Neglected shots raise questions

When lawmakers added a pair of vaccinations two years ago to the list of those schoolchildren are required to get, they thought there would be plenty of time for everyone to get their proper shots.

But when a deadline passed last week, 12,000 students without proof of the hepatitis B and chickenpox vaccines were excluded from school - despite a three-month extension and two-week grace period.


Officials were left scrambling to get the students into compliance, while scratching their heads to figure out what went wrong.

This wasn't what Paula C. Hollinger, a former state senator from Baltimore County who chaired the committee that was responsible for the latest vaccine requirements, envisioned. Hollinger was shocked that so many students are still out of compliance.


"I thought at one point that we were heading in the right direction," said Hollinger, who has worked as a nurse and is the former chairwoman of Senate Education, Health and Environmental Affairs Committee.

There was an appreciation that requiring the 280,000 student in the state through ninth grade to receive the shots would be a large undertaking. But supporters of the additional requirements, such as Hollinger, were taken aback that thousands of students would miss the deadline.

The legislation establishing the new vaccine requirements was passed in 2005. The deadline for compliance was originally the beginning of the 2006-2007 school year. It was later extended to Jan. 1, but students with a scheduled appointment to receive the vaccines were permitted to attend classes for two additional weeks. But even that was not enough to get every student into compliance.

School systems are usually able to inoculate all students in a few months, according to Dr. Neal Halsey, a professor in the department of international health at the Johns Hopkins Bloomberg School of Public Health.

"A vast majority of states now have highly effective programs to evaluate children coming into the schools and to work with parents to get them immunized," said Halsey, who has written several articles about school immunization requirements.

He could not pinpoint what caused the breakdown in Maryland.

Hollinger, who gave up her state Senate seat for an unsuccessful run for Congress, said clinics should have been set up at schools and nurses should have been able to administer the shots when students arrived on the first day of school.

"Why were those kids in school to begin with?" Hollinger asked. "The first day of school is when this should have happened."


Health and education officials at the state and local levels defended their efforts, saying they mailed letters to students' homes, called parents, scheduled vaccination appointments, held conferences with students and set up clinics.

Some officials have blamed procrastinating parents, a lack of nurses and a delay in funds that would have provided accessible health clinics.

Greg Reed, the program manager for the state health department's Center for Immunization, said that if he had received $1.3 million in state funding last January - when school systems sent out letters informing parents of the new immunization laws - instead of waiting until September, he would have been able to set up free and reduced-priced vaccines before the school year began.

"Having more clinics and later hours would have helped earlier on," Reed said Tuesday. "The funding was not there to make that happen."

State and local officials have said that there has been no common thread among the excluded students, though Reed said that the students have "procrastinating parents."

Halsey also said the parents share in the blame.


"They have been informed several times," he said. "The state has bent over backward to get people immunized."

Recent numbers show progress in getting students back to school. At the end of last week, Baltimore City had 3,802 students still excluded; Baltimore County had fewer than 250; Harford fewer than 100; Howard County was down to 59; Anne Arundel had 52; and Carroll County reported 2.

Reed said it is too early to evaluate the methods used to achieve compliance.

"We need some time to find out from [local health departments] what their experiences were," he said.

Overall efforts to get students inoculated were good, Halsey said.

"I can't say that the state or the schools have specifically done anything to drop the ball," he said.


District of Columbia public schools faced a similar problem five years ago. At that time, 41,000 of the system's 58,000 students were not fully inoculated by the start of the new school year. A 40-member task force - made up of health care providers, school employees and parents - was quickly formed.

The task force began to analyze data, sponsor health fairs, send mobile clinics into neighborhoods and consistently contact parents of students who had not received vaccine.

The task force also provided incentives such as coffee and lollipops to attract families, said Jennifer Ragins, school health policy officer for the District of Columbia public schools.

"The idea is not to be punitive against the parents," Ragins said. "It is hard for working parents to get the kids to a doctor."

By 2004, the number of students who were out of compliance had been reduced to about 6,000.

When schools opened in August, about 1,000 students were not inoculated.


"Keeping the network together is critical," Ragins said.