Exactly how many students receive their required vaccinations before school started two years ago? Turns out, Washington state doesn’t actually know, according to a new audit.

The audit, released Thursday, looked at data for the 2017-18 school year, before the Washington Legislature this year eliminated the personal and philosophical exemptions that parents could claim from the combined measles, mumps and rubella (MMR) vaccine. This school year, the first under the new vaccination law, families could only cite medical or religious reasons to exempt their children from the MMR vaccine.

Yet even before those stricter rules went into effect, the state cannot know its true vaccination rate for students, according to the audit. That’s because of gaps in records and reporting: Roughly 1 in 10 school districts did not submit any immunization data to the Washington Department of Health.

“Of the schools that did report, 8% of all kindergarteners lacked complete immunization or exemption records,” the state auditor’s office found. “But because of the number of districts and schools that failed to report, the actual percentage of kindergarteners without records may be greater.”

Public health officials strive to get at least 95% of a population vaccinated, a threshold known as herd immunity. Getting enough children vaccinated to reach that point keeps people who can’t get immunized — such as children under a year old or those with health issues — from becoming sick.

State law requires principals to collect the immunization records (or a valid exemptions) for every student on or before the first day of school. Without that proof, children may be excluded from school.

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The auditors looked at data for all districts that submitted it, and also closely audited eight districts. In four of those districts that had high rates of noncompliance during the 2017-18 school year, the state auditor’s office found principals chose not to exclude those students from classes.

“Some said they would rather educate students than exclude them,” according to the audit. “Furthermore, by keeping students in school, they said they had a better chance to work with families and bring them into compliance.”

Among the 20 districts with the highest rates of noncompliance, the share of kindergarteners without the proper records ranged from 90% in Orcas Island to 25% in Port Townsend. Most of those 20 districts enrolled fewer than 100 students in kindergarten, with the exception of Evergreen in southwest Clark County — the site of a large measles outbreak in early 2019.

Nearly a third of all Evergreen kindergarteners were out of compliance as of the 2017-18 school year.

“We know that we need to make improvements,” said Gail Spolar, spokeswoman for Evergreen Public Schools. “We’re kicking off a very robust and comprehensive outreach program with the folks who are out of compliance.”

Before the measles outbreak this year, Spolar said the district had recognized its record-keeping “was not the most robust.” Budget cuts prompted the elimination of a districtwide compliance clerk in 2011, and schools did not have as many secretaries to help families during the registration process.

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Now, the district has hired another compliance clerk and started training more staff to gather records. It also has warned families of stricter compliance rules starting next school year. Despite the new law restricting vaccine exemptions for the current school year, a district spokesperson said they’d rather keep kids in school while working out the missing records — until next fall.

“Parents will absolutely know those children will not be allowed back in school in the fall of 2020 without their updated records,” Spolar said.

As of Monday, the out-of-compliance rate in Evergreen this school year hovered just above 13% for kindergarten, she added in an email.

In King County, the Lake Washington school district had the highest rate of noncompliance at 18%, according to the audit of 2017-18 data. A district spokeswoman said it has since improved communication with families to remind them when students are out of compliance.

“As of the end of November, less than 1% of our students are out of compliance with immunization records and we will continue to work with families to get accurate records,” spokeswoman Shannon Parthemer said in an email.

In neighboring Issaquah schools, no kindergarteners were out of compliance two years ago.

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“The district achieved its highest levels of success when staff began telling both parents and principals that they would be ‘following the law’ when it came to excluding students that lacked complete immunization documents,” the audit said, quoting an administrator in Issaquah. “By framing compliance with record-keeping as a matter of legality, it ‘took away a lot of the added pressure from parents opposing immunization while building support among school staff.'”

L. Michelle, a spokeswoman for the Issaquah schools, said principals often call families who haven’t submitted the required records. And nurses, she added, also play a key role.

“It’s our nurses that take on a large part of that community outreach,” Michelle said. “If [families] struggle with transportation to get to the doctor, or they can’t pay their electric bill — let alone afford the required immunizations — the nurses are the ones that would likely help to arrange for that.”

The audit cited some common challenges that schools encounter when trying to help families meet compliance with the state rules: Access to vaccination resources, and language barriers that make it hard for parents to understand the requirements.

Rep. Sharon Tomiko Santos, D-Seattle, sponsored the legislation that this year eliminated the personal and philosophical exemptions for the MMR vaccine.

She noted the different ways that districts cited in the audit worked with families to overcome those barriers. The small Orondo school district, with just 15 kindergarteners, “actually put their kids on a school bus and drove them to a clinic to get vaccinated,” Santos said.

Although the auditor’s report suggested state leaders might consider creating a statewide accountability system to help meet the goal of herd immunity, Santos questioned whether individual schools should have to bear the full weight of that responsibility — as opposed to, say, school boards or partnerships with health agencies.

“We really want our schools to focus on educating our students. Do we want them also to focus on those nonacademic elements that can deter our students from being their best scholarly selves?” she asked. “Yes, but we don’t fund the nurses, social workers and family support workers in a robust way to do that.”