All parents want to protect their children from suffering, and yet they do so differently. Despite this inevitability, some commentators have used the current measles epidemic as an opportunity to attack those parents who exercise freedom of conscience and freedom of religion and have done so in an especially strident and sensational way.
Writing in Forbes, Dan Diamond titles his piece, “Measles Can Kill And It’s Spreading. Sue Parents Who Didn’t Vaccinate? Absolutely…” Diamond equates measles with Ebola and confuses US measles risks with the worldwide risks.
He also recommends, as you can tell from the title, that “we” sue parents who don’t vaccinate—whether for philosophical, medical, or religious reasons. Plus he states equivocally, as do many, that “…there is no link between the measles vaccine and autism. None. Zero” so it is foolish for parents to question the safety of vaccines.
My local paper, The Santa Fe New Mexican, published an opinion piece by Petula Dvorak, columnist for the Washington Post, entitled “Anti-Vaccination Parents Prove Their Point.” Much of Dvorak’s argument is based on name-calling. Among the names she calls those who choose not to vaccinate are: “organic, cage-free, Buddha-mama, mindful-parents, CDC Barbie; wackadoodle, fruitarian, and Bokonoistic,” and those who do not keep up perfectly with the vaccine schedule are categorized as “disorganized, and do-nothing parents.” Dvorak concludes, “Refusing to immunize puts the rest of us at risk.” But, does it?
HOW DID THE MEASLES EPIDEMIC BEGIN?
Contrary to popular reports in the media, the current measles epidemic did not start in Disneyland—though an outbreak occurred there—but in the Amish community in Ohio, with a missionary recently back from the Philippines. In fact, since 1993, most reported cases of measles have been directly or indirectly linked to international travel, and many have been in adults.
Endemic measles has been eliminated in the US since 2000, but travelers can bring measles to the US from countries with measles epidemics, such as the Philippines in 2014.
WHAT IS THE STATUS OF MEASLES IN THE US?
Prior to the introduction of the single dose measles vaccination in 1963, there were about 500,000 cases of measles a year and 500 deaths (1 in 1,000 cases). Infection with measles virus was nearly universal during childhood, and more than 90% of persons were immune by age fifteen.
Between 1989 and 1991, a second dose of the vaccine was added and since 1997 the incidence of measles has remained below one case per million. During the recent 2014 epidemic 644 cases were reported, the highest number in nearly 20 years. Since 1995, an average of one measles-related death per year has been reported in the US (2.54 and 2.83 deaths per 1000); pneumonia accounts for about 67% of the deaths.
About 30% of measles cases have complications such as diarrhea (8%), ear infections (7%), and pneumonia (6%) and complications are higher among young children and adults.
WORLDWIDE MORTALITY OF MEASLES
The measles virus is one of the leading causes of death among young children worldwide; it is still common and often fatal in developing countries. The World Health Organization estimates that there were 145,700 deaths globally from measles in 2013, about 400 deaths every day. In countries where measles has been eliminated, like the US, cases imported from other countries remain an important source of infection.
THE HEALTH OF THE UNVACCINATED
It is true that the incidence of measles infection is more prevalent among unvaccinated children. However, A 2013 independent German study concluded that, overall, unvaccinated children get sick less often than do vaccinated children. Physicians who work with populations of vaccinated as well as unvaccinated children report that unvaccinated children have more acute illness while vaccinated children have more chronic illness.
Many parents today are more concerned about the risks of chronic disease than the risks of rare acute diseases. In the US, one in 13 children (8%) have food allergies and tree nut allergies among children tripled between 1997 and 2008. Autism has spiked 1,500% in the last 20 years: one in 88 children is on the spectrum: 825,000 in the US; 89,000 in Canada; 131,000 in the UK.
THE MMR VACCINE, CHRONIC DISEASE AND AUTISM
Parents are not only concerned about the unexplained increase in chronic disease, but specifically about the possibility that vaccines may have contributed to this increase. While an association between the MMR vaccine and autism has been continually debunked by the media, the evidence suggests otherwise.
My name is William Thompson. I am a Senior Scientist with the Centers for Disease Control and Prevention, where I have worked since 1998.
I regret that my coauthors and I omitted statistically significant information in our 2004 article published in the journal Pediatrics. The omitted data suggested that African American males who received the MMR vaccine before age 36 months were at increased risk for autism. Decisions were made regarding which findings to report after the data were collected, and I believe that the final study protocol was not followed.
Parents also worry because of MMR damage claims that have been awarded. In a 2013 landmark decision, Sadid and Parivash Mojabi of San Jose, California were awarded $969.474.91 in compensation for a severe and debilitating brain injury that their son, Ryan, suffered after administration of the MMR vaccine.
