Benchmark

There is a local cliché that Nevada is at the bottom of every good list and the top of every bad list. The state has an almost unbroken record of poor quality-of-life rankings in national standings.

So its success in immunizations is striking. From 51st in the nation in 2007, 48th in 2013, 38th in 2015, the state reached 31st in 2016.

In percentage terms, the state went from 51 to 62.2 to 67.7 to 71 percent immunization of those aged 19 to 35 months. That leaves Nevada just short of the national average of 72.2 percent.

In 2013, the Nevada State Health Division adopted a five-year plan with this goal:

“By 12/31/2017, improve Nevada’s immunization rate to at or above the national average for children 19–35 months of age, improve adolescent immunization rates on recommended vaccines, and improve adult immunization rates for influenza and Tdap [tetanus, diphtheria and pertussis].”

The state is closing in on that goal, now just 1.2 percent short of the national average.

Two factors that seem to help Nevada are that many vaccinations are free at health fairs and one-day clinics, and anti-vaccine activists are not well organized in Nevada.

In some areas, heavy publicity in earlier years of the rise in infectious diseases as a result of anti-vaccination efforts caused anti-vaxxers to lay low. But in some areas, they are again at work. In May, a virulent measles outbreak in Minnesota was attributed to anti-vaxxers. That news coverage was expected to reduce their activities, but instead they have been becoming more active, using social media to organize “measles parties” at which parents expose their unvaccinated children to children with measles in order to allegedly give them immunity.

“I’m shocked by how emboldened they’ve gotten,” Voices for Vaccines Executive Director Karen Ernst told the Washington Post. Voices is a parents group. “I think most people thought the anti-vaccine voices would sit home and lay low. … Instead, they became more public, they did more outreach.”

There is a webpage titled “Nevada’s VAXFAX” that is laced with false information. For instance, after noting that “vaccines contain … Mercury (thimersal [sic]),” it adds, “Mercury is the second most toxic substance known to man, according to the EPA.”

It does not give a citation, so there is no way of knowing who or what report at the Environmental Protection Agency is being quoted, making it difficult to sort out what is being argued here. But we do know that (1) yes, there are toxic forms of mercury, such as dimethyl mercury, (2) yes, there is mercury in thimerosal, (3) no, the mercury in thimerosal is not a toxic form but is ethylmercury, which passes through the body easily, (4) thimerosal prevents the growth of bacteria in vaccines and (5) thimerosal was removed from childhood vaccines in 2001 to calm parents’ concerns caused by anti-vaxxers.

Two Nevada anti-vax contacts are listed. We were unable to reach them.

Far from backing away from the need for immunizations in the face of opposition, Nevada this year increased the requirements. Starting with the 2017-2018 school year, public and private school students at the seventh grade level were required to receive the meningococcal conjugate vaccine and all first-year college students 23 years or younger had to produce proof of the meningococcal vaccination. In February, Immunize Nevada Executive Director Heidi Parker issued a prepared statement about the new requirements, emphasizing the benefits:

“Twenty-one percent of all meningococcal disease occurs in adolescents and young adults; so this requirement will not only lengthen the time for which immunized students are protected from vaccine-preventable diseases, but will also lower their chances of spreading it to infants, the elderly, classmates with weakened immune systems, and others.”

The free vaccination programs rely heavily on federal funding, and this is the eighth month of a two-year Republican Congress that has already adopted some proposed budget measures that cut the funding. All of the failed GOP alternatives to the Affordable Care Act contained cuts in immunizations. Parker says the current version of the budget “would go from $606 million to $556 million, based on the House FY18 Labor-HHS appropriations bill. This bill does not reflect all of the proposed funding level cuts in the president’s FY18 budget. His budget includes an $82 million cut to the immunization program.” Those are national figures, and there is no way to know what size of an impact will hit Nevada. The state has already lost about $224,000 in immunization funds. Will the state be able to sustain the progress it has made in the last decade in the face of the expected cuts?

The answer to that question is unclear. There are several related programs, but many of them area also federally funded.

“Now, I will also say, though, we … do fund-raise, and we work with partners like Renown Health and some of our NGOs [non-governmental organizations] like Silver Summit Health Plan, Amerigroup and the Health Plan of Nevada,” Parker said. “So they support our community events that we do, especially back to school, and their support actually helps us be able to serve whoever walks in the door.”

It’s unlikely that would make up for the loss of a substantial amount of federal funding, though.

As is so often true, Nevada has its own kind of problems.

“We have partners who might extend clinic hours,” Parker said. “We know not everybody works the traditional schedule in Nevada, and so we have industries that definitely parents are working non-traditional hours. We have clinics and providers that have made access to appointments easier, [some] bringing vaccines to the people in the community. So whether it’s a community event, whether maybe for back-to-school, maybe it’s at a mall, they’re kind of getting into those zip codes that we know need a little more access.”