At Public Health of Delta and Menominee Counties, registered nurse Haille Van Steen, right, prepares to administer a vaccine to 13-year-old Laylee Nikcevich of Escanaba. (Escanaba Daily Press photo)

ESCANABA — The state of Michigan allows guardians to choose whether or not to immunize their children, even when enrolled in pubic school.

Schools collect medical data and request that vaccines are administered according to the Center for Disease Control’s guidelines, but an alternative option is the submission of a waiver, which can be used for one or multiple vaccines.

In Delta County, the highest student vaccination rates last year were seen in Gladstone and Bark River-Harris. Elsewhere in the Upper Peninsula and statewide, however, immunization rates have been plummeting since 2020, and without herd immunity, diseases that were nearly eradicated have resurfaced.

Schools must hit a benchmark of 90% of its student body compliant by Nov. 1 and 95% compliant by Feb. 1. However, “compliant” doesn’t mean vaccinated — it means either vaccinated or with a form stating the guardians are electing to forgo vaccination. If a school doesn’t meet those compliance rates by the given dates, 5% of funding from the Michigan Department of Education is withheld. Records are collected by schools at the kindergarten level, at the seventh-grade level, and when students transfer in.

In some instances, medical conditions prevent children from receiving certain vaccinations, and in those cases, a physician needs to submit a medical contraindication form. But more common are waivers signed by parents who choose not to vaccinate for other reasons. In order to obtain such a waiver, a parent or individual “in loco parentis” (in place of a parent) must receive education on infection risks and vaccine benefits from the local health department, which then issues a certified waiver stating that the child’s guardian is making an informed decision. Only one guardian signature is required.

The Michigan Department of Health and Human Services Division of Immunization recently published data from the 2023-24 school year with the number of students vaccinated at each school across the state, drawn from the Michigan Care Improvement Registry.

The number of kids with waivers (meaning their caregivers chose not to immunize) was at its highest — 8.6% — in 2010 when more vaccine requirements were added. It fell to a low of 3.1% in 2015 when guardians began to be required to receive education from the health department before signing the waiver. It hovered around 3% to 4% until 2020, when childhood immunizations fell into general decline.

Every year since 2020, the number of students in Michigan whose guardians chose not to vaccinate has increased. Statewide, the number of students with vaccine waivers rose to 5.7% for the last school year.

Some communities have much higher numbers — in 109 schools across Michigan, more than 30% of kindergarteners are not up to date on vaccinations, which puts those communities at higher risk for transmission of dangerous diseases.

“When less than 70% of children are vaccinated in a particular community, pockets of low vaccination create an environment where diseases can take hold and spread. Public health officials are most concerned when children who have not yet received all school-required vaccines are clustered together in the same school building,” said public information officer Lynn Sutfin of the MDHHS. “From 2015 to 2023 … the number of Michigan middle schools with seventh-grade vaccination rates below 70% more than doubled (from 48 to 110 schools).”

Some of the lowest immunization rates are seen at private and Christian schools and in the lower-age range. Several U.P. counties made the list for having especially high numbers of not-completely-vaccinated toddlers.

Areas of the state with exceptionally low vaccination rates for children aged 19 to 36 months were Keweenaw County (37%), Oscoda County (38%), Mackinac County (54%), Houghton County (55%), Gladwin County (56%), the city of Detroit (56%), Lake County (58%), Clare County (59%), Sanilac County (59%, Baraga County (59%), and Delta County (59%).

Immunization Coordinator Jennie Miller with Public Health of Delta and Menominee pointed out that the desired minimum is 70%. The number of 13- to 18-year-olds in Delta County who are completely vaccinated is also well below that minimum, but it’s possible some people receive their shots late.

In Gladstone, where the MDHHS reported a relatively high immunization rate in 2023, school nurse Kathryn Sinclair said that only a very small fraction of parents opt out.

“I would say we saw a decline (in vaccination numbers) in the year or two post-COVID, in my experience due more to the lack of routine health care — well child visits and vaccine appointments — available during the pandemic than from hesitancy,” she said, estimating that regularly only between 1% and 1.5% of parents submit waivers actively choosing not to vaccinate. “Rates are back to normal now.”

The only vaccine-preventable illness seen in Gladstone Area Public Schools in the last six years has been chickenpox — and in every case, the children were unvaccinated with waivers on file, Sinclair said.

Seventy-six local cases of vaccine-preventable diseases have been reported in Delta and Menominee counties in the last five years, according to Miller.

“This included 21 cases of pertussis (whooping cough), 11 cases of Haemophilus influenza, five cases of chickenpox, one case of mumps and 38 cases of shingles,” she reported. “This number is actually low, because chickenpox and shingles are likely under-reported. In this time frame, we have also seen 14 cases of (hepatitis) B and one case of Hep A.”

Other vaccine-preventable diseases are also known to be circulating in the country. The first case of measles seen in Michigan in five years was reported in February, and since then, another six cases were confirmed. 2024’s whooping cough cases within the state are already double what they are in all of 2023, according to Sutfin. In 2022, polio — which had disappeared from the Western Hemisphere for many years — was contracted by an unvaccinated adult in New York state.

The following figures on local school immunization data have been obtained from the MDHHS.

Guardians for over 8% of schoolchildren waived their immunizations in Schoolcraft, Alger, Houghton and Ontanagon Counties for the 2023 to 2024 school year.

Last year at Bark River-Harris, 94% (33 of 35) of its 7th-graders were up-to-date on vaccinations, as were 90% of kindergarteners (47 of 52).

At Big Bay de Noc School, 92% of 7th-graders (12 of its 13) were vaxxed; so were 86% of kindergarteners (19 of 22).

At Carney-Nadeau, 88% (14 of 16) of 7th graders and 83% of kindergarteners (15 of 18) had been immunized.

At Escanaba Junior/Senior High School, 89% of 7th-grade students (127 of 143) were vaccinated; 93% of kindergarteners (138 of 148) at Webster Elementary School were.

In Gladstone, the number for 7th-graders was 93% (92 of 99), and 92% of kindergarteners at Cameron had received all their shots — 118 of 129.

In Manistique, 91% of 7th-graders (58 of 64) were vaxxed, and 90% of kindergarteners at Emerald Elementary were.

At Mid Peninsula School, 90% (18 of 20) in 7th grade had been immunized, and 83% (15 of 18) in kindergarten.

At North Central, 77% (17 of 22) of 7th graders and 76% of kindergarteners (28 of 37) were vaccinated.

“This is concerning as it means we, as a community, are less protected,” said Miller of the drop in vaccinations.

Teachers are not required to be vaccinated, although it is encouraged. Some schools host a flu shot clinic for staff — in addition to the other advised vaccines, most of which are to be administered in childhood, the CDC recommends an annual flu jab for anyone 6 months of age or older.

Most medical providers and pediatricians offer all the regular vaccines, as does the health department. In Escanaba, Public Health for Delta and Menominee (PHDM) at 2920 College Ave. hold vaccination clinics on Wednesdays by appointment. Their number is 906-786-4111.

Adolescents over the age of 18 can also get caught up on vaccines at the Center for Youth Health and Wellness at Bay College.

Next week, on Tuesday, Sept. 10 and Friday, Sept. 13, PHDM is offering flu shots between 9 a.m. to 4 p.m. with no appointment necessary.