By Diana Lambert, Daniel J. Willis and Yuxuan Xie | EdSource
More than 500 California public schools are being audited by the state because they reported that more than 10% of their kindergarten or seventh-grade students were not fully vaccinated last school year. Schools that allow students to attend school without all their vaccinations are in jeopardy of losing funding.
The audit list, released by the California Department of Public Health, includes 450 schools serving kindergarten students and 176 schools serving seventh graders with low vaccination rates. Fifty-six of the schools serve both grade levels. Another 39 schools failed to file a vaccination report with the state.
“Schools found to have improperly admitted students who have (not) met immunization requirements may be subject to loss of average daily attendance payments for those children,” the California Department of Public Health said in an email.
Students who are overdue for their vaccinations or who have been admitted to schools conditionally while they catch up on vaccines are not fully vaccinated, according to the state. Students who are in special education or have a medical exemption are not required to be vaccinated.
California law requires school staff to report vaccination rates to the state each fall and to check up on those catching up on vaccinations while attending school at least every 30 days. If the student who is catching up on their vaccines does not have a second dose of a vaccine within four months of the first dose, they must be excluded from school, according to a state audit guide.
“After the personal belief exemption was gone, we found a significant number of schools were behind on their reporting and were allowing a lot of conditional admissions and weren’t following up,” said Catherine Flores Martin, director of the California Immunization Coalition.
More than 30 Oakland Unified schools make audit list
More than half of Oakland Unified’s 48 elementary schools and eight of its schools serving seventh graders are on the audit list for 2022-23. This includes Markham Elementary where 65% of the 66 kindergarten students were not fully vaccinated last school year. The school had the highest percentage of kindergartners in California’s traditional public schools — with over 20 students — who were not fully vaccinated.
Of the 27 Oakland Unified elementary schools on the list, more than 20% of kindergarten students in a dozen schools did not have all the required vaccinations last school year.
Oakland Unified district spokesperson John Sasaki did not comment on the audit list for last school year by publication time. Previously he told EdSource that lower vaccination rates at some schools in 2021-22 were due, in part, to the difficulty families had getting medical appointments during the pandemic, and a district backlog logging vaccinations.
The Bay Area district isn’t the only large school district struggling to get students fully vaccinated, according to state data. Los Angeles Unified has 75 of its non-charter schools on the audit list, while Pomona Unified has 13, San Francisco Unified 14 and San Juan Unified in Sacramento County eight.
Pandemic still affecting school vaccination rates
The state’s vaccination rate, which had grown steadily since the state eliminated personal belief exemptions in 2015, plunged in the months after the Covid-19 pandemic closed schools. Thousands of California students were unable to start the school year in 2022 because they did not have their immunizations.
The state did not relax vaccination requirements during school closures, but not all school officials cooperated with the requirements, Martin said. She isn’t sure that has changed.
“Some schools may be out of practice and, in some areas, their leadership has changed and it isn’t a priority,” she said.
The state’s kindergarten vaccination rate was 92.8% in 2020, down from 95% in 2018. But districts sent information about vaccinations home and held vaccination clinics and made up some ground. In 2021 the vaccination rate rose to 94%.
A vaccination audit has been part of the state’s annual financial and compliance audit of public schools since the 2021-22 school year, according to the California Department of Public Health. That year the vaccination audit found that 45 school districts did not meet state vaccination requirements. Seventeen were further reviewed for potentially allowing students to attend school unvaccinated, said Scott Roark, spokesperson for the California Department of Education.
Schools in violation of the state law must submit corrected attendance reports that reflect the reduction in average daily attendance cited in the audit finding, which will likely reduce their funding, Roark said.
Parents opposed to vaccines are often drawn to charter schools
Parents against vaccinations found few options for their children as California laws became increasingly more restrictive. Some decided to home-school their children or sought independent study or virtual learning options, mostly provided by charter schools. Students who learn from home without any in-person instruction or school-related activities are not required to be vaccinated.
About 90% of the state’s 1,300 charter schools offer in-person instruction to students, according to the California Charter School Association; 67 of those are on the 2022-23 audit list.
Of all California schools, Agnes J. Johnson Charter School in Humboldt County had the highest percentage of kindergartners who were not fully vaccinated last school year. Ninety percent of the 11 kindergartners still needed at least one vaccine. Mountain Home Charter in Oakhurst had the second-highest percentage of kindergartners — 83% — who were not fully vaccinated, followed by Gorman Learning Center – 76% – serving 140 kindergarten students in the San Bernardino and Santa Clarita areas.
Gateway Community Charters has been trying to improve vaccination rates at Community Outreach Academy by working with a nearby health care provider to offer immunization clinics for the students, and to ensure there is a nurse on-site daily. Despite that, almost a third of the 219 kindergartners who attended Community Outreach were reported as being behind on their vaccinations last fall.
Vaccination rates at the school, which have been low for years, began improving before the pandemic but decreased after schools closed and have remained low, said Jason Sample, superintendent of Gateway Community Charters, which operates the school.
Community Outreach Academy offers in-person instruction in buildings on a former Air Force base in Sacramento County. The school primarily serves the Slavic community, whose members are often suspicious of the government and vaccines, Sample said. Its enrollment ballooned to 1,200 students in recent years as refugees from Ukraine, Russia and Afghanistan moved to the Sacramento area.
