“We’ve been inundated,” Kristen Wagner said as she unpacked vaccines inside the Yates County public health offices in Penn Yan.
“We’re trying the best that we can,” she said, continuing to set cartons of measles, mumps and rubella vaccine on top of a tray that was already too full to fit any more.
Wagner and her colleague Chelsea Bailey were just back from a trip to Mennonite homes scattered across the largely rural county.
This year, as for the past several years, they were offering in-home immunizations on a sliding pay scale. But their trips over the last few weeks have taken on a new urgency.
Not only has a measles epidemic among a religious community downstate only recently begun to subside, but now a new state law, passed earlier this summer, ends religious exemptions to vaccinations for school-age children.
In Finger Lakes Mennonite communities, families have taken full advantage of the religious exemption for years.
At the Gravel Run Mennonite School in Dundee, 10 miles south of Penn Yan, 100% of students received a religious exemption from vaccination for the 2016-17 and 2017-18 school years – the most recent years for which data is available from the state health department.
Over the last five school years for which data is available, religious exemption rates of 75% or more have been recorded at 13 different schools in Yates County.
As a result, there were more than 400 children in the county whose immunizations were out of date as the start of the school year approached.
Those schools have proven difficult to contact. WXXI News and CITY Newspaper sought help from the Yates County public health department and other government agencies to contact Mennonite school directors. Those agencies declined to put a reporter in touch with the directors, expressing concern that doing so would undermine the trust that government officials have slowly built over years of working with the Mennonite community and jeopardize their ability to immunize children.
Yates County public health deputy director Sara Christensen said many Mennonite families are receptive to the new rules. She’s been ordering vaccines for them as fast as providers can supply them.
“We’ve had to order extra vaccine three times now,” said Christensen. “We usually order once a month, and we’ve ordered three times in the last four weeks.”
And for each shipment, she said, “I’m ordering 50 to 60 doses of vaccines when I usually order 10 to 20.”
The surge in demand for the vaccines is promising, Christensen said, but it doesn’t tell the whole story.
“It’s not possible” to have every student’s vaccinations up-to-date by 14 days into the school year, as the law requires, she said.
The students’ homes are scattered across a rural landscape, and some of the children have never been vaccinated. They require multiple visits from health department staff, who must pack sterile supplies in temperature-controlled cases each time they make the trip.
“We have a staff of four nurses and myself. We’re going to do what we can, but we don’t have the capacity for all those students.”
“I’m hoping by the end of the school year. That’s how long it’s going to take to get these vaccinations in them,” Christensen said.
Jill Montag, a spokesperson for the state health department, which is responsible for enforcing the law, said in an email to WXXI News and CITY Newspaper that the department will be “auditing schools to assure compliance and address deficiencies.”
“A school could be subject to a fine of up to $2,000 for each student admitted in violation of the vaccination requirements,” Montag said, “but we do not anticipate having any problems securing compliance from schools.”
Christensen, however, painted a less certain picture.
“We’re going to have more vaccinated kids,” she said. “But we also know there’s going to be Mennonite children who aren’t vaccinated but their families want them to go to school.”
“At that point, it’s up to the school director. Will they enforce compliance? I have to say I’m not sure.”
The uncertainty is not limited to Yates County, though it does fit a regional pattern.
Four of the five counties in New York state with the highest rates of families claiming religious exemptions last school year -- Yates, Allegany, Seneca and Cattaraugus -- were in the health department’s western region.
Livingston County ranks further down the list but is home to an Amish population that officials said is challenging to define statistically.
Some Amish children are vaccinated, said Kathy Root, the Livingston County health department’s director of patient services.
But in other cases, community institutions are operating outside of government oversight.
“I know there are little schoolhouses,” Root said, but “we’ve never been invited into them, so I can’t exactly tell you what their rules are.”
Government officials declined to put WXXI News and CITY Newspaper in touch with Amish community leaders, citing concerns similar to those that Yates County officials expressed about a reporter contacting Mennonite leaders there.
In Yates County, too, some schools might be operating without oversight. The Mennonite community is growing, driven by a high birthrate and large families. Because of the community’s isolation, Christensen said, new schools can start without her knowledge.
“They don’t have addresses,” she said. “They’re one-story schoolhouses, just in one of the family’s fields.”
Years of building relationships in the community mean that she usually finds out about the schools “relatively quickly,” she said.
Then the challenge is getting vaccines to the young students. Some parents are amenable, Christensen said. Others are not, and want to send their children to school without vaccines, or home-school them to avoid being subject to the law.
“Our role is to educate,” she said. Without vaccines, “these children are vulnerable. We know measles can happen any day here. Kids die from these diseases.”