12 May 8th-May 14th, 2025 phoenixnewtimes.com PHOENIX NEW TIMES | NEWS | FEATURE | FOOD & DRINK | ARTS & CULTURE | MUSIC | CONCERTS | CANNABIS | According to the Arizona Department of Health Services, only 89.3% of Arizona kindergartners were fully vaccinated against measles during the 2023-24 school year — less than required for herd immu- nity, but not terrible. However, some areas of the state are more protected than others. Only two Arizona counties — Yuma and Santa Cruz — reached herd immunity, with central county Pinal falling just short at 94%. In Yavapai and Mohave counties, herd immunity is basically a fantasy. Only 79.4% of kindergartners are vaccinated against measles in Mohave County. Yavapai County’s rate is a state-worst 77.9%. “You’ve got this whole giant cohort in these parts of the state where we have really susceptible kids,” said Will Humble, the executive director of the nonprofit Arizona Public Health Association. In other words, parts of the state are a powder keg. “If it does happen in our community, I anticipate a fairly large outbreak,” said Smith, who owns Yavapai Pediatrics. “It’ll be a lot like that county in Texas.” If parents would get their kids vaxxed, none of this would be a concern. But as Smith knows, the anti-vax current is strong. Every day at her practice in Prescott Valley, she talks to new parents about vaccines. She reassures and presents the facts. “There’s a good portion of parents that just want more information,” she said. Another cohort cannot be convinced. Those parents “are very adamant that, ‘I’m not comfortable with it,” Smith said. Because she requires all her patients to be vaccinated, those parents have to find another pediatrician. Why are vaccine rates so low? There’s the epidemic of misinformation — the bunk science RFK Jr. promotes is nearly as contagious as measles — but there’s also the fact that generations of kids have grown up without having to worry about measles at all. Because many parents haven’t seen the firsthand effects of a measles outbreak, they tend to underesti- mate how deadly one could be. “It seems like we think that things happen to other people and not to us,” said Dr. Kathy Krieg, a pediatrician based in Gilbert. “We have this magical thinking that because we haven’t died of this before, therefore if it hasn’t personally happened to us, it’s not going to happen to us.” People don’t always do what’s best for them, which is why your mom made you eat your vegetables. But in Arizona and many other states, no authority figure is lording over the table to say, “No dessert until you vaccinate your child.” Especially since the COVID-19 pandemic, when many conservatives rebelled against mask mandates and vaccine requirements, flying the banner of personal choice has been an avenue to political power. Lawmakers in Arizona and beyond have won office spouting conspiracy theories about COVID-19 and about vaccines at large. Gov. Katie Hobbs, a Democrat, has already vetoed four anti-vax bills this year. Last month, when RFK Jr. visited the Arizona Legislature to promote a healthy- food bill, reporters were cut off and booed when they audaciously asked him — the man in charge of the nation’s health care infrastructure — about the country’s largest measles outbreak in decades. “People who aren’t vaccinating their kids aren’t just doing that and being quiet about it,” said Ashley Chambers, the exec- utive director of Arizona Families for Vaccines. “They’re trying to convince other people not to vaccinate their kids, and they’re trying to influence our lawmakers to enact policy that supports anti-vaccine people and their opinions.” As a result, Arizona has lax vaccine laws. Many states require up-to-date vaccines to attend public school, insisting upon medical documentation and granting exemptions only for religious reasons. But in Arizona, all that stands between a parent and sending their unvaccinated child to public school is a two-page form. ARS 15-873 allows parents to submit a signed statement to a school administrator outlining that “due to personal beliefs,” they “do not consent to the immunization of the pupil.” It’s as simple as checking a few boxes. When it’s that easy to get out of vacci- nating your kids, low-information parents or those who aren’t already pro-vaccine are all the more likely to let it fall by the wayside. “You get a lot more parents who say that they don’t want their children to be vaccinated because it’s easy,” said Kelly Murphy, a coordinator at the Arizona Early Childhood