In late August, Missoula Public Health nurse Abbie Kalemba ran through the pitch she made to seventh graders at a public back-to-school immunization clinic.
“Well, today you are due for one vaccine that you are required to have for middle school, which is your tetanus vaccine. It’s the Tdap, but you’re also due for two other vaccines; your HPV and meningitis or meningococcal vaccine.” Kalemba said.
Kalemba calls this three-vaccine combo the seventh grade special. Most families visiting the public clinic want all three vaccines, though only the Tdap is required by law.
“So you will be getting three pokes total today. I think the hardest part is just to receive the shot, but you should feel totally cool later,” Kalemba said.
The back-to-school clinic is one way Missoula Public Health encourages vaccination, despite a nationwide dip in immunization rates. The Centers for Disease Control and Prevention (CDC) reported that immunization rates in kindergartners fell by 1% between the 2020 and 2021 school years.
Montana Public Health Institute CEO Matt Kelley believes access isn’t the main issue.
“It’s about attitude. It’s about information. It’s about misinformation in some cases,” Kelley said.
In Montana, parents can submit a medical or religious exemption if they do not want their child to receive a required vaccine. In 2020, nearly 400 kindergartners used this option to opt out of the four required immunizations for once-common diseases like measles, polio and chickenpox. That places Montana well above the national rate for vaccine exemptions.
Medical exemptions require the signature of a health care provider attesting that the child cannot safely receive a vaccine due to allergy, immunodeficiency or other medical issues. CDC data shows that only about 0.2% of schoolchildren use medical exemptions each year.
Religious exemptions are easier to get.
In prior years, Montana parents had to sign and notarize a form stating a religious opposition to one or more of the required vaccines. This year, it’s even easier.
“If we could really just mind our own business on this, it’d be great,” Rep. Jennifer Carlson of Manhattan said.
Carlson carried House Bill 715, passed by Republicans in the state Legislature. It removes the notary requirements and mandates that schools provide information on how to obtain a religious or medical exemption.
Carlson said these changes are necessary to protect the privacy of individuals.
“The law now says you can’t continue to lie to people about vaccine requirements and we shouldn’t be discriminating against people based on their medical decisions that are truly none of anyone’s business,” Carlson said.
“The law now says you can’t continue to lie to people about vaccine requirements and we shouldn’t be discriminating against people based on their medical decisions that are truly none of anyone’s business,” Carlson said.
Proponents from across Montana voiced support at an early hearing for the bill, including Jessica Kirkendall from the Flathead Valley.
“Every child has different genetics, history and different daily nutrition, so one size never fits all and risk versus benefits must be personalized to each child,” Kirkendall said.
But Matt Kelley said vaccines don’t only protect individuals, they also prevent individuals from spreading disease. He recalled working as the Gallatin County health officer during outbreaks of infectious diseases like measles, mumps and pertussis.
“The level to which the people in that school are vaccinated is directly related to the amount of disruption that you have in trying to keep people safe once you have the disease,” Kelley said.
Researchers often refer to the term "herd immunity" when speaking about vaccines. When a group of people has high vaccination rates, infectious diseases are far less likely to spread. When vaccination rates fall, the danger of catching a disease increases, even for those who are vaccinated.
“It’s a decision that, you know, objectively impacts not only them, but it impacts all the people around them,” Kelley said.
“It’s a decision that, you know, objectively impacts not only them, but it impacts all the people around them,” Kelley said.
Other states are strengthening the requirements for non-medical exemptions in response to outbreaks of diseases like measles. Four states removed personal or religious exemptions. Three others strengthened education about the benefits of vaccines.
The use of vaccine exemptions declined in several of these states following such changes, but whether the reverse will be true for Montana remains to be seen.