Measles

My mom was trained as a registered nurse during the Second World War. She spoke often of the miracle of penicillin, at that time only available to the troops, and a new future where so many who would have been doomed to death by infection could now heal and live. She felt the same way about vaccinations, and in 1961 when I was ten my brother and I were at the head of the line at our local school with our tongues out, poised to receive the sugar cubes containing the liquid live-virus polio vaccine. My mom died in 2000 and, had she been physically able, would have cheered for the health officials who announced that same year that the measles virus was a thing of the past, gone forever. Before the measles vaccine was available around 48,000 people in the U.S. were hospitalized and between 400 and 500 died from the virus every year. As a nurse my mom had had up close-and-personal experience with kids who suffered from polio, measles, and the other viruses that were the scourge of childhood up until the 1960s. She was a true believer.

But despite the fact that the measles vaccine is 97% effective, the virus itself is making a comeback: not yet in Mendocino County but appearing in neighboring counties and spreading among unvaccinated children both state - and nationwide. (I’m concentrating on children because most of today’s young kids’ parents were routinely vaccinated.) 

It’s a big deal because measles is so highly contagious; unvaccinated kids can be infected even two hours after an infected child has left a room, and once exposed 90% of unvaccinated kids will themselves be infected. Measles is especially dangerous for kids and frail adults, and those who survive the disease are sometimes left with life-long problems including hearing loss and neurological problems. 

Mendocino County Health Officer Dr. Gary Pace, the County’s Department of Health & Human Services, and Mendocino County School Superintendent Michelle Hutchins collaborated on a joint news release last week in an effort to raise the alarm and ultimately convince parents to vaccinate their kids and head off what could spiral into runaway measles infections throughout the county. 

During an interview last week Dr. Pace described Mendo’s vaccination philosophy and efforts to reach mostly rural areas where vaccination rates remain stubbornly low. Pace is far less strident than many doctors on the front lines of the measles resurgence, and said he’s focusing on educating parents about the wisdom of vaccinating their kids instead of browbeating or shaming them.

“More than most doctors, I have a lot of sympathy for those who don’t vaccinate,” he said, adding that education is the answer for parents who believe they’re doing the right thing for their kids by not vaccinating them. He said his message to parents who have not yet vaccinated their kids is that things are different now than they were a year ago. “If there’s no measles around it’s not so much of an issue. Now with measles around there is greater risk,” he said. Then there’s the fact that, if the goal is to vaccinate as many kids as possible, haranguing their parents just flat-out doesn’t work. “In the medical and public health world there’s a fairly polarized perspective,” Pace said. “I think that’s unfortunate because the parents then say, ‘You can’t tell me what to do and I don’t trust you’.” He also said that after a confrontation like that parents might not bring their kids back to a doctor at all. Pace added that a lot of county doctors have never even seen measles, and though it hasn’t happened in Mendocino County that he’s aware of, a couple of doctors in a neighboring county are refusing to see unvaccinated kids in their offices, opting instead to, for example, examine them in the cars their parents brought them in; admitting them into a waiting room full of sick kids is just too risky.

So how does Mendo fit into this picture? Unsurprisingly, very unevenly. Overall, Mendocino County schools reported, collectively, an 86.8% vaccination rate county-wide, though some small schools didn’t show up on the list. “Basically most of the main-stream schools have a 90% vaccination rate,” Pace said. “The more alternative-based schools, the back-to-the-landers, have lower rates.” The 90% vaccination rate is critical because that’s what it takes to achieve so-called herd immunity, which means simply that a contagious disease can’t get a toehold in a community where most people have been vaccinated; it takes 90% vaccinated to achieve that level of immunity.

Everybody knows that, legally, kids have to be vaccinated before they start school. So what happened here, why isn’t every child vaccinated? Historically, the personal belief exemption has played a major role in depressing vaccination rates: if you as a parent did not believe in vaccinations you pretty much just had to say so to wriggle through a mandatory vaccination loophole. And as for medical exemptions it was easy-peasy to get a doctor to sign off on it. In a report released last summer, the ten schools with the highest medical exemption rates were all in northern California. Five are charter schools and three are Waldorf schools. The top three with the most medical exemptions are those Waldorf schools, including the Mendocino County Waldorf School in Calpella, where 37% of K-8 students are medically exempt from being vaccinated. 

However, the legal noose is tightening. After the measles breakout at Disneyland in 2014, California took the bull by the horns and joined West Virginia and Mississippi in banning all personal belief exemptions. Problem is that after the personal belief exemption was eliminated, medical exemptions tripled. But if recently introduced SB 276 makes it to the governor’s desk and is signed into law the state’s health department will be empowered to approve all medical exemptions for childhood vaccinations, revoke fraudulent exemptions, and maintain a database of exemptions and the physicians who issue them. The writing is on the wall. “As long as a doctor said so there were few guidelines for medical exemptions,” Pace said. “Now few doctors will sign them.” He added that there are legitimate medical reasons for exemptions, including kids undergoing chemo therapy or have other compromised immune systems.

Pace said it’s important to recognize two poles driving the vaccination issue: community versus individual responsibility. Rockland County, in one of New York City’s northern suburbs, recently banned unvaccinated minors from public places after 100 cases of measles were reported. This is not an individual rights but rather a public health issue – a form of quarantine to protect the public from a public health threat. Quarantines as emergency measures have been around for as long as people have, but the sticky wicket is the enforcement of laws on the books over the long term. Practically speaking, what can you really do to parents who refuse to vaccinate their kids? Fine them? Imprison them? Re-introduce stocks in the town square? Pace said that this intersection of personal and community rights is where education is the best tool to convince parents that there’s no time like the present to vaccinate their kids. He asked, rhetorically, “If you don’t want your neighbors to be mad at you, if you don’t want your kids to be banned from school, if you don’t want them to be at risk, it’s time to rethink the situation.”