Alliance. “If you don’t make it easy for people to opt out, then they won’t.” Though Arizona’s exemption has existed for decades, long before COVID-19 hit, exemptions have skyrocketed since then, according to Axios. Last year, 8.5% of kindergartners had vaccine exemptions, which Chambers said leaves the state “absolutely ripe for a measles outbreak.” What’s more, vaccination rates tend to follow a pattern depending on the type of school. If an unvaccinated student in a Maricopa County public school classroom catches a case of measles, “there’s a pretty good chance that every other kid in that homeroom, at least, is vaccinated, and it’s not going to spin out of control,” Humble said. However, the vaccine exemption rate in Arizona’s charter schools is 6.6%, nearly double the rate at public schools. At private schools, it’s 10.7% — nearly triple. If there’s a measles outbreak, don’t be surprised if it starts at a private school. “It’s much easier to get a cascade of cases at a charter or private school,” said Humble, “than it is at a public.” WHEN AN OUTBREAK HAPPENS Measles hasn’t been a stranger to Arizona in recent years. But it’s no snowbird, buckling down for an extended stay — it has popped in briefly, then disappeared. In 2024, Maricopa County had two cases and Yavapai County had one. In September 2022, three related measles cases were confirmed in unvaccinated people in Maricopa County, and one person required hospitalization. A 1-year- old was also diagnosed with measles in Pima County in 2019. The next outbreak may not be so contained. But health officials have had plenty of practice. Nicole Witt, the assis- tant director of preparedness for the Arizona Department of Health Services, said Arizona “prepares for a measles outbreak every day.” When a measles case pops up, here’s what happens. If a child comes into a hospital’s emer- gency room or physician’s office with a rash, fever or measles-like symptoms, doctors and hospital staff immediately isolate the patient and contact their coun- ty’s health department. Next, an on-call epidemiologist with the county asks a series of questions about symptoms and testing. The county health department facilitates testing through the state, reaching an ADHS epidemiologist via an online form. A courier picks up a sample — generally a urine sample or nose swab — and drives it to an ADHS lab in Phoenix for testing. Depending on travel time, results are back in four to eight hours. Since the Texas outbreak started, Maricopa County’s public health depart- ment “decreased the index of suspicion” for measles cases, meaning they’re testing more suspected cases than they would otherwise. Dr. Nick Staab, the chief medical officer for the Maricopa County Department of Public Health, said the department is testing 10-20 cases per week. None has come back positive. Yet. In the meantime, county health depart- ments begin to mobilize their incident command teams, which Witt called “the boots on the ground.” ADHS provides resources in support, but counties run the show. For larger counties like Pima and Maricopa, a team works to treat infected people and contain further spread. In Pima, Emergency planners, trained to respond to disasters, coordinate with a 15-person public health team that includes epidemiologists and clinicians in Pima. Staff from other departments are reas- signed to bolster the department’s response. “It’s not one person on the phone trying to figure out if there was a positive case. We have a system on standby to be acti- vated,” said Dr. Andrew Saal, the assistant medical director at the Pima County Health Department. “It’s all hands on deck. That’s how serious measles is.” Epidemiologists launch an investigation to trace the infected person’s whereabouts over the previous four days and determine who else might have been exposed. Clinicians administer MMR vaccines to exposed people within 72 hours of their exposure, which can help prevent serious health effects. People in high-risk groups — such as infants, pregnant women and immunocompromised people — may receive immune globulin “People who aren’t vaccinating their kids aren’t just doing that and being quiet about it,” said Ashley Chambers, the executive director of Arizona Families for Vaccines. “They’re trying to convince other people not to vaccinate their kids.” (Morgan Fischer) Will Humble, the executive director of the Arizona Public Health Association, said some parts of Arizona “have really susceptible kids.” (Morgan Fischer) >> p 14 Bracing for Impact from p 11