Community Outreach Academy isn’t the only school in the Gateway Community Charter system on the audit list. Community Collaborative School, which offers both in-person and online instruction, had 39% of its kindergartners and 14% of its 42 seventh-grade students not fully vaccinated last fall. Two other schools run by the charter system — Empowering Possibilities International Charter School and Gateway International School — each had more than 28% of their students without all their vaccinations last school year, according to the audit report.
Empowering Possibilities International Charter lost average daily attendance funding for two students for three months of last school year after its audit was completed, Sample said.
Students who do not have all the required vaccinations are given information about the state vaccination guidelines to take home, Sample said. A health services team then reaches out to the family to connect them with vaccination resources. Students who still don’t provide proof of vaccination are excluded from school, he said. The charter system has a non-classroom-based virtual academy as an alternative until students are up-to-date on their vaccinations.
Vaccine hesitancy has hurt vaccination rates
Vaccine hesitancy has helped to reduce vaccination rates across the country and sparked outbreaks of infectious diseases, including measles outbreaks in Disneyland in 2015 and another Ohio in 2018. Last year, 121 cases of measles were reported, up from 49 cases in 2021, according to the Centers for Disease Control and Prevention.
A UNICEF report released in April shows that 67 million of the world’s children missed out on one or more vaccinations between 2019 and 2021 because of strained health systems, scarce resources, conflict and decreased confidence in immunizations. The report says that while overall support for vaccines remains strong, vaccine hesitancy seems to be growing.
Vaccine hesitancy stems from growing access to misleading information, declining trust in expertise, uncertainty about the response to the Covid-19 pandemic and political polarization, according to the report.
Bernardo Lafuente said he isn’t worried his son, Gavril, will be infected by measles or other childhood diseases. He doesn’t trust reports about outbreaks.
“I don’t believe what they are saying. I don’t believe it,” he said. “We don’t see an epidemic. I haven’t seen anyone with measles or smallpox; they are virtually nonexistent in America.”
Lafuente and his family left California in 2018, in part, because of its vaccination requirements and moved to Nevada where vaccines are not required to attend school.
“The government in Nevada pushes vaccination of not just kids, but everybody, but in Nevada we have a choice,” Lafuente said.
Gavril, now in fifth-grade, had some vaccinations when he was younger. His father set up a schedule he devised, instead of the vaccine schedule endorsed by the CDC. But he doesn’t intend for his son to get any more.
“He’s vaccinated except for boosters,” Lafuente said. “I’m not against vaccines if someone else wants to get them. I’m personally against vaccines. I don’t think everybody should have to get a vaccine, unless there is an outbreak, but even then, it should be a choice.”
Pockets of unvaccinated students dot most districts
Even districts with high overall vaccination rates often have schools that have vaccination rates low enough to land on the audit list. In 2021, the last year overall student vaccination rates were available, 95% of Sacramento City Unified students were fully vaccinated. Yet last school year, it had eight schools on the audit list.
“We encourage everyone to get vaccinated,” said Susan Sivils, lead nurse for the Sacramento City Unified vaccination clinic. “If they are opposed for any reason, we follow up. The vast majority of people are not opposed to getting their vaccinations.”
The district is working to increase its vaccination rates with weekly free vaccination clinics throughout the year and two weeks of clinics before the beginning of the school year. In an effort to get more students vaccinated, the district increased the number of vaccination clinics last year and called parents directly to make them aware of the vaccination requirement and clinics.
Cecilia Reyes and her older sister Chzaray, nervously waited for their turn at a vaccination clinic at the district headquarters on Aug. 22. Cecilia was preparing for her first day of kindergarten, but this would be the first time she got a vaccination. The Covid pandemic prevented the family from getting needed appointments, her mother said. Chzaray, who would be entering seventh grade, would need four shots to be up to date. The girls may need several appointments before they are fully vaccinated.
The Sacramento City Unified vaccination clinic immunized about 50 students that day in preparation for the first day of school. The number of students who visited a district vaccination clinic skyrocketed from 1,154 in 2021-22 to 1,739 visits last year, Sivils said. Students who are uninsured or are on Medi-Cal qualify for the clinic.
Damien Burkholder blinked back tears as a nurse gave him his Tdap booster last Tuesday. The shot is required for all seventh-grade students. His mother, Vanessa Martinez, had tried to get Damien an appointment for the shot with the family’s primary physician but would have had to wait a month.
“This is very convenient,” Martinez said of the clinic. “He would have had to miss a whole month of school if this weren’t here.”
CALIFORNIA’S SCHOOL VACCINATION REQUIREMENT
Parents do not have to immunize their children. But under the law, children must be immunized against 10 serious communicable diseases — diphtheria, Haemophilus influenzae Type B (bacterial meningitis), measles, mumps, pertussis (whooping cough), polio, rubella, tetanus, hepatitis B and chickenpox — if they want to attend public or private schools and child care centers.
Families are asked to show proof of vaccination when their child is first enrolled in the district, and at kindergarten and seventh grade. Students in special education or with medical exemptions don’t have to be vaccinated.
School vaccination legislation
California has mandated school vaccinations for decades, but recent legislation has made the shots harder to avoid.
Senate Bill 277: A measles outbreak tied to a case at Disneyland in 2015 prompted lawmakers to pass legislation eliminating the personal and religious belief vaccine exemptions.
Senate bills 714 and 276: These two pieces of legislation require the review of medical exemptions at schools with immunization rates below 95%, or if a doctor has written more than five medical exemptions in a year.