Immunization Gaps in Snohomish County
Health Leaders Discuss How to Navigate Changing Landscape
The good news is the vast majority of people still believe in the power of vaccines. The bad news? Immunization rates continue to decline in Snohomish County and across the state.
To explore the impacts of the downward trends, local health leaders and providers took part in a panel discussion this month before the Snohomish County Board of Health. The panel was held in part to recognize National Immunization Awareness Month in August.
“Accurate information on vaccines and immunizations is critical for public health,” said Megan Dunn, County Councilmember and Chair of the Board of Health. “It’s imperative that everyone from newborns to young students starting the school year and to our seniors are safe and thriving in a healthy environment. This was an important discussion for our board members to hear about local vaccination efforts and to be prepared for any future work related to barriers for access and availability.”
Health Officer Dr. James Lewis kicked off the discussion by noting a steady decline in immunization rates since 2019. “Across Washington, we’ve been heading in the wrong direction for MMR (Measles, Mumps and Rubella) coverage over time,” he said.
The US has seen more measles cases this year than at any other time in the last 30 years. More than 1,400 cases had been reported by the end of August.
Dr. Lewis shared a slide created by the department’s Epidemiology and Informatics team that showed overall immunization coverage in Snohomish County declined from a high of just under 94 percent in the 2020-21 school year to just over 90 percent in 2024-25.
If such trends continue, we could expect to see more cases – as well as an increase in severity – of diseases once considered eliminated. “That would be a tragedy of high magnitude,” said Dr. Jay Cook, former chief medical officer for Providence Regional Medical Center in Everett.
He cited a recent study in JAMA (the Journal of the American Medical Association) that projected measles could once again be an endemic – or regularly occurring – disease if MMR vaccination rates remain at current levels. If all immunization rates dropped 50 percent, he added, the U.S. could average more than 2 million cases of measles a year over the next quarter century. It could also see a total of more than 4 million cases of polio and 10 million hospitalizations.
“It’s mind boggling,” Dr. Cook said, noting the potential impact on hospitals, which don’t have enough inpatient beds. “It’s vitally important for individuals, families, communities to keep a lid on these diseases that you know can be prevented or minimized by safe and effective vaccines.”
Dr. John Dunn, a long-time pediatrician and recent medical director of preventive care at Kaiser Permanente Washington, spoke about the challenges of navigating the current federal landscape. The panel that historically makes recommendations on vaccines is being remade, he said, with less emphasis on evidence-based decisions.
In the future, he warned, it’s not going to be clear whose advice should be followed on vaccines. “We may find ourselves very soon in a situation where recommendations can vary from state to state,” Dr. Dunn said, and even from county to county. People may not be able to find a “single source of truth.”
All of this will have implications on who can gain access to vaccines and whether insurance will cover the shots. “Stay tuned and be nimble,” Dr. Dunn advised the board. “A lot of things are going to happen, but they are all going to happen very fast and we need to be prepared to make adjustments on the fly.”
Dr. Catherine Yee, an interventional pain physiatrist, told Board of Health members she finds ways to bring up vaccines in her conversations with her patients.
“When I talk to patients about a painful condition, I might say, ‘Hey, by the way, are you up to date on your pertussis vaccine?’” Dr. Yee said. “And they might say, ‘Oh, my gosh, why are we talking about pertussis in a back pain clinic?’ And it’s because I’ve actually seen patients who suffered from whopping cough and fractured their backs and blown discs. ‘I’d love to prevent you from having that. Let’s get you updated.’”
Dr. Cornelius Van Niel, clinical director of pediatrics for SeaMar Community Health Centers, who sees patients in Seattle and Marysville, spoke about effective strategies for promoting vaccines in a clinical setting.
“Coming from a collaborative perspective is what works best,” he said, adding that “leveraging the reasons that parents might have for giving vaccines, having a partnership with families, coming from a place of curiosity, asking for permission to offer my perspective, and acknowledging concerns genuinely I think are the best ways to promote vaccines in clinic.”