UPDATED, 9:36 a.m. Friday, to correct statewide immunization rate.

Child immunization rates are low in the silver mining community of Wallace, and school district superintendent Bob Ranells is well aware of it.

There is no simple, single explanation.

School nurses are expected to manually load data for every individual student — and, as Ranells puts it, nurses went into their profession to help people, not to sit in front of a computer.

Other forces are at work. “Our people aren’t the greatest fans of government in this neck of the woods,” Ranells said.

The bottom line: Only 54 percent of Wallace’s kindergartners, first-graders and seventh-graders were considered “adequately immunized,” according to 2014 Department of Health and Welfare records. Only four of Idaho’s 115 school districts had a lower rate.

State health officials are concerned about pockets of low immunization rates that leave children susceptible to contagious diseases such as measles or whooping cough. But in Wallace, and similar communities, the numbers tell a complicated story.

Summarizing the statistics

Health and Welfare tracks immunization rates for kindergartners and first- and seventh-graders, based on data submitted by the schools. In 2014-15, 85.6 percent of students were adequately immunized. (Click here to download the report, and see how your local school stacks up.)

The good news: 85.6 percent represents Idaho’s best child immunization rate since 2010 — a year before the state tightened its kindergarten requirements and established requirements for seventh-graders.

The bad news: 85.6 percent falls shy of Health and Welfare’s 90 percent immunization goal. The higher the immunization rate, the less likely the outbreak of a contagious disease — and provides a measure of protection, even to students who aren’t immunized.

But across much of Idaho, schools are falling short of that 90 percent goal, according to a further analysis of the state’s report:

• Idaho Education News calculated district-by-district immunization rates, totaling the numbers for kindergartners, first- and seventh-graders. Overall, only 38 of Idaho’s 115 school districts hit the 90 percent mark. (Click here to download our spreadsheet.)
• Numbers were slightly worse at the kindergarten level. Only 36 districts had a kindergarten immunization rate of 90 percent. Last fall, fewer than half of the state’s kindergartners entered a public school that met Idaho’s immunization goal.
• The numbers were even lower for the state’s charter and private schools, where overall immunization rates came in at 80 and 76 percent, respectively. Only seven of Idaho’s 34 charter elementary schools had a 90 percent kindergarten immunization rate.

Reporting issues

The numbers are grim, but are they complete?

Not necessarily.

It’s up to the school districts to compile data, student by student, and submit it to Health and Welfare by Nov. 1. In school districts such as Wallace, the job falls to the nursing staff.

The schools are required to maintain their own, separate paperwork on student immunizations, said Mezelle Moore, Health and Welfare’s immunization outreach and assessment coordinator. Schools are encouraged to check their reports against the state’s immunization registry, but that isn’t required.

And sometimes that isn’t as easy as it sounds. The other day, Moore took a call from a harried school nurse, who was struggling to use the state’s registry for the first time. “She was getting frustrated, because it was a lot for her to keep track with.”

In Post Falls, Superintendent Jerry Keane looked at the numbers his district reported to the state — and found wide discrepancies against the numbers in the state registry. More than 90 percent of students are immunized, well above the 52.5 percent rate his district reported.

District staffers are trying to figure out what went wrong in their reporting.

Access issues

Some of Idaho’s lowest immunization rates can be found in small, remote communities — such as Swan Valley (a 30 percent immunization rate), Riggins’ Salmon River district (36 percent) and Garden Valley (46 percent). Idaho’s rugged and sprawling landscape poses a challenge to access health care in general, and to immunizations in particular.

The state is trying to bridge the geographical divide, with regional health districts hosting immunization clinics in rural schools. “Hopefully, that’s bringing the care right to the schools, right to the students,” said Megan Keating, Health and Welfare’s immunization outreach and assessment manager.

Even in Post Falls, a suburban district sandwiched between Coeur d’Alene and Spokane, Wash., the district hosts a free immunization clinic, Keane said.

The state has tried to eliminate cost as a factor. Vaccines themselves are free to anyone under age 18 — whether the shots are administered at school, at a health clinic or at a doctor’s office. Parents may still have to pay administrative costs, on a sliding scale, based on their income.

The state appears to be gaining ground on the access issue, said Dr. Christine Hahn, Idaho’s state epidemiologist and Health and Welfare’s public health medical director. Since the state’s immunization rates are trending upward, she says, it follows that access to immunizations is improving as well.

Overcoming opposition

Even so, Idaho’s immunization rates are among the lowest in the nation, according to an August Centers for Disease Control report. Just under 90 percent of kindergartners were immunized for measles, mumps and rubella; only five states ranked lower.

However, Idaho did lead the nation in the percentage of parents who have sought, and received, an exemption to an immunization. In all, 6.5 percent of Idaho kindergartners were covered by a philosophical, medical or religious exemption.

An exemption doesn’t necessarily mean a child hasn’t been immunized. Exemptions are easy to get under state law, and parents sometimes file the paperwork simply because it’s easier than lining up immunizations right before the start of the school year.

The numbers seem to bear out that theory, Hahn said. Idaho’s immunization numbers tend to improve from kindergarten to first grade — a sign that some parents catch their children up on their shots.

This trend also may shed some light on the extent — and the intensity — of the anti-immunization movement in Idaho. Some parents may be what Hahn calls “vaccine hesitant.” They’re skeptical about the effectiveness and the safety of vaccinations. But a public awareness campaign, or advice from a trusted family physician, may be able to persuade them.

Then there are the hardliners, a minority that adamantly opposes vaccinations. “We are not going to change their minds,” Hahn said.

The first line of defense

In Wallace, the school district tries to get the word out about vaccinations, at back-to-school night and open houses and during parent-teacher conferences. Ultimately, the challenge doesn’t just come down to boosting immunization numbers. It comes down to ensuring student health.

Here, said Ranells, a small district has some advantages. Rural districts may struggle to keep up with immunization paperwork, but they can also keep close tabs on their students every day. If a student appears to be sick, a school nurse or a local physician is a call away. Teachers become the first line of defense.

“They’re pretty quick about letting the secretary know or the principal know,” Ranells said.

Idaho Education News data analyst Randy Schrader contributed to this report.