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There are few topics in public health that are as controversial or attention-grabbing as the ongoing debate over vaccination rates and vaccine policy. When our Jan. 9 hour looking at a growing state-by-state pushback against the anti-vaccine movement hit the airwaves, our phones lit up with people on both sides of the debate.
Parents, pediatricians and registered nurses alike called in to tell us their own experiences with vaccination, while our Facebook, Twitter and comment feeds burst open with heated debate as to whether or not state governments have the right to require families to vaccinate their children.
In Colorado, proposed new state regulations have required just that. The state, with one of the higher rates of voluntary immunization opt-out, is exploring possible enforcement mechanisms to increase public participation in vaccine campaigns, especially among students in the public school system.
Reporter Michael Booth of The Denver Post gave us a great run through of the state's domestic politics around immunization.
"Colorado has gone at this on a couple of fronts right now. We did this about a year and a half ago, two years ago. Where they saw that flu obviously is a big problem every year in every state. And they went after it by saying that up to in this following year 90 percent of people who came in contact with people at health facilities — whether it's a hosptial or a nursing home, — across the board have to be immunized.
There was some controversy about that. Some nurses and other people ho work in those studies did not like being told what they had to do in order to keep their job, but Colorado was pushing ahead on that and saying that it's clear that people who are vaccinated against flu viruses every year are much better protection for public health, and that in public heath situations in medical situations, those are the very people who should understand that and those employees should be immunized.
Now since then we have continued to have outbreaks of pertussis-whooping cough in Colorado and many other states major spikes in that in the last couple years and now as you've seen and as you mentioned, measles outbreaks that are very worrisome to people because measles was really one that was supposed to have been conquered a long time ago.
So now in Colorado and some other states there is talk of tightening up this form that people have that they can, when their kids go to school, say that they don't want vaccinations, and their kids are exempt from it. This is a very simple process in Colorado — you just sign a form that says you have some personal objection — can be religious, it can really just say 'Personally I disagree with it or I don't like it.' And your kids can still go to public school.
And the way that Colorado and other states are going about it is talking about, 'What can we do to make that system more difficult?' If five or six percent of kids are showing up at school without proper vaccinations and getting exemptions, that's when you start getting to this problem; that's not whole herd immunity, that's not enough people to protect us from future outbreaks. So how can we make it, inform those parents and make it more difficult for them to just opt-out. And one of the ways to do that is to make it, my phrase has been informed dissent. So that before you make that dissent from what the customary practice is, you have to go through an education process. So that a doctor a public health official person, a nurse would sit down and explain to you why public health officials believe that vaccination is important, how it protects the general public and protects your own child,. And then you could sign the form but you would have to go through that education process first."
Booth also explained how having a seemingly overwhelming but not universal number of vaccinated citizens can still affect public health.
"That's the map that you don't want to stand out on, but we do in Colorado. Depending on which study you're looking at, somewhere between about five and six percent of students are coming with the exemption, without the vaccinations or at least without proper proof that they on the schedule that public health officials want them to be on.
Now five or six percent may not sound like that much, you might say ninety five percent of anything must be some kind of public policy success. But the way it works in epidemiology and in medicine is that people come in contact with so many other people that that one person or that small group of people makes a big difference in things like vaccinations in these kind of highly communicable illnesses."
Indeed, as our public health expert Steven Salzberg told us later, the success of public health campaigns like vaccination drives has lead to the recent surge in vaccine opt-outs.
"The very success of the vaccines programs over the past few decades has lead to the rise of this anti-vaccine movement. One of the problems is that people simply don't see many of the infectious diseases that used to be common in the U.S., so they're not worried about them. Even a tiny hint of some risk, whether it's based in science or on some rumor is enough for people to say 'Oh, I think i'll just opt out of that.' So states over the past 10 or 20 ears have allowed these exemptions to creep in and made it easier and easier for people to adopt."
Booth told us about how diverse the groups of people pushing against vaccination schedules truly can be in practice.
