Monthly Archives: January 2015

A Herd of Vulnerability


There’s a measles outbreak in California that took flight at Disneyland this month. It  frankly sounds benign to those of us who have never encountered the disease.  But before a vaccine was introduced in 1963, 4 million people a year were infected. Hundreds died annually and thousands were permanently disabled.

Minds don’t get changed by argument or data or science. Minds are changed by direct personal experience with a traumatic event. I was aware of the science and politics around vaccinations only when I became a mother thirteen years ago. The first conversation I had was with Dr. Granader, a seasoned pediatrician working at St. Luke’s Hospital in San Francisco. While I held my hours-old baby in the standard issue newborn blanket, he answered our questions about the risks of shots. He said vaccine refusals were a new trend that had been troubling him. He told us side effects are a miniscule risk whereas the diseases they protect our children from are horrific. When he did his residency it was before the pneumococcal vaccine had been introduced. Children came into the ER and never left or if they did, their lives and brains were permanently damaged. And then the vaccine was introduced and the cases stopped.  He said as a doctor he wasn’t in the business of performing miracles but he had seen how a new vaccine can indeed be miraculous. He gently told us he had decided to stop taking patients who used the personal belief exemption. He had known the before and the after and would never forget the lives lost.

The California Department of Public Health tracks the vaccination rates for all schools, public and private, in the state. I knew anecdotally that our kids’ school had a lower than average rate of vaccinated kids but my children were up to date with their shots and not at risk. Then I became pregnant and suddenly this information took on new and perilous meaning. When I looked up the school’s rates I was surprised to find our immunization rate wasn’t just low, it was below the level that provides societal protection, called the “herd effect”. This is the immunity that a vaccinated public provides those people who cannot be immunized: babies, immune-compromised, chemo patients, etc. Some diseases are more contagious than others and there is no perfect target percentage. But in general, herd immunity is in effect when over 80% of the population is immunized.

The most recent report shows the rate of personal belief exemptions in California has doubled in the past 7 years from 1.5% to 3%. But what this statistic doesn’t show is those un-vaccinated children are not distributed across the state. The increase is concentrated – highly –  in groups like the close-knit community where my kids go to school.

When I drill down into the publicly accessible data on the California Department of Public Health’s website it’s the religious schools and the Waldorf schools – public and private – that show the increase. At my kids’ school, the rate of exemptions for personal belief (a form parents can fill out instead of submitting a vaccination card) went from 23% in 2007 to 51% in 2014.   On the other hand, our neighborhood public elementary school (where we would go if we hadn’t gotten into the charter school), has a 1% personal belief exemption this year. There is one child in 114 kindergartners whose parents signed a personal belief exemption. At my kids’ school the number is 21 kindergartners out of 41 enrolled and the number increases every year.

In January 2013,  legislation was passed requiring personal belief exemptions to be signed by a health practitioner. Parents have to confirm they were counseled by a healthcare worker on the risks of their choice. Previously, only the parents signature was required. Our Deputy Health Director, Dr. Karen Smith, told me last year she hoped this change to the law would result in reducing the number of exemptions. Since the law changed, however, our school’s rate of exemptions jumped 14%.

Ironically,  as we cluster more in like-minded circles like charter schools where our belief systems are reinforced, we make ourselves more vulnerable. It becomes as normal to do the exemption as it is normal to vaccinate elsewhere. We support each other in finding health practitioners sympathetic to our beliefs. And as our world narrows to this tiny public school with a very specific ideology, we begin to forget the role we play, biologically, in the larger public.

I feel incredibly lucky to live in the United States at a time when safe drinking water, clean air, highway safety are all ordinary features of daily life. Regulations imposed by the legislative process have made this so.

What is more American: the freedom to opt-out of public health in favor of private belief? Or the freedom to send your kids to public school without fearing for their exposure to a deadly, vaccine-preventable disease? Don’t schools – particularly public schools – bear a responsibility for educating parents and protecting their students?

We are all doing the best we can with our kids with an overwhelming amount of information.  What school is best for our child, what books, what medicine, what kind of discipline. And every family has their own protocol for maintaining good health: vitamins, exercise, organic food, alternative or mainstream doctors.  But these are personal choices pertaining to private health (and luxuries many can’t afford). Vaccinating our children is about participating in public health.

To the parents who opted out of vaccines this year: please re-consider your decision.  At least get your child vaccinated for those diseases which pose the greatest risk to the weak in society.

We are a healthier public because of the advances in medicine, not despite them. This is a good time to be alive and raising children.  But as Michael Specter says in his book, Denialism: “Prevention is invisible…Nobody celebrates when they avoid an illness they never expected to get.” I hope this Measles outbreak serves as a warning and this wave of vaccination denials wanes because of the triumph of reason and not tragedy.