WASHINGTON - Childhood vaccination rates are going up Down East. In 2014, Maine had the highest rate of toddler immunizations in the country, with 84.7 percent of 19- to 35-month-old children receiving all seven vaccines recommended to protect against 11 diseases. This rate was up from just 68 percent the year before, according to a new report from the Centers for Disease Control and Prevention -- a major victory for the state.
As doctors and legislators nationwide wrestle with the question of how to raise childhood vaccination rates, the success of Maine's vaccination program offers some important lessons in how to turn around low immunization rates.
The national average for the seven vaccine series among toddlers is 71.6 percent, making Maine a standout when it comes to across-the-board vaccinations. The state also topped national averages for five of the seven vaccines, including the drugs protecting against measles, mumps and rubella (MMR); diphtheria, tetanus and pertussis (DTaP); hepatitis B (HepB); hepatitis A (HepA); and rotavirus.
Most states mandate the MMR vaccine and the DTap, but parents don't always make sure their kids get all of the recommended drugs and doses. The real achievement in Maine was its success in raising the average rate for all seven of the recommended toddler vaccines, and not just the required ones.
The dramatic increase was not the result of one drastic change in law or health policy, according to experts. Instead, it was the product of a sustained effort over five years that addressed multiple parts of the health system.
"What ultimately worked in Maine was using a lot of different tactics in tandem," said Dr. Amy Belisle, a pediatrician and the medical director with the nonprofit health collaborative Maine Quality Counts. "If we'd just done one thing, like only working with families, or only changing policy, it would not have worked."
The lessons from Maine's vaccine success can't come soon enough. Across the country, states and communities are grappling with deadly outbreaks of diseases like whooping cough and measles, which were largely thought to have been eliminated in recent years. In January, an outbreak of measles that spread to more than 100 children was linked to the Disneyland theme park in Southern California.
The sudden return of these diseases can be traced to the anti-vaccine movement that has been growing in the United States for more than a decade, fueled by debunked science and celebrity advocates. Despite the weak evidence, the movement has raised alarm among parents about the alleged side effects of vaccines, leading thousands of families to "opt-out" of protecting their children.
But opting out of vaccinations can reverberate far beyond an individual family. The effectiveness of vaccines relies heavily on herd immunity, or the indirect protection from disease that exists when nearly every member of a community is immunized. And some people can't be vaccinated for medical reasons, including the very young and those with weakened immune systems. This only increases the importance of maintaining high vaccination rates.
It was against this tide that health officials in Maine set out to encourage more parents in the state to protect their kids from these dangerous diseases.
Belisle said a five-year federal grant for improving children's health allowed the state Medicaid agency and doctors to work on innovations together, including training and mentoring younger health care providers on how to talk to families about vaccines.
"We also owe a debt of gratitude to the generation of physicians who remember what it was like, personally, to lose children to diseases that we now vaccinate for, like meningococcal meningitis," said Belisle. "They can speak from personal experience, in a courageous way that some of us who've been practicing in the era of really comprehensive vaccines just can't do."
Across the state, there was also a coordinated effort to make it easier for parents to learn about vaccines on their own. In 2012, the Maine Immunization Coalition launched Vax Maine Kids, a website and a blog to communicate directly with families. It also revamped patient information sheets to make them easier to read and understand.
The achievement rate for immunizations in Maine is all the more impressive in light of the state's vaccine opt-out laws, which are some of the most permissive in the nation. Parents can obtain an exemption from required vaccines by citing "philosophical reasons," a murky term which can be used by vaccine skeptics to justify opting out of state requirements.
Twenty states currently allow for philosophical or conscientious exemptions. In Maine, 750 children went unvaccinated for non-medical reasons in 2013, the fourth-highest rate in the nation of philosophical exemptions.
Earlier this year, the question of parental vaccine opt-outs sparked heated debate in the state legislature, where lawmakers introduced bills designed to tighten Maine's philosophical exemption clause. The most promising measure passed both chambers by wide margins, but in a dramatic rebuke, Republican Gov. Paul LePage vetoed the bill, saying it infringed upon parental rights. Public health advocates have vowed to keep fighting to strengthen vaccine requirements.
The good news is that despite the opt-out provisions, Maine's multi-year effort to raise the state's overall vaccination rate has worked.
Belisle largely attributed the success to the fact that the most important conversations about vaccines still take place between doctors and parents.
"Health care provider recommendations make the biggest difference in whether a family gets a vaccine or not," she said.
Supporting and educating physicians is critical, "because they have to be on the front lines of a debate that can get ugly sometimes," she said, adding that some physicians have even received hate mail from the members of the anti-vaccine movement.
As the state's five-year federal grant comes to an end this year, Belisle said it's time for Maine to dedicate more funding to children's health in order to maintain the high rates of immunization. "We have not invested as much as we need to in children's health, and soon it's going to matter more than ever."