In 2012, the Italian court ruled that a child “has been damaged by irreversible complications due to vaccination (prophylaxis trivalent MMR)” and ordered the Ministry of Health to compensate the child with a 15-year annuity and to reimburse the parents for court costs.
Also in 2012, a medical assessment panel found that a Scottish woman was made deaf by the MMR vaccine.
WHO ARE THE NON-VACCINATED?
While articles about the current measles epidemic call into question the integrity of parents who do not vaccinate, Aviva Jill Romm, MD, counters this assumption,
Pediatricians need to let go of this knee-jerk reaction that parents who don’t vaccinate are irresponsible. Many of the parents I know who have chosen not to vaccinate are actually well-educated, active and contributing members of society. They are physicians, educators, people involved in government, law professors, medical professors, and academic professors.
Romm’s experience is borne out by a 2007 study in the American Journal of Public Health that found that low maternal educational levels and low socioeconomic status were associated with high vaccine compliance.
While more unvaccinated children will get sick when there’s an epidemic, this does not mean that they can be blamed for starting it. According to Jay Gordon, MD,
When children or babies who have been in contact with other children (or adults) contract most illnesses, there is no feasible way to know from whom they got the disease. Parents must protect [infants too young to have received a full complement of shots and immuno-compromised children] by keeping them away from too many other children.
It’s no coincidence then that the recent outbreak of measles occurred at Disneyland, a place where there are a lot of people and many from other countries.
We have to tolerate some disease because even when a vaccine is as effective as the measles vaccine, it won’t work for about 2% to 8% of recipients. And, measles vaccine acquired immunity is reported to wane in at least 5% of cases, within 10 to 15 years after vaccination.
A report published in 2012 by the Cochrane Collaboration reviewed 57 clinical trials and studies that involved about 14.7 million children vaccinated with the MMR vaccine. Cochrane found that:
Based on the evidence provided by three cohort studies (3104 participants), vaccination with one dose of MMR vaccine is at least 95 percent effective in preventing clinical measles among preschool children; in schoolchildren and adolescents at least one dose of MMR vaccine was 98 percent effective in preventing laboratory-confirmed measles cases; one or two MMR doses were respectively 92 percent and 95 percent effective in preventing secondary measles cases.
And, even though there is no endemic measles in the US, the disease can occur even among a population of 100% vaccinated, suggesting again the possibility that protection can wane over time.
HOW MANY DON’T VACCINATE?
Sometimes it seems as though there are vast numbers of unvaccinated children, but in fact, the numbers are small. The goal of the Healthy People 2020 objectives is 95% MMR vaccination coverage and in 2011, the overall median school vaccination coverage in the US was 94.8%, with a range of 86.8% in Colorado to 99.3% in Texas. For those receiving two doses of the MMR vaccine, the median coverage was 93.2%, with a range of 84.0% in Colorado to 99.2% in Mississippi and Texas.
Out of an estimated total of 4,124,185 kindergarten children, only 89,133 claim vaccine exemptions The median total vaccine exemption level in the US is 1.5%. Exemption levels range from less than 1% in Mississippi to 7% in Alaska. When looked at separately, the rate of nonmedical exemptions is 1.2% with a low of less than 1% in Delaware and Kentucky to 5.8% in Oregon.
FREEDOM OF CONSCIENCE CAN BE TOLERATED
It’s illogical to blame unvaccinated children for epidemics when they often originate in other countries or are related to the limited effectiveness of vaccinations. While unvaccinated children may have a higher incidence of the disease than their vaccinated counterparts, they cannot be blamed for causing it.
If one concludes that unvaccinated children put others at risk and that their parents should be sued, what is next? Will we sue people who travel to areas with disease? Or, only those who travel unvaccinated? And, if their vaccine status is unknown will we consider them a risk? Will we sue them too? Will we sue vaccine manufacturers because it is impossible to make a vaccine that is 100% effective?
The truth is, that despite our best efforts, disease exists and with it come inevitable differences of opinion and variations in religious practices regarding how best to prevent and treat that disease. With a disease like measles that occurs once in 1,000,000 people in the US, we can certainly tolerate some dissent from vaccination policy without compromising its effectiveness.
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Peggy O’Mara is the editor and publisher of peggyomara.com. She was the editor and publisher of Mothering magazine from 1980 to 2011 and the editor-in-chief of Mothering.com from 1995 to 2012.. The author of Having a Baby Naturally; Natural Family Living; The Way Back Home; and A Quiet Place, Peggy has conducted workshops at Omega Institute, Esalen, La Leche League, and Bioneers. She is the mother of four and grandmother of three.