Undervaccinated children also a public health concern

This article originally appeared in the San Jose Mercury News

The recent measles outbreak has raised the temperature of the vaccination debate, vaulting it into the public policy arena. 

But while politicians and health officials ponder whether California should continue to allow parents to refuse vaccines for their children based on personal belief, there is another category they have overlooked – an all-but-invisible school-age population — the under-vaccinated.

Across the state, schools are admitting kindergarteners without all their shots. According to an analysis of state data by the CHCF Center for Health Reporting, some public and private schools in the Bay Area and in Los Angeles report more than 80 percent of kindergarteners enter school not fully immunized. And it is NOT because of the raging parent choice versus public health debate. It is because state law allows under-vaccinated children – children who have started but not completed their inoculations — to enter school as “conditional entrants.” 

Each fall, schools record these “conditional” students, sending the tally to the state alongside numbers for children who are fully vaccinated and those who, for medical or personal belief reasons, are unvaccinated.

But after that early fall report, what happens? 

We don’t know.


There is no additional data submitted to show whether those under-vaccinated students ever complete their inoculations.

By law, schools are supposed to make sure that conditional students get the rest of their shots. But there is no required reporting back to the state — or any other health agency.

Some schools may follow up; some may not. We don’t know. 

It is wholly possible that a student – or 80 percent of a kindergarten class at a school – may drift through the entire school year under-vaccinated.

One can only imagine the possible consequences.

We do know from history that vaccination sends infection rates plummeting. We know that a little more than 60 years ago, America reported almost 800,000 cases of measles in one year, with about 50,000 hospitalizations and 500 deaths. Many of those who died were children. 

We know that after the introduction of the measles vaccine in the 1960s, the number of cases immediately plunged, and that by the end of the century public health officials confidently pronounced the eradication of measles in America.

But now the window of infection has been pried open again, with the public’s attention focused on the unvaccinated.

Some physicians are refusing to treat unvaccinated children. Some schools reporting measles cases have barred unvaccinated students from attending until the outbreak passes. And now, two California legislators, Senators Richard Pan (D-Sacramento) and Ben Allen (D-Santa Monica), have proposed eliminating personal belief as a reason for parents to refuse to vaccinate their school-aged children. 

But the “conditional” kids?

Alameda County’s Amy Pine, who directs its immunization program, knows that “conditional” students aren’t being looked after and need to be brought up-to-date. 

“We have a conditional entrant problem here,” she told the Center. “They’re not immunized, they’re not protected.”  

Pine is focusing on it, looking into better ways for her county’s schools to follow up. But she is one health officer in one California county.

Is it too much to ask the state to require a second report on this public health issue, one that demands schools show evidence of following up, and that comes with a sanction if they don’t? Shouldn’t parents know how many under-vaccinated kids attend their child’s school? 

With infectious disease again on the loose, we need to know.

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