Hanan Babikir Bedri, MS, MA, is the executive director of the New Hampshire Public Health Association. 

This year, House Bill 1213, an act that pertains to immunization requirements for private schools and childcare agencies, was introduced. The bill focuses on three key areas: records, reporting, and immunization requirements.

First, on records, the bill exempts childcare agencies from keeping immunization records for all enrolled or admitted children. Also, the bill exempts schools, whether public or private, and childcare agencies, from keeping such records available for inspection during reasonable hours upon request by the commissioner. Second, on immunization reporting, the bill exempts private schools and childcare agencies from making annual reports to the commissioner concerning the immunization status of enrolled children.

Finally, on immunization requirements, the bill makes immunization optional for childcare agencies. It allows private schools and childcare agencies to admit children without demonstrating the following: 1) Immunization under paragraph I (Paragraph I states that “All parents or legal guardians shall have their children who are residing in this state immunized against certain diseases. These diseases shall include, but not be limited to, diphtheria, mumps, pertussis, poliomyelitis, rubella, rubeola, and tetanus.”) 2) Partial immunization relative to the age of the child, as specified in rules adopted by the commissioner, and 3) Exemption under RSA 141-C:20-c. New Hampshire RSA 141-C:20-c states that a child may be exempt from required school and child care immunization if a licensed physician or authorized health care provider certifies that immunization against a particular disease may be detrimental to the child’s health.

This bill would remove immunization requirements in private schools and childcare agencies. At the hearing, the bill sponsor said that the bill is intended to eliminate paperwork completed by private schools and childcare agency staff. She argued that staff at these institutions are overworked and underpaid, and that the proposed legislation is intended to lighten their workload.

Employees at many childcare facilities and private schools are indeed under-compensated. According to the Center for the Study of Child Care Employment, the median wage for a childcare worker in 2020 in the Granite State was $11.69, and one can understand why some would wish to make those jobs easier. But we must consider the unintended consequences of dropping or even relaxing immunization requirements, a move that has the potential to harm not only the kids at these institutions but also the adults who staff them.

In the United States, diseases such as polio, measles, diphtheria, and rubella were prevalent in the past, affecting a great many infants, children, and adults. These diseases claimed the lives of thousands annually. In Ohio, in 2022-2023, an outbreak of measles infected eighty-five people. Of the children affected, 71 percent were eligible for the measles, mumps, and rubella (MMR) vaccine but had not been immunized. One person afflicted with measles is likely to infect anywhere from twelve to eighteen people, on average, which makes it one of the most infectious diseases we know of. In 2022, 9 million people came down with it worldwide, and an estimated 136,000 people died from it, most of them children. And while measles was declared to be eliminated in the United States in 2000, the nation later saw it reemerge due to a decline in immunization rates.

When we administer vaccines to young people, we prevent them from catching illnesses that can make them very sick, debilitate them, or even end their lives. We safeguard the health of everyone those children come into contact with. Public health researchers have found that when vaccine mandates are in place, the infection rate for everyone is reduced.

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This not only has clear and obvious benefits for people in communities at risk of infection; high vaccination rates come with economic benefits, and outbreaks of vaccine-preventable diseases are expensive. A school in Nebraska saw an outbreak of whooping cough that ended up costing $52,000. A 2017 measles outbreak in Minnesota accrued costs of $1.3 million.

According to the American Academy of Pediatrics, following the childhood immunization schedule may prevent as many as 31,000 deaths and 17 million disease cases. It stands to save us $13.7 billion in direct costs, the costs of treating the sick, and $55.1 billion in total societal costs, according to an economic assessment of the 2017 U.S. birth cohort. Societal costs include losses from people missing work due to illness and other disruptions to the economy.

Vaccinations play a crucial role in preserving lives and safeguarding the well-being of our children. They stand as a remarkable accomplishment in public health. Polio, measles, mumps, rubella, and pertussis, among other viruses, once killed scores of people annually, but have since been brought to heel through the distribution of vaccines. We must maintain vaccine requirements in all schools and childcare facilities, for the sake of staff, children, and everyone with whom they come into contact.