When epidemiologist Sophia Newcomer tries to evaluate how well Montana might be able to ward off the measles outbreak spreading across the U.S., she doesn鈥檛 have much data to work with.
A last year showed that just over 86% of Montana鈥檚 2-year-olds had recently received the measles, mumps, and rubella immunization. That figure has decreased in recent years, according to earlier surveys, and at the University of Montana, said the latest rate is 鈥渨ell below鈥 the ideal 95% threshold for community protection against highly contagious diseases.
But beyond that statewide estimate, information about Montana鈥檚 local and regional immunization trends is hard to come by. State officials no longer collect aggregated vaccination reports from schools and child care centers, or the included data about medical and religious exemptions. The administration of Republican Gov. Greg Gianforte discontinued the practice after he signed striking the requirement.
The last of the localized reports were from the 2018-19 school year, before the disruptions of covid-19. Without the information, Newcomer said, local and state officials have struggled to strategically prevent the spread of vaccine-preventable disease.
鈥淪tate averages are helpful, but really drilling down to county level or smaller geographic levels are really what we need to assess risk of outbreaks,鈥 she said.
Montana is the only state that no longer collects immunization reports from local schools, creating a data gap for the Centers for Disease Control and Prevention. The information shortage also affects city and county health officials who may not have their own data-sharing agreements with school districts.
Supporters of the 2021 measure to stop collecting data said they were aiming to protect students鈥 personally identifiable information and medical records and did not intend to cancel the reporting system in its entirety.
鈥淚 wasn鈥檛 trying to bomb the system. I was just trying to make sure children had their privacy respected,鈥 said Jennifer Carlson, a former Republican legislator and the sponsor of the bill the state health department cites as the reason for discontinuing the data collection.
State lawmakers to undo the 2021 policy, while keeping privacy protections for individual student records. After stalling earlier this session, the Democratic-sponsored advanced in March with bipartisan support, clearing the House with a 66-31 vote.
The bill, sponsored by Democratic , has also received support from the state health department, an agency within the Gianforte administration.
Republican said that he believes the bill is good policy for the state.
鈥淚t鈥檚 important that public health authorities have access to aggregate information so they can track where vaccinations are not being used,鈥 he said.
Montana hasn鈥檛 confirmed a case of measles . But with more than across Texas, New Mexico, and 17 other states, one child confirmed to have died from the disease, and another death under investigation, Newcomer said she and other disease experts are 鈥渙n edge鈥 about Montana鈥檚 defenses. Three cases have been confirmed in March south of Calgary, in the Canadian province of Alberta, which shares a border with Montana.
鈥淚 like to say that when vaccination rates drop in a community, it is not a question of if. It鈥檚 a question of when measles is going to come, because it is so incredibly contagious,鈥 said David Higgins, a pediatrician and researcher at the University of Colorado Anschutz Medical Campus.
Higgins used to work in Montana when the law requiring schools and state officials to share data was still in place. He said he鈥檚 disappointed in the 2021 rollback, given how outbreaks begin at the hyperlocal level.
鈥淲hen community leaders don鈥檛 have a good understanding of the local level of vaccination and community immunity, that鈥檚 a significant challenge,鈥 Higgins said. 鈥淭hey鈥檙e hamstrung without having that data readily available.鈥
Measles is one of the world鈥檚 most contagious diseases, , much more so than covid. It can be very dangerous, especially for infants and children under 5 who have not completed the two-dose vaccination series. Infectious particles can hang in the air and on surfaces for up to two hours. People carrying the virus can spread it up to four days before they begin showing symptoms.
鈥淚f we do have a measles case arrive in Montana, and particularly if it arrives in a community that has low vaccination coverage, we鈥檙e going to see spread over like a multi-week or even multi-month period,鈥 Newcomer said. 鈥淪o an unvaccinated person can get sick simply by going into a school, store, or home where someone infected with measles recently was.鈥
The infection can have short-term and long-term consequences for people who are not immunized, including encephalitis, pneumonia, deafness, blindness, and death. State and community health departments have been advertising free MMR vaccinations at clinics throughout the state for anyone who needs them.
While HB 364 is aimed at increasing data collection, other vaccine measures in the state legislature are advancing that would make it easier for children to be exempted from standard immunizations required to attend schools or child care centers.
A recent version of , which has been amended several times, would create an 鈥渋nformed consent鈥 exemption in which a parent or guardian could decline immunizations for school-age children without stating a reason.
Supporters of the bill said that some families struggle to receive exemptions on the grounds of religious beliefs or medical causes and want broader flexibility to opt out of requisite vaccinations against measles and other infectious diseases, such as pertussis. According to Montana鈥檚 most recent reporting, from the 2018-19 school year, roughly 3% of children in public schools had a religious or medical exemption.
SB 474 also would strike another part of state law that allows schools and day cares to deny admission to children because they are unvaccinated, an exemption included in a 2021 law aimed at protecting unvaccinated people from discrimination. The lawmaker sponsoring the current bill called the carve-out for schools and day cares an 鈥渁berration鈥 in Montana law.
鈥淭here鈥檚 no reason that they should be discriminating based on vaccine status,鈥 Republican said during a March debate on the Senate floor.
Emrich and others framed the bill as enabling individual decision-making around vaccinations based on how well a parent knows their own child.
鈥淰accines are pretty effective,鈥 Emrich said. 鈥淚f you鈥檙e concerned about unvaccinated children, you have the option to get your kid a vaccine to protect them in whatever way you want. This bill is really about choice.鈥
During the debate, opponents of the bill contended that the lower Montana鈥檚 overall immunization rate drops, the more at risk many community members are, including those who, because of age or medical issues, can鈥檛 be vaccinated.
, a Democrat representing Bozeman, said that vaccinated Montanans, including children, are acting as 鈥渟hields鈥 against contagious diseases like measles and pertussis. But if vaccination rates continue to drop, Neumann said, that protection will only get weaker.
鈥淲e just saw a kid die of measles [in Texas]. It鈥檚 going to continue, and it is going to be scary. It is going to be deadly,鈥 Neumann said. 鈥淚t feels like a luxury right now. We can choose. It is not going to be if we continue down this path.鈥
The bill passed the state Senate on a 28-21 vote. It is now under consideration in the House.