"So we talked to many people and talked to many doctors and nurses who talk to a lot of people, they're the ones meeting the parents on the front lines coming in and hearing what their objections are or what their thinking is. It's not just one group of people or one political or social ideology that we're talking about. I think that people often assume that it's people who are very distrustful of the government, maybe from a conservative point of view, more Libertarian who might consider homeschooling their kids, do not want to be involved in all of the public schedules of things that they feel is required of them. And there certainly is that group of people in Colorado, and in some of the other states. But there also is in Colorado, a significant group of people who might have a more left-leaning ideology who are very well informed, who have thought about things like genetically-modified foods and what they're putting into their bodies in other way and they have decided that they feel that that they are risks to vaccinations, that it's better to expose their children to the diseases that are out there and have them build up their own immunities.
What drives doctors and nurses crazy is they are often latching on to old and very discredited information about dangers of the vaccines themselves and the immunization process themselves. There was a study that was done that claimed there might be a link between the increase of reports in autism in kids to vaccination. And that has been thoroughly discredited over and over again since then, but doctors tell us many times that what they hear very frequently as parents come in us that particular study, it sticks in people's heads and they're trying to figure out how to change that dialogue.
It happens in Boulder, CO, also an affluent area, a highly-educated area. I'm sure you would find that reflected in other areas that might not be your first candidate in the other states that are highlighted on this map. So I don't think that there is just the one pattern. Economically another aspect of this is there really shouldn't be much of an economic reason in terms of whether it's affordable or not to avoid vaccinations. We've pushed now school clinics so deep into the process of medicine and health care in America, both through things like private health care foundations in Colorado and in other states. Obamacare put a lot of money into bolstering school clinics. And now there are a lot of communities where not just the students but their families are getting a significant amount of their health care through the school. And that's a great way for public health officials to make contact and give out free or reduced prized vaccinations and try to figure out if the people they're seeing having the full schedule. There is an infrastructure available to make sure that his push can happen. Now you gotta deal with the laws and rules in place that make it too easy for people to back out."
And despite the public health infrastructure and rules, there will always be public pushback against this kind of government instruction, Booth noted.
"There will always be pushback on this, when the government comes through and says, 'We think this it's important that you do something and now we're going to make it even more of a requirement or we're going to make it a higher penalty if you font do it.' There will always be the pushback that it's government arrogance, they shouldn't have the right to tell me what to do. They are assuming they know better than I do when it's my children. And that's certainly understandable. But I think on the other hand that some public health officials are feeling their muscles a bit more in terms of dealing with these problems. They're not just gonna sit back and let the problem get worse. They're taking steps like requiring the health workers to get flu vaccines and now they're're considering this step in Colorado and other states, saying 'We understand, but the whole point of public health is to protect the public when the public doesn't always understand the situation or have time to deal with it.' They sometimes have to follow mandates when the mandates have been proven to improve the overall health of the population."
A caller told guest Dr. Paul Offit that she's not "anti-vaccine," she's "anti-over-vaccination." Offitt responded to the caller.
"Children aren't over-vaccinated. I mean, when vaccines come onto to the market to have to be tested in so-called concomitant use studies to make sure that the vaccine that's added doesn't interfere with the safety profile or immunogenic profile of existing vaccines and visa versa. These vaccines are well tested and well tolerated. The question that the caller raised is 'What are the side effects and are they serious?' And certainly vaccines do have side effects, but those side effects are pain and redness at the injection sites. Some vaccines include gelatin, which can case a reaction and very, very rarely a server allergic reaction. Some people are allergic to the egg proteins contained in the flu vaccines. For the most part, that's about it. Vaccines don't cause permanent harm, children aren't being scarified by vaccines, quite the opposite. I think a parent's most important job is to put children in the safest position possible and that's what vaccines do."
What's your take on the public health arguments in the ongoing vaccine debate? Have you seen the return of forgotten illneses in your community as more and more people opt out of mistrusted vaccine campaigns?
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