Brenda Isaac, Britney Brogan and Mindy Liller, of the West Virginia Association of School Nurses, visited the West Virginia State Capitol in Charleston, W.Va., for Nurses Day in 2024. (Courtesy photo)
Alisa Shepler has been a school nurse for 25 years, and though she could retire, the enjoyment of her work has kept her at Fairplains Elementary in Wood County. But if state leaders succeed this year at loosening the state’s school mandated vaccination laws, she may reconsider that.
“It definitely gives me more emphasis to retire, because I don’t want to have to mitigate [a vaccine preventable disease outbreak],” Shepler said. “I really don’t. I will be so incredibly frustrated that this was preventable. It’s one thing for kids to get sick and unwell because it’s just the nature of the illness, but when it comes to something that was preventable, that is ridiculous.”
State lawmakers, directed by Gov. Patrick Morrisey, are advancing Senate Bill 460, which would allow parents to opt out of the state’s school vaccine requirements by signing a note saying they object to them on religious grounds. The bill would also allow a family’s medical provider to submit a medical exemption without needing approval of the state’s immunization officer.
The West Virginia Senate passed the bill Friday, with a vote of 20 to 12 . The bill will next go to the House of Delegates for consideration.
Every state requires students attending schools to be vaccinated for certain infectious diseases, like measles and polio. Until this year, West Virginia has been among only five states that have allowed only medical exemptions to those requirements. Medical experts have credited the strong laws for keeping the state’s vaccination rates high and disease outbreaks at bay. School nurses fear the legislation this year will change all that.
“I think it’s a sad day for the state of West Virginia,” Shepler said. “I think that, as you look at our state, there are so many things in the country that West Virginia is at the bottom of. We’re always in the news because we have a high obesity rate. We have a high drug addiction rate.” “The one thing repeatedly that is like a shining star for the state is our vaccine preventable illnesses,” she said.
The West Virginia Association of School Nurses, a professional organization representing 166 school nurses around the state, opposes the legislation, as does the state chapter of the American Federation of Teachers, a union that represents the school teachers and school personnel, including school nurses.
“Vaccines keep our students and staff safe and protect the health of those who are medically unable to receive vaccines,” AFT-WV president Kristie Skidmore said in a statement provided to West Virginia Watch. “West Virginia’s vaccine laws have long been regarded as among the best in the country. Why would we want to change something in a category where our state ranks at the top?”
Under the current law, West Virginia’s school nurses monitor students’ immunization records, making sure each child is up to date with required shots. In case of disease outbreaks like chickenpox or measles, they keep track of the students whose medical issues mean they can’t be vaccinated and notify parents that their children may be at risk.
“My main concern is certainly the resurgence of those vaccine preventable diseases in our childhood population,” said Julie Bertram, health services coordinator for Wood County Schools. “The risk that places to our children and our communities is incredible. That’s my primary concern.”
In Texas, a measles outbreak has now spread to 90 people. Of those, only five were confirmed to have been vaccinated. Sixteen of those 90 people have been hospitalized because of the virus, which is highly contagious and can lead to serious complications and death.
“The perfect example is Texas right now,” Bertam said. “I just don’t understand how we could further put those at-risk children more at risk. I just don’t understand it. It doesn’t make any sense to me how our legislators could think that that’s a good idea.”
Last year West Virginia reported its first measles case in 15 years, in a partially vaccinated Monongalia County resident who had recently traveled abroad. The county’s health department spent more than $15,000 responding to the single case. Dr. Lee Smith, the county health officer at the time, credited a high vaccination rate for the reason the virus did not spread to other people.
West Virginia senators on Tuesday voted down an amendment that would have required schools to submit yearly reports to the state on the number of exempt students or children enrolled in the school or child care center along with the total number of students at the school. The reports would be updated yearly and posted online.
Brittany Brogan, a school nurse in Lincoln County and the co-chair of government relations for the West Virginia School Nurses’ Association, worries that without those records, nurses would be forced to respond to potential outbreaks without crucial information.
