A collaborative multiple stakeholder model for improving public school immunization rates

Recent nationwide outbreaks of pertussis and mumps over the past few years serve as a sentinel and reminder of the importance of assuring adequate immunization coverage within a community. Although US childhood immunization rates have risen over the past 2 decades, disparities continue with lower rates among children living in poverty, among urban children and among black and Hispanic children.

Local public health agencies (LPHAs) are often perceived as being on the frontlines in the monitoring and enforcement of state immunization laws that assure the health of students and protection of the community at large. However, lack of sufficient resources and well-defined as well as coordinated enforcement mechanisms and policies often hamper discernable improvement. The Milwaukee Health Department (MHD) participated in the formation of School Immunization Task Force in 2005-07 that resulted in a marked increase in student immunization compliance from 64% to 83%. Members of the task force included various representatives of the State and Local Public Health Agencies, Public School District, County District Attorney and City Budget Office.

Recommendations and actions jointly endorsed by Task Force member agencies focused on sharing resources, identifying best practices, determining cost-effective resource allocations and adopting an outcomes management approach. Initial success and incremental improvement of student immunization compliance occurred after implementing data reconciliation efforts, streamlining parent alert letter timelines and conducting off-site vaccination clinics in coordination with district attorney non-compliance notifications. This approach is proving viable and assures leveraging or assets, consensus of key stakeholders and equitable sharing of responsibility.