Ouch! The declining immunization rates for Washington and Idaho toddlers are painful. The lowly rankings among the 50 states sting, too.

But there it is in black and white. For children ages 19 months to 35 months, the Centers for Disease Control and Prevention reports that the two states reside in the bottom five. About two-thirds (65.6 percent) of Idaho kids are immunized. It’s 69 percent for Washington. West Side and East Side counties showed similar numbers. The national average is 77.4 percent.

That’s disheartening news because public health officials had worked hard to boost Washington state’s rate – from 56.2 percent in 2003 to 71.2 percent in 2006. Idaho’s rate represents a decline, too.

The stakes are high.

Dr. Anne Schuchat, who heads the immunization program for the Centers for Disease Control and Prevention, told the Spokesman-Review editorial board in April that by the time a cohort of toddlers reaches age 18, immunizations prevent 14 million infections and 33,000 deaths, while saving the health system $43 billion.

Jefferson and Roosevelt elementary schools had chicken pox outbreaks last spring. Because it is highly contagious, the schools had to send home several dozen children until parents could produce proof of immunization. As inoculation rates decline, such events could increase for any of the 18 diseases targeted by health officials.

Immunizations are not mandatory nor should they be. It is reasonable to allow parents to opt out for medical, philosophical and religious reasons, and most states allow for that. But Washington and Idaho are among the most lenient when it comes to waivers. Parents need only sign a form, thus opt-out rates are among the highest in the nation – about 6 percent in Washington and 5.2 percent in Idaho.

In other states, parents must provide an explanation. That’s reasonable considering the potential consequences to other children in crowded settings such as schools. States that have that requirement report higher compliance rates. Lawmakers in both states need to act.

Another reason for the decline in Idaho is that a statewide reminder system hasn’t been fully accepted after stumbling out of the blocks. The Immunization Reminder Information System was rolled out in 1999, but software problems stymied efforts to send cards to families to remind them when shots were due, according the Idaho Statesman. The software has been fixed, but the system still has not gained the confidence of the medical community.

Said a frustrated Dr. Christine Hahn, the state epidemiologist: “You get those (reminders) for your dog’s rabies shot, but nobody gets it for their kids’ immunizations.”

It’s embarrassing that this region would be among the worst in preventing childhood diseases. We can do better.