“If we have a student that comes down with measles, we’re not going to know which students have been vaccinated for it or not,” she said. “So there’s going to be no way for us to know who needs to be quarantined at home, no way to know who to monitor for potential symptoms. It’s basically like how COVID was in the beginning, trying to just scramble to figure out who possibly is at risk.”
While medical experts have argued the state’s strong vaccination laws have made West Virginia a leader in preventing disease, Morrisey and supporters of Senate Bill 460 have expressed a different viewpoint: that by not allowing exemptions for religious beliefs, the state has violated students’ rights.
“Essentially we are depriving a child of an education,” bill sponsor Sen. Laura Wakim Chapman, R-Ohio, told West Virginia Watch. “Forty-five other states [allow religious exemptions]. We’re in the super duper minority. These other states have found that it’s safe to allow students to exercise their religious beliefs. As a relatively religious state, it always kind of shocked me that we weren’t also honoring that religious belief.”
Chapman acknowledged the potential of a measles outbreak down the road.
“What I would say to that is, vaccines are effective, they’re safe,” she said. “If you want to prevent your child from having the measles, vaccinate them. This is solely based on a deprivation of their religious beliefs. I don’t believe that we should violate the First Amendment.”
Medical experts say a high rate of vaccination can lead to what is called “herd immunity,” which can protect even those who cannot be vaccinated because of their age or another reason. The number of people in a community that need to be vaccinated to achieve herd immunity varies by disease. For polio, the threshold is 80%, while 95% is needed for measles.
“There are a lot of teachers who are immunocompromised,” Brogan, with the West Virginia School Nurses’ Association, said. “We have kids in the state who are fighting cancer. We have kids that have immunocompromised systems. They’re all going to be at risk if a disease outbreak was to happen. It’s not only going to affect the students, but it’s going to affect staff as well.”
Chapman, the bill’s sponsor, said she doesn’t believe that enough families will want religious exemptions for vaccines that it would affect the school’s herd immunity.
According to the U.S. Centers for Disease Control and Prevention, during the 2023-2024 school year, vaccine exemptions among kindergartners grew from 3% to 3.3%. Fourteen states exceeded 5% exemptions to one or more vaccines.
According to a report from the state Bureau for Public Health, the state saw “a growing atmosphere of anti-vaccine sentiment” in 2023, as evidenced by the number of parents who asked for a medical exemption for all school required vaccines.
In 2023, 19 of the 53 medical exemption requests were for all required vaccines. Previously, the requests were mainly for the chickenpox or measles, mumps and rubella shots, both of which use live viruses. The report notes, though, that the number of exemption requests is small compared to the state’s more than 250,000 school age children.
School nurses trace the vaccine distrust to the COVID-19 pandemic and its aftermath, when workplaces and some establishments were requiring people to be vaccinated.
“A lot of it is based on misinformation and everything that went down with the COVID vaccine, a lot of people are very skeptical of that,” Brogan said. “So unfortunately, our vaccines for preventable childhood disease have now been lumped into that same category, even though these vaccines have been around for years and been proven to be safe and proven to be effective.”
Many people are distrustful of the government, she said. They see the vaccination requirements as the government trying to force their hand.
“That seems to weigh more than ‘My child could die from measles or polio.’” Brogan said. “It’s not so much that people are against the vaccines themselves. They’re more against the government telling them that they have to do it. That seems to be the sentiment that I get when I talk to people.”
Nurses also raised concerns about the students who may not see a medical professional at all if they’re not required to get the shots. The vaccine appointment was a reason for them to see the doctor. In a state with a high number of students being raised by grandparents and other family members, Brogan said it might be easier for some families to sign a note than to schedule an appointment with a health care facility.
“It’s not so much those who truly feel they don’t want to vaccinate their kids; It’s more the side of ‘we don’t have time to take them to the doctor,’ or ‘we don’t care enough to take them to the doctor,’” she said.
“Those kids are already disadvantaged in life,” she said. “Like I said, we have kids who come to kindergarten registration who have not seen a doctor since they were born, and that’s a problem. Those are the children that personally I’m more concerned about.”
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