After two measles cases were recently diagnosed in Boston, public health officials issued a warning reminding the public that the disease can spread fast among the unvaccinated — or about 3 percent of the state's population.
They flagged western Massachusetts in particular for its rising number of parents who decline or delay recommended immunizations. And that's creating a quandary for many pediatricians concerned about old diseases making a comeback.
When Anna Popp was pregnant with her daughter five years ago, she had no trouble finding reams of information on childhood vaccines. For one, she’s a professional librarian. And the topic is hot these days.
"There's books, there's magazines, there's popular stuff, but I also have access to a bevy of academic databases," Popp said. "Some stuff I had to put aside because it was too technical and I couldn't understand it."
She felt she understood enough to question what pediatricians were telling her about vaccine safety. Some parents are still worried by a famous 1998 study linking vaccines to autism, even though that study has been widely debunked and retracted. Popp has different concerns; she doesn't trust the vaccine ingredients or the high number of shots kids get.
"Is she gonna have a seizure? Is her fever gonna peak at 105 degrees?" Popp said. "Those can all start on a downward trend."
Popp and her husband have accepted some vaccines for their daughter, like polio, and refused others, like chicken pox. They also delayed some shots until after the ages recommended by pediatricians, including hepatitis B, and the measles, mumps and rubella — or MMR — vaccine.
"I just felt if I could put some of these off until later, I would rather not overburden my child's system with a bunch of toxic organisms,” she said.
While studies show there are rare side effects from vaccines, scientists say there's no evidence that the standard vaccine schedule overwhelms a child's immune system, or that the ingredients at these doses are toxic. Popp says she knows that, but "it's just what sits well with me. You've got to make a decision based on your own intellect and your own conscience."
Popp is certainly not as anti-vaccine as some, but she does represent a growing population of skeptics that pediatricians like John Snyder find maddeningly hard to argue with.
"Ironically, the more educated you are the more you are brought up in a culture where you are emboldened to question authority and know how to read up on things and to make choices for yourself, the more likely you are to make the wrong choice in this case,” he said.
Snyder, who lectures nationally in favor of vaccines, works at Amherst Pediatrics in Hampshire County — which, like Franklin and Berkshire counties, has rates of vaccine refusal around three times the state average. Snyder used to work in Springfield and New York City, where he says many of his low-income patients missed their regular shots due to spotty health care. But those communities still have higher vaccination rates than wealthier ones, where more parents claim a medical or religious exemption from school vaccine requirements.
"I feel for them because I know they're dealing with a lot of misinformation,” Snyder said. "And they're struggling to make the right choice. But if we see this trend continue, we're talking about the emergence of some really nasty diseases."
That's because "herd immunity" — where the unvaccinated few rely on the disease-free majority to stay safe — can disappear with a slight shift in numbers.
“It’s a plane ride away,” Snyder said. “And if you think you can hide in this country unvaccinated, you're wrong because the larger our little pockets of under-vaccination get, the more likely some kid's going to come over from another country where these things are endemic and give it to your community."
Snyder thinks if vaccine skeptics understood that danger — along with the scientific method behind vaccine trials — they'd be less likely to shun the advice of the American Academy of Pediatrics and the Centers for Disease Control. But many of them believe the medical establishment is at best fallible, and at worst, beholden to pharmaceutical companies that make vaccines. And that creates tension in the exam room.
"These pediatricians clearly shut down when I bring up vaccination ideas,” said Popp, who goes to a pediatric practice in Northampton. "When you leave now, you get a little form that tells you everything that's been done, and down at the bottom is this coyly worded, ‘Has a history of undervaccinations.' And although it's certainly phrased very objectively, it feels judgmental.”
Word does get around which doctors are receptive to vaccine skeptics. Greenfield Pediatrics, for example, has been praised on alternative parenting websites. That prompted the doctors there, including Sarah Rourke, to review their vaccine records.
"What we ended up seeing was we had one provider who had a higher number of patients and families who opted out of your traditional immunization schedule,” Rourke explained.
So they created a more standardized vaccine script based on CDC recommendations and now require parents who still refuse vaccines to sign a form saying they're going against medical advice.
"Some families are going to have some alternative viewpoints to immunizations,” Rourke said. “So we wanted to make sure that we maintain that respect, but also just stress the education."
John Snyder actively tries to change the minds of resistant parents — and sometimes succeeds. But he'd like to see a state law making it more difficult for parents to get vaccine waivers — a hard sell politically. He just hopes it doesn't take a disease outbreak to drive the point home.
This program aired on October 7, 2013.