Hawaii health officials are expressing concern over a growing number of students without all of their required immunization shots for school.
The state Department of Health said 39,583 students from the 2023-2024 school year were not up to date on their required immunizations — a 25% jump from the prior year. The data includes public, charter and private schools.
Some students are missing records, while others are missing one or more required vaccines. A growing number are claiming religious or medical exemptions.
“An increase in the number of students without up-to-date immunizations is a cause for concern,” said Dr. Kenneth Fink, DOH director, in a news release. “High vaccination rates help protect those who are unable to receive certain vaccines due to medical reasons and those with a non-medical exemption through what’s called herd immunity.”
On the other hand, he said, “Low vaccination rates mean unvaccinated keiki are at increased risk of infection, especially at schools with a high rate of the student population not being up to date.”
He added, “We are already seeing increased cases of pertussis and are at risk for a measles outbreak.”
The latest data reveal a trend occurring nationwide, as more parents of kindergarteners seek exemptions from routine vaccinations, according to KFF, a nonprofit health policy research group.
“These trends began with the COVID-19 pandemic and appear to be related to increasing vaccine hesitancy, fueled in part by vaccine misinformation,” said KFF in a recent report. “Furthermore, public opinion on vaccine requirements has become increasingly partisan.”
During the 2023-2024 school year, fewer than 93% of kindergarteners in the U.S. received all state-required vaccines, down from 95% in pre-pandemic times in 2019-2020.
The number of exemptions from one or more vaccines among kindergartners increased to 3.3% from 3% the year before, according to the Centers for Disease Control and Prevention.
Exemptions increased in 40 states and the District of Columbia, with 14 states, including Hawaii, reporting exemptions exceeding 5%. In Hawaii, 5.3% of kindergarteners were exempted from one or more vaccines.
The state Health Department noted that a majority of missing immunizations were due to seventh grade school requirements implemented in 2020 during the COVID-19 pandemic.
Hawaii state law requires students to be immunized with a number of vaccines before attending school, unless they have exemptions for medical or religious reasons, with appropriate documentation.
Required vaccines include those for diphtheria-tetanus-pertussis (DTaP), hepatitis A, hepatitus B, measles-mumps-rubella, polio, meningitis and chickenpox for those in kindergarten through 12th grade.
Starting July 1, 2020, the state added human papillomavirus, or HPV vaccines, to requirements for seventh graders.
For the 2023-24 school year, DOH said 55% of seventh graders were not up to date on vaccines, compared with 16% of kindergarteners.
The state Health Department received immunization reports from 382 schools for the 2023-24 academic year, which includes enrollment and number of exemptions.
Nearly 10% reported that more than half of their student populations were not up to date.
Among them were schools in rural areas, such as Kahuku High & Intermediate School.
Approximately three-fourths reported more than 5% of their student populations did not comply with state immunization requirements.
DOH data also indicates a religious exemption rate of 4.1% for the 2023-24 school year when averaged across the entire state, compared with 2.1% in 2019-2020.
Medical exemptions have increased to 0.16% in 2023-24 from 0.07% in 2019-20 but continue to remain low overall.
Based on an analysis of DOH data, the Honolulu Star-Advertiser found that the highest percentage of religious exemptions appear to be among Waldorf schools, some public charter schools, and schools in rural areas where access can be more challenging — but not necessarily religion-based schools.
The Malamalama Waldorf School, a private school on Hawaii island, reported about 63% of its nearly 100 students sought religious exemptions from school immunizations. At Haleakala Waldorf School, 58% sought exemptions.
Most public elementary schools had a good compliance rate, but some stood out for higher rates of religious exemptions.
Among them were Hanalei Elementary School on Kauai, where 36% of students sought religious exemptions. On Oahu about 27% of students at Sunset Beach Elementary School on the North Shore sought religious exemptions.
On Maui, only 6% of students at Kekaulike High School sought religious exemptions, but more than 71% were not up to date on required vaccinations.
DOH said it is working closely with educational partners and health care providers to educate families on vaccines as the best defense against diseases, and improving access to the vaccines.
Staying healthy
A snapshot of school vaccination compliance:
>> 382 schools reporting.
>> Total students not up to date: 39,583 (21%) in the 2023-2024 school year.
>> 55% of seventh graders were not up to date on vaccines.
>> 16% of kindergarteners were not up to date on vaccines.
>> Nearly 10% of these schools reported more than half of students were missing one or more required vaccines.
>> Religious exemption rate: 4.1% (compared with 2.1% in 2019-20).
>> Medical exemption rate: 0.16% (compared with 0.07% in 2019-20).
Source: State Department of Health
Immunization by school
Among the highest
>> Malamalama Waldorf School, Hawaii island, 63%
>> Haleakala Waldorf School, Maui, 58%
>> Alakai o Kauai Public Charter School, 36%
>> Hanalei Elementary School, 36%
>> Kilauea Elementary School, 32%
>> Kauai Christian School, 29%
>> Haiku Elementary School, 28%
>> Sunset Beach Elementary School, 27%
Among the lowest
>> Hahaione Elementary School, 0%
>> Halau Ku Mana Public Charter School, 0%
>> Farrington High School, 0%
>> Our Lady of Good Counsel School 0%
>> St. John Vianney Parish School 0%
>> Waianae High School 0%
>> Waolani Judd Nazarene School 0%
Other schools
>> McKinley High School 0.5%
>> Campbell High School 1.1%
>> ‘Iolani School 1.7%
>> Punahou School, 2.5%
>> Mid-Pacific Institute 4.7%
>> Kamehameha Schools (Honolulu) 3.9%
>> Hawaii Preparatory Academy 8.8%
Source: State Department of Health
Note: Self-reported percentage of enrolled students with religious exemptions 2023-24 (fewer than 50 students not included).
