was an epidemic of meningitis and we had kids who were basically coming with convulsions, who were basically subconscious, with seizures,” says Deng. “I literally signed 11 death certificates that night. It was very traumatizing.”
A recent study from Brigham Young University in Utah found that having vaccine-hesitant college students interview people who had survived vaccine-preventable diseases resulted in improved attitudes toward vaccines. (So did intensive coursework on vaccine-preventable diseases).
“People don’t feel threatened by infectious disease,” said Lindsay Diamond, who runs a nonprofit based in Boulder called Community Immunity and is a molecular biologist by training.
She said Thursday the executive order seemed to happen quickly and without much consultation with a major group of stakeholders: parents.
“As a scientist, there is proof in the literature that changing legislation improves vaccination rates,” she said. “There is not that same level of proof about executive orders.”
Diamond paid for a billboard in Boulder County to promote immunizations and was named an Immunization Champion by the CDC.
“It falls short of what legislation can do,” she added.
Diamond says Polis’ order doesn’t seem to address convenience exemptions, a term used to describe scenarios in which a parent gets their child a vaccine exemption primarily because school is about to start and they can’t a pediatrician appointment in time.
“There have been studies that show that when you make it a little bit difficult to get an exemption, you start to close the loophole on convenience exemptions,” she said. “And that is something an executive order cannot do.”
There’s some debate about what policies lead to higher public health protection.
In 2016, California eliminated non-medical exemptions. Researchers writing recently in the journal Pediatrics found that after the law went into effect, an uptick in the number of homeschooled students and in the number of students with medical exemptions took a bite out of gains in vaccination among incoming kindergartners.
“Previous geographic patterns of vaccine refusal persisted after the law’s implementation,” the authors wrote.
Measles was declared eliminated in the U.S. back in 2000. So far, more than 1,000 cases have been reported to the CDC this year, including in Colorado, Idaho, New Mexico and Nevada. It’s the greatest number of cases since the year 1992. The World Health Organization has named vaccine hesitancy among the top ten threats to global health.
Correction: The story originally said that homeschoolers and medical exemptions "canceled out" gains in vaccination after a California law was passed. It was corrected to say they "took a bite out of" such gains.