Reasons range from our permissive school personal exemption law to gross over-regulation of Vaccines for Children providers by ADHS during the Ducey/Christ administration
Each year the CDC compiles vaccination data reported by schools across the country, giving us a pretty good picture of how well protected kindergartners are against diseases like measles compared to other states.
The new numbers came out this week, and you won’t be surprised to learn that the news isn’t good for Arizona.
Just 87.4% of Arizona kindergartners are up to date on their MMR vaccine, down from 88.6% last year. Arizona ranks 44th among the 48 states (who submit data). Only Utah, Minnesota, Wisconsin and Idaho had lower reported MMR coverage.
Vaccination Coverage and Exemptions among Kindergartners | Data | Centers for Disease Control and Prevention
Nationally, MMR coverage slipped to 92.4%.
That’s a long way from the roughly 95% coverage needed to provide community immunity against measles, one of the most contagious diseases around.
So, Why Is Arizona Doing So Poorly?
There isn’t just one reason.
One big one – probably the biggest reason – is our very permissive personal-belief exemption from school vaccination requirements. Arizona parents can simply opt their kids out of required vaccines based on personal beliefs.
But vaccine hesitancy and the resultant personal exemptions isn’t the only reason the whole story.
Another huge reason for our bad vaccination rates is that the Ducey/Christ administration grossly over-regulated doctor’s offices that participated in the Vaccines for Children program, which made it unnecessarily difficult for parents who did want to vaccinate their kids to actually be able to do so.
AZ Childhood Vaccination Rates Declined During the Ducey Administration: Is it Bad Luck or Bad Policy & Management?
Arizona schoolkids’ immunization coverage declines, new numbers show
Arizona Ran Off Half Its Vaccines for Children Providers
The federal Vaccines for Children (VFC) Program supplies vaccines for kids who otherwise might not be able to afford them, including children enrolled in Medicaid. ADHS manages the program here in Arizona.
During the Ducey administration, Arizona lost 50% of its VFC providers — falling from about 1,200 providers in 2015 to just 600.
By the time Ducey and Christ left Arizona had only 6 VFC providers for every 10,000 Medicaid-eligible kids. The national average was 24. In other words, Arizona had just one-quarter of the national average VFC provider capacity for Medicaid kids.
Why did so many providers quit VFC?
During former ADHS Director Cara Christ’s tenure, ADHS imposed a bunch of burdensome administrative requirements on VFC practices. One of the biggest problems was a punitive policy requiring providers to financially replace vaccine when their wastage exceeded certain levels.
Providers also reported cumbersome ordering and return procedures, difficulties working with the state’s immunization registry and an adversarial enforcement culture. A later assessment of Arizona providers confirmed that those administrative burdens and punitive practices were important barriers to participation.
The result? Doctors dropped out of VFC participation. And when doctors drop out of VFC, parents with kids on AHCCCS have fewer places to get their children vaccinated — including parents who very much want their kids vaccinated.
Today’s Kindergarten Numbers Carry Yesterday’s Baggage
The kids entering kindergarten now were babies and toddlers during the latter part of the Ducey administration, during the years when they’re supposed to be getting many of their routine childhood vaccinations. So today’s worse kindergarten vaccination numbers are partly because of decisions and actions at the ADHS Vaccines for Children program when Director Christ was in charge.
The Hobbs Administration Changed Course
The good news is that ADHS under the Hobbs administration eventually recognized the problem and made major changes to the VFC program in 2024 – and the bleeding of participating providers stopped.
Among other things, ADHS ended the controversial dose-for-dose restitution penalties, relaxed unnecessarily rigid operating-hour requirements, simplified temperature-monitoring requirements, clarified rules for mobile clinics and began taking a more provider-friendly approach.
Those were important changes and long overdue but we’re still digging out of the hole. But… once a pediatric or family practice quits VFC, dropping the rule that drove them away doesn’t automatically bring them back.
ADHS needs to continue aggressively rebuilding the VFC provider network, especially in communities where lots of kids are enrolled in AHCCCS.
At the same time, policymakers need to recognize that Arizona’s super-easy personal-belief exemption law continues to drive vaccination rates down.
Both need to be fixed.
Conclusion
Arizona now has the fifth-lowest childhood MMR vaccination rate among states reporting numeric estimates to the CDC. That means we’re more susceptible to measles and other vaccine-preventable disease outbreaks than just about anywhere else in the country.
Our permissive personal-belief exemption makes it super easy for parents to send an unvaccinated child to school. If Arizona wants vaccination rates comparable to better-performing states, the legislature will need to change that.
The second is access. For years ADHS made it harder than it needed to be for pediatricians and family practices to participate in Vaccines for Children. ADHS over-regulation ran off half the providers… and most of them haven’t been willing to come back.
The Hobbs administration has made a good start fixing the VFC mess it inherited. But rebuilding that network will take years – and it needs to be a top agency priority.
