They call them nonmedical exemptions, and the resurgent measles virus loves them.
Measles, a disease that was essentially eradicated in the U.S. less than two decades ago, has stormed back to prominence, thanks to an outbreak in Clark County – the neighbor to Portland that has one of the highest levels of unvaccinated kids in the state.
It’s just the latest crack in our weakening bulwark against communicable diseases, one of a series of cracks that is driven in part by fear and ignorance and fake science. It’s got public health officials scrambling to contact schools and encourage families whose kids aren’t immunized to encourage them to do so, and it’s putting the state on a course for an important and difficult policy debate – whether we should curtail nonmedical exemptions for vaccination requirements for people who put their kids into the public schools. Whether we should effectively force people to vaccinate or stay out of the public schools.
A proposal in the Legislature would eliminate the personal exemption for the measles, mumps and rubella immunization, and the measure is sure to draw opposition on the personal freedom front, as well as the whole phalanx of anti-vaxxer arguments.
The tensions between public safety and individual freedom won’t be easy to resolve. But there’s a personal freedom issue on the other side of the matter, too: Those who vaccinate their kids are not free from the consequences imposed by those who do not.
Put another way, the people in Clark County who vaccinated their kids against measles are now living in a community where their chances of coming down with the measles, though much lower than those who are unvaccinated, are a lot higher than they used to be.
Vaccines are highly – but not entirely – effective against measles. That’s why health officials spend so much time emphasizing the importance of immunizations. Getting both MMR shots is 97 percent effective against the disease, but to really banish it from the community almost everyone needs to get those shots.
Health officials believe that a 95 percent immunization rate is required to protect everyone from measles; in Clark County, the vaccination rate for kindergartners has plummeted from more than 90 percent in 2005 to 77 percent today.
“The thing that keeps me up at night is that we could end up seeing a severe complication or even death from this, and it’s completely and utterly preventable,” Clark County Health Officer Dr. Alan Melnick told King 5 News in a recent interview.
Measles came storming into Washington as the new year began, with 43 confirmed cases in Clark County so far, 8 suspected cases, and the expectation that it’s just getting started. Most of the cases involved children; 37 of the cases are known to involve nonvaccinated individuals, and the vaccination status of the others is unknown. One case has been reported in King County.
Spokane has not had a reported case of measles yet, but health officials worry that our immunization rates – like those all across Washington – aren’t high enough to protect the community from disease. The number of Spokane County kids who have received both MMR immunizations is 74 percent.
The outbreak provides local officials the chance to encourage unvaccinated families to reconsider, said Susan Sjoberg, a program manager in disease prevention and response for the Spokane Regional Health District.
“It’s an opportunity for us to get the message out to the public,” Sjoberg said.
That message is clear and simple: Immunization “is an amazing way to prevent disease and protect the community in a very safe, well-proven, well-studied manner,” Sjoberg said.
In Spokane County during the 2017-18 school year, 8 percent of students had been granted exemptions, almost all of which were considered “personal,” rather than religious or medical, according to the Department of Health.
Washington schools require students to prove they’ve received a range of vaccinations – or to apply for an exemption. Exemptions have grown and grown in some pockets of Washington. Conspiratorial anti-vaxxer arguments used to be mostly a province of the religious right; these days, it comes just as often from the natural medicine left, and the movement is flourishing online with a big assist from lots of pseudoscience.
In any case, vaccination rates have been weakening, and the Clark County measles outbreak is our latest alert. And though the outbreak is occurring hundreds of miles away, it doesn’t mean that it won’t make its way to other communities, Sjoberg said.
“Measles is considered the most communicable disease known to humans,” she said.
Sjoberg noted that measles was declared eliminated in the U.S. in 2000. For a few years thereafter, there were 40-something cases per year in the country; most were travel-related.
In subsequent years, the number of cases – along with the increase in people taking a pass on vaccines – began to rise. In 2013, there were more than 600 cases nationally. Who knows how this year will stack up.
We know how to get rid of the measles. We’ve done it once already.
The only question now is how many painful reminders it will take for us to wake up and do it again.