“It takes a single imported case to be brought into a low-immunization county to cause an outbreak.” Dr. Natasha Bagdasarian, Michigan chief medical executive.
Recent data from the Michigan Department of Health and Human Services shows that 91% of kindergarteners in 2022 were up to date on their vaccinations, while rates of younger ages are seeing a decline. Particularly in a post-COVID age, local public health organizations are working closely with health care providers, schools and families in order to tackle why school-aged kids are or are not getting their vaccines. 

Dr. Natasha BagdasarianMichigan chief medical executive Dr. Natasha Bagdasarian says that one possible reason for a decline in rates could be that many millennial-aged parents have not personally experienced or lived through diseases like typhoid and diphtheria because of the effectiveness of their associated vaccines, leading them now to believe they don’t need to vaccinate their children against these diseases. 

“Public health is a victim of its own success, so to speak,” says Bagdasarian. “People just aren’t seeing the consequences of some of these diseases, so they choose to not get vaccinated. When you make a choice like that, not only are you putting your child and family at risk, you’re putting your community at risk.”

Bagdasarian mentions other possible reasons for the vaccination rates MDHHS is currently seeing, for example, the vaccination requirements presented by schools in order to get students registered for kindergarten. Also, COVID prevented many students from going to school in person and they are still attending school virtually or have opted for homeschooling. Bagdasarian stresses that vaccinations at this age are integral to keeping communities healthy and to prevent outbreaks of diseases like measles. 

“What could be a mild disease in someone could have very serious and long lasting effects in another individual,” she says. “It’s important to recognize the impact on us and those around us.”

Trust, or a lack of trust, in public health organizations also seems to be playing a large role in vaccination rates. Senior advisor at the Center for Health and Research Transformation (CHRT) Marianne Udow-Phillips mentions COVID not only had an impact on health and the way individuals view their own health, but also the way they view and trust public health. 

“Trust is so foundational,” says Udow-Phillips. “The problem with this decline and trust in public health is it leads to people choosing not to follow public health guidance as much as they might have if they had more trust.”

An Ottawa County Department of Public Health children's vaccination event.
Both Bagdasarian and Udow-Phillips cite misinformation and disinformation as playing a significant role in the declining trust in public health. Udow-Phillips says seeing lower vaccination rates is “not surprising” with lower rates of trust in public health. 
 
“In 2009, the public rated high trust and high confidence in public health nationally, and there was a 10 point decline during the pandemic,” says Udow-Phillips. “When you get that kind of decline in trust you see a similar decline in following public health guidelines.”

In the State of Michigan, parents and families looking to enroll their children in school for the first time have a number of vaccination requirements to meet before they can register their students. Parents can opt out of the requirement by applying for a waiver. However, waiver requests fluctuate just as much as vaccination rates do. For example, Washtenaw County Health Department administrator Susan Ringler-Cerniglia says that while Washtenaw County tends to see higher rates of vaccination and acceptance of vaccines than other areas of the state, she and others at the health department are seeing an uptick in families who are applying for vaccination waivers.

“We don’t know for sure if more people are declining than in the past or if we are leveling back to where we were before, prior to the pandemic, when regulations in Michigan changed and made it more difficult to opt out of vaccinating school-aged kids,” says Ringler-Cerniglia. 

Ringler-Cerniglia mentions that although Washtenaw’s overall childhood vaccination rates are on the higher end, barriers like reliable transportation and language still present themselves to some families with school-aged children. While she recognizes that vaccine-related misinformation circulated during and after the pandemic has played a part in current vaccination rates, she hopes that as families get used to the post-pandemic “new normal,” Washtenaw County and the rest of Michigan will see an increase in vaccination rates. 

“I think we’re optimistic that hopefully most of what we’re seeing is about interruption and not a change in trust of vaccines,” says Ringler-Cerniglia. “Even beyond the idea that you couldn’t get routine appointments, we’re all changed by the fatigue from illness or losing loved ones. Recovering from that doesn’t happen overnight.”

Kerri Hudson, David White, Lupe Cervantes, and Susan Ringler-Cerniglia at a 2021 Washtenaw County Health Department vaccine clinic.
Ringler-Cerniglia explains that Washtenaw’s health department not only works closely with area schools in order to provide up-to-date vaccine information and vaccine clinics for incoming students but also by reaching out to parts of the community with statistically lower vaccination rates in order to make the health department as accessible as possible. Services like its  mobile unit and frequent information events for community members are two steps Washtenaw County Health Department has taken. Ringler-Cerniglia also mentions that in order to provide these additional services to the community, the department’s facilities need funding and staff. Public health is among the many industries in desperate need of a post-pandemic workforce. 

“As a health department, we do a lot of work to share info with community members and make that info as accessible as possible,” says Ringler-Cerniglia. “Staffing our clinics has been a huge challenge to doing some of these things we want to do in the community.”

At both the state and county levels, public health officials in Michigan are in agreement that childhood vaccines are vastly important to the health of students and to their greater community. Immunizations are heavily researched and updated with each year to ensure the highest percent efficacy. As families become more accustomed to post-pandemic life and rebuild their trust in public health institutions, public health officials hope to see Michigan’s school-aged vaccination rates continue to grow.

“It takes a single imported case to be brought into a low-immunization county to cause an outbreak,” says Bagdasarian. “When we’re dealing with transmissable diseases and vaccines with high efficacy, it really becomes sad that we aren’t able to prevent outbreaks.”

For more information on Michigan’s most recent immunization rates and up-to-date information regarding vaccines, visit michigan.gov/mdhhs. 

Rylee Barnsdale is a Michigan native and longtime Washtenaw County resident. She wants to use her journalistic experience from her time at Eastern Michigan University writing for the Eastern Echo to tell the stories of Washtenaw County residents that need to be heard.

Lead photo and Washtenaw County Health Department by Doug Coombe.
Dr. Natasha Bagdasarian photo courtesy MDHHS.
Ottawa County Health Department photo courtesy Ottawa County Health Department.
Masthead photo Yan Kruka via pexels.com.
List photo courtesy the CDC via Pexels.com. 

The Yours, Mine, and Ours — Public Health series highlights how our state's  public health agencies keep us healthy, safe, and informed about issues impacting physical and mental health in our communities, homes, workplaces, and schools. The series is made possible with funding from the Michigan Association for Local Public Health.