Sparring over the syringe

Blue Oak Charter School, just off of East Avenue in Chico, is a handsome campus, with a tidy manicured colonial look to it. There, well-mannered students rush about care-free, ebullient with the freedom and joys of childhood. However, for parents concerned about the return of vaccine-preventable diseases, Blue Oak is a potential pathological ground zero. For the 2014-15 school year, only 48 percent of the kindergarten class was fully vaccinated, according to immunization data compiled by the California Department of Public Health.

This isn't an isolated occurrence in Butte County. Butte CORE Charter School, a home-school support network, has an even lower vaccination rate of 35 percent, the lowest in the county.

Vaccination rates in Butte County have been falling since 2000. Back then, the overall rate was 92.95 percent, exceeding the state, which stood at 92.2 percent. Currently, 87.2 percent of kids entering local kindergarten programs have been fully vaccinated (the statewide average is 90.4 percent). California’s vaccination goal in schools is 92 percent. Only five of Chico’s 19 campuses meet this minimum threshold for “herd immunity,” which occurs when a large enough proportion of the population has been vaccinated so that disease cannot get a toe-hold. Herd immunity for measles, for example, is between 92 percent and 95 percent. (Officials from Blue Oak declined to comment for this story.)

The downward trend is attributed to parents increasingly filing the so-called “personal belief exemption,” a way to opt out of vaccinating their children due to personal or religious beliefs. That exemption has come under intense scrutiny in the wake of the recent whooping cough epidemic and measles outbreak. As a result, in October 2012, Gov. Jerry Brown signed Assembly Bill 2109, which makes it a bit harder to get the exemption by requiring parents to get vaccine counseling from a medical doctor. Since then, vaccination rates have improved for the first time in a decade. But state lawmakers and health agencies remain concerned about the threat to public health, and now the Legislature is considering another bill that would eliminate the exemption altogether.

Emilia Erickson, 36, a local mother of three unvaccinated kids, will pull her children out of Concow Elementary School if that happens.

“I’d home-school,” she said. “I wouldn’t want to, but I would have to.”

For Erickson, who has degrees in chemistry, biology and zoology, it’s a matter of trust. “People think they are so smart; they are constantly discovering things, and think they have solved some major problem—only to find out later that they have just caused another problem,” she said.

She pointed to thalidomide, a nausea drug from the ’60s, as an example. “That drug was really effective, and then we found out it caused all sorts of problems and birth defects,” she said.

“Why do we have all these maladies: autism, obesity, cancer? I’m not saying autism is because of vaccines, but what I am saying is that we don’t know what the end product of our industrial lifestyle will be,” she continued. “Maybe we wouldn’t have all these problems if we weren’t cooped up in a house without fresh air and sunshine, and lived a bit more naturally. The question I ask is: Why am I evil or irresponsible because I am uncertain whether or not the vaccine is safe? I acknowledge there is a risk either way. And I am taking sides with nature.”

State Sen. Richard Pan, a pediatrician, is one of the authors of Senate Bill 277, which aims to mitigate California’s growing anti-vaccination movement. If passed, it would mandate immunization for diseases like measles and whooping cough for children prior to attending kindergarten, and also would require the school district to notify parents about current vaccination rates.

The bill has galvanized vehement opposition from the anti-vax movement in California. There have been 600-700 speakers opposed to the measure at the first two legislative hearings, including one on April 8 before the Senate Health Committee, where members of a very vocal contingent dressed in red in solidarity of their opposition.

Prior to that hearing, during a hurried lunch in his office at the Capitol, Pan spoke about the bill with a few supporters of SB 277, among them attorney Leah Russin, a young mother and the founder of Vaccinate California, a vaccine advocacy group.

Referring to the informed refusal law, AB 2109, Russin said: “If we thought education was enough, then we wouldn’t need this bill [SB 277].”

She went onto express her disappointment in Robert Kennedy Jr., who had just given a speech against SB 277 during a rally on the steps of the Capitol.

“I like Robert Kennedy,” she said. “I admire his work to save the gray whales and on climate change, but, in a way, he is a reason why we need this bill. There is just so much bad information out there about vaccines that it has confused and misled even bright, smart people.”

Later, undaunted by the hundreds of red-T-shirt-clad opponents milling in the halls of the state Capitol, Pan was both cheery and confident that science would eventually win the battle. Nearby, muscled bodyguards stood watch outside the door to his office, as he had received several death threats for authoring the bill. Pan, who’s been a practicing pediatrician for more than 20 years, noted that he’s never seen a major negative reaction from a vaccination.

He and others pushing for mandatory vaccination cite the decades’ worth of scientific research showing its success. SB 277 passed through the Health Committee and last week was approved by the Senate Education Committee. It still has a long road ahead of it, however.

According to the World Health Organization, only clean water has been more important to public health than vaccinations. In fact, the WHO estimates that the vaccination for measles has saved the lives of 15.6 million children since 2000.

And measles isn’t a thing of the past, as California knows from the state’s recent brush with the disease, following an outbreak traced back to an infected person visiting Disneyland in December. As of mid-April, according to the California Department of Public Health, 136 cases of measles had been reported in California residents since December, all but five of which have been linked to the outbreak that started at Disneyland. Forty-two of them had visited the theme park; 31 involved residents of a household with close contacts to a confirmed case; and 14 were exposed in an area where a confirmed case had been present. The remaining 44 victims also were traced to the outbreak based on the strain.

The health department has gathered immunization records for a portion of the cases. So far, the agency’s data show that at least 57 of those who contracted the illness were unvaccinated and 25 others had received at least a single dose of MMR vaccine. Nearly 20 percent of the cases required hospitalization. No one died.

A 2004 Centers for Disease Control and Prevention study revealed that kids who weren’t vaccinated tended to be white, have an older married mother with a college education, and live in a household earning $75,000 a year or more—precisely the sort of family that could afford to visit Disneyland during the winter break from school.

The last time there was a measles epidemic in the U.S. was 1990. That year, there were over 27,000 cases, resulting in nearly 6,000 hospitalizations and 89 deaths. The death rate was 3.2 for every thousand cases, according to the CDC.

But memories of burying children 25 years ago have faded away, and three things have happened in the time since to spur Americans to question the practice of vaccination. First, the sheer number of shots on the CDC schedule has grown substantially, from five diseases in the 1960s, to eight a decade later; currently we vaccinate against 14 illnesses. With all the scheduled boosters, that is at least 24 injections (and as many as 33) by the time a child is 5 years of age. With crying children who sometimes become cranky after a shot, parents increasingly started to ask, “Is this really necessary?”

By the mid-1990s, the Internet was there to answer that question. The invention of the search engine—Google University, if you will—enabled countervailing theories to gain wide exposure with anxious parents as they contemplated an ever-growing list of vaccines. Hence, you will find the axiom “do your own research” in order to “make an informed decision” repeated ad nauseum within the anti-vaccination movement.

However, it took an act of fraud by a British medical doctor to give the movement traction, and ultimately, to start endangering 50 years of progress to public health. That doctor’s name is Andrew Wakefield and in 1998 his research team released a study of 12 patients linking the measles, mumps and rubella (MMR) vaccine to autism. The notion was already popular among parents who were scouring the Internet for information. Autism rates had been rising for years without a known cause. As Eula Biss writes in her excellent book on the subject, On Immunity, “Those who went on to use Wakefield’s inconclusive work to support the notion that vaccines cause autism are not guilty of ignorance or science denial so much as they are guilty of using weak science as it has always been used—to lend false credibility to an idea that we want to believe for other reasons.”

The study never was replicated. In fact, dozens of studies, including one published last week in the prestigious Journal of the American Medical Association, have found that there is no “harmful association between the MMR vaccine receipt and [autism spectrum disorder] even among children already at higher risk for ASD.”

In 2010, The Lancet, a British medical journal, retracted the research paper by Wakefield linking autism to vaccines. The British General Medical Council launched an investigation and subsequently pulled his medical license for ethics violations, including conflicts of interest. Wakefield now lives in Texas and, despite being discredited, continues to enjoy a lucrative cult following.

The irony is that vaccination rates began to fall in the year 2000, at a point when measles was declared extinct in the U.S. by the CDC. Even still, vaccines increasingly were under suspicion of causing a number of ailments.

Some critics have argued that dangerous ingredients in the vaccines, like mercury, aluminum and formaldehyde, were poisoning children. However, vaccines containing mercury were pulled from the market in 2001 with the exception of multidose flu vaccines. Moreover, mercury never has, nor is it currently, a danger in the amounts and the chemical composition used in vaccines. Similar charges against formaldehyde and aluminum also have been debunked. There is more formaldehyde in a pear than there is in a vaccine; children receive more aluminum from breast milk and infant formula in the first year of life than from vaccines.

Still, fears about them had reached new levels.

In 2010, pertussis, commonly called whopping cough, hit California with a vengeance. Ten infants died. When epidemiologists translated the data from the outbreak, they discovered that affluent ZIP codes, such as those in Marin County, were more heavily affected than poorer ZIP codes. Not vaccinating had become an upper-middle-class phenomenon. Risk factors for not vaccinating can be identified as affluence, higher education, a preