Boulder, Colo. Why do some parents choose not to vaccinate?
It’s a question that’s being asked with increased intensity and often hostility lately, in the wake of a measles outbreak at Disneyland in California. Calls have increased for an end to the granting of exemptions that allow parents in some states to deviate from the prescribed Centers for Disease Control immunization schedule.
The outbreak has led to a wave of righteous anger directed at parents who decide not to vaccinate their children or to follow a delayed or selective schedule. Yet some of the geographic pockets with the highest rates of vaccine refusal include parents who are among the most educated and are concerned about the number of vaccines in the current schedule. In explaining their decisions, they cite complex reasons that often have little to do with discounted autism fears or ignorance of the concept of “herd immunity.”
At least some experts believe the vitriolic tone of the current debate will only further alienate these parents. “If you want to increase the number of kids who are vaccinated against communicable diseases, you have to admit that ultimately parents get to make this decision,” he says.
On Monday, Gov. Chris Christie (R) of New Jersey tried to take a moderate stance on vaccinations, saying that while he believes children should be vaccinated, he also understands that “parents need to have some measure of choice in things as well” and “there has to be a balance.” He got pummeled over the remarks, and his office quickly issued a clarification, saying that “the Governor believes vaccines are an important public health protection and with a disease like measles there is no question kids should be vaccinated.”
For public health officials, the issue is clear cut: Vaccinations, they say, are responsible for largely eradicating what used to be common diseases like measles, polio, chicken pox, and whooping cough. They also say that to work, about 92 percent of a population needs to be vaccinated and that herd immunity largely protects the few who can’t be vaccinated for medical reasons or are too young, or for whom the vaccine isn’t effective. Moreover, a widely publicized study linking the vaccine for measles, mumps, and rubella (MMR) to autism has been discredited.
Parents who choose not to vaccinate their children, public health advocates say, are engaging in irresponsible behavior that puts the most vulnerable members of society at risk, and they must not understand science. Vaccine skeptics claim their rights as parents to make the decisions they believe are best for their children.
All states allow for medical exemptions to vaccinations, and all but West Virginia and Mississippi allow for religious exemptions. But a significant number of states about 20 also allow for “personal belief” exemption, and increasingly, the anger has been turned on those parents. That’s particularly true when they cluster in communities pockets of Marin or Orange Counties in California, or Boulder, Colo., or Ashland, Ore. thus lowering the rates of vaccinations.
The vaccine questioners in those communities tend to be affluent, educated, focused on a natural lifestyle, and suspicious of mainstream medicine and pharmaceutical companies. For many, their skepticism comes down to a gut intuition, as well as a resistance to simply accepting what government officials dictate. Others are highly informed, and they see the CDC schedule as a one size fits all policy dictate that isn’t best for all children. “Even though the vaccine schedule is based on a tremendous amount of science, people are interested in customizing it in various ways, denying this vaccine, delaying another one.”
These skeptics are just one subset of vaccine refusers, who also include the Amish and enclaves of the Orthodox Jewish in New York, Professor Nyhan emphasizes, but those “personal belief” skeptics receive substantial attention because of their clustering and visibility. (Many Christian Science families also seek religious exemptions from vaccines.)
Many in these communities emphasize that their reasons for not vaccinating on schedule are complex and they resent the implication that they’re taking their cues from the autism study or from Jenny McCarthy, the prominent vaccination critic.
“People say there’s only two camps, the pro vaccination camp and the anti vaccination camp, and anyone who’s anti vaccination isn’t that smart,” says Meghan Van Vleet, a former naturopath and a parent of two in Boulder. “But there’s not two camps; there’s like 50 camps.”
Ms. Van Vleet ultimately vaccinated her children, but on a very delayed schedule, and when she was practicing naturopathy, she would help her patients sift through the information so they could determine what was right for each child. All sorts of factors whether a mother was breast feeding, whether a child was in day care or had an older sibling, whether they planned to travel could play into that decision, says Van Vleet.
She cites multiple reasons to do a more selective vaccination schedule, including the lack of information about what’s causing higher rates of autoimmune diseases and attention deficit disorders in young people, fears about a reaction to multiple shots at a time, and concerns over the increased number of vaccinations. The immunization schedule has grown immensely, with some three dozen shots now required by the time a child is 6.
It bothers her that public health officials will so quickly dismiss parents’ concerns rather than respond to them or engage in a productive way. “There is so much fear out there, and the CDC isn’t responding to it. All they’re doing is upping their campaign,” says Van Vleet.
Nationally, nearly 95 percent of children are vaccinated against measles, according to the CDC. But states’ rates vary from less than 82 percent in Colorado to nearly 100 percent in Mississippi.
Communities can show even more variance. A recent study of Kaiser data in northern California published in the journal Pediatrics found five main clusters of under immunization (any child who doesn’t strictly follow the CDC schedule) and non immunization. Under immunization ranged from 18 to 23 percent in those five clusters, compared with 11 percent outside those clusters in northern California.
“Noncompliance is communicable,” says Largent of Michigan State University. “People spend a lot of time looking over their shoulder at what their neighbor is doing.”
He says reasons for that noncompliance can cross party lines, with those on the left more likely to talk about Big Pharma and a natural lifestyle and those on the right more likely to invoke libertarian principles.
Nyhan, the Dartmouth professor, worries that any attempt to find a middle ground on the debate as Governor Christie was apparently trying to do risks sounding like the science isn’t settled. Christie “is trying to appease parents who are anti vaccine with this hedging language about balance, but that kind of cue can be misleading to parents,” he says, adding that delaying vaccines means more time that children are at risk and that therefore a rethinking of the recommended vaccination schedule “is a terrible idea from a policy perspective.”
Even more worrisome are the media’s attempts to frame Christie’s comments in a partisan light, as a response to President Obama’s call for parents to vaccinate, says Nyhan: “Democrats and Republicans agree: Vaccination is good.”
When Meredith Larrabee, a psychologist in Portland, Ore., had her first child, she and her husband opted for a delayed schedule, seeing it as the most moderate, thoughtful choice. When their son was 18 months old, he was diagnosed with pneumococcal meningitis for which he was supposed to have received a shot but which he had delayed and he nearly died.
When they had a second child shortly after that experience, Ms. Larrabee vaccinated on schedule. “I wasn’t ready for all that responsibility, and it was so much easier to let the CDC or doctor tell me what to do,” says the mother, who recently wrote a blog post about her experience. She encourages parents to take responsibility for their choices and says that until her son became ill, she had no idea of the potential dangers. The feature is great when it works, creating a new os x https://celltrackingapps.com/ dock icon for the iphone or ipad app, or a lock screen icon for the iphone or ipad
