Health officials are facing a number of obstacles to containing polio as it continues to circulate in New York State and threatens to become endemic

By: Sharon Otterman NYT

In the hamlet of Monsey, N.Y., where polio partially paralyzed the legs of a young unvaccinated man in June, only 37 percent of 2-year-olds were up to date with their polio vaccinations as of the beginning of August.

In the Amish farmlands in Cattaraugus County in the Southern Tier of New York State, just 9 percent of young children were up to date with their polio vaccines. And along the Pennsylvania border in nearby Steuben County, and in a small hamlet in the farmlands of Tompkins County, barely a quarter of 2-year-olds were up to date.

Because vaccinations are required to enroll students in public or private school in New York State, most children are caught up by age 5: Statewide, 99 percent of school-aged children are vaccinated for polio. Still, roughly 100 schools reported vaccination rates at or below 90 percent in the 2020-21 school year across the state. Sixty schools did not submit any vaccination data at all, including some tiny rural schoolhouses that serve Amish students.

The specter of polio becoming endemic in America again was once unthinkable. But as state public health officials embark on an urgent campaign to get more people vaccinated, the low rates among preschoolers in some pockets are evidence of both the challenges they face and the threat to the state’s youngest children — the very age group among whom polio is most likely to spread.

If vaccination rates do not increase, experts and health officials fear polio could continue to quietly circulate in the state and beyond within a pool of vulnerable people, leaving a fraction of them paralyzed — nearly 50 years after the disease was eliminated in the United States.

The disease, which in its current variant can paralyze one in 1,900 unvaccinated people it infects, used to kill and disable thousands of people a year in the United States, until polio vaccines were discovered and distributed to millions of Americans. But now, delayed childhood vaccination throughout the world caused by the Covid-19 pandemic, combined with a rising tide of government mistrust and vaccine misinformation, has caused the nation’s most sustained transmission of polio since 1979, experts say, creating an emergency for health officials.

Local health officials and community organizations have been appealing to parents to bring their youngest children in for vaccination, and since late July more than 6,400 doses have been given in Rockland County alone, where the original case was identified.

But even as pediatricians see some upticks in demand, “they’re also seeing plenty of people who are questioning the seriousness of the moment,” said Eli Rosenberg, the deputy director for science at the New York State Department of Health.

“We have a long road ahead of us,” he added.

The largely silent nature of polio’s spread — in most people, it causes flulike symptoms or no symptoms at all — is fueling skepticism that this is a true emergency among some families, Dr. Rosenberg said.In 2019, during a measles outbreak, New York City health officials took aggressive action. They designated outbreak ZIP codes, ordered adults and children who lived or worked in those areas to be vaccinated for measles within 48 hours and closed entire schools that did not exclude unvaccinated children.

Religious exemptions to childhood vaccination have been barred since a measles outbreak in 2019.

But the 2020-21 data, collected during the pandemic, showed 114 schools self-reported polio vaccination rates of 90 percent or less, representing less than 1 percent of schools in the state. The schools had diverse affiliations: Catholic, Lutheran and Mennonite, as well as Waldorf schools, private schools that have a high rate of vaccine hesitancy, and international schools. About 17 percent were Orthodox Jewish yeshivas, according to that data.

In Rockland County, six Orthodox Jewish schools of the 80 in the state database had vaccination rates below 90 percent, according to OJPAC, an Orthodox Jewish advocacy group. Taking the size of each school into account, 96 percent of all school-age Orthodox children in the county were vaccinated, the group said.

“Since virtually all kids at Jewish schools are fully caught up with their mandated vaccinations by the time they go to school, it is absurd to claim that this community as a collective has more anti-vaccination sentiments than elsewhere,” said Yossi Gestetner, the group’s co-founder.

In Oneida County, a tiny Amish school, Meadow Valley, reported that 11 percent of its students were vaccinated against polio. Dan Gilmore, the county’s director of public health, said he wasn’t sure that vaccinations were required in Amish schools, though he encourages them. In any case, he added, enforcement would fall to the state. The public health director in Cattaraugus County said that some 20 Amish schools in his area did not submit any vaccine information to the state.

The state Health Department confirmed that it is responsible for investigating complaints about vaccination reporting for private schools outside of New York City, conducting annual audits of a “select number” of schools and issuing corrective action plans. How often audits take place, however, is unclear.

After the state removed religious exemptions for vaccinations in 2019, one Amish family in rural Seneca County sued, saying they opposed vaccination because they believed “God made his children ‘right and good’ and to vaccinate his children is to lose faith in God,” according to the lawsuit.

Under state law, the family’s unvaccinated children should have been excluded from school. But although the family lost in a first round of the court battle, the state backed off and did not enforce the rule, said James G. Mermigis, the lawyer for the family, who dropped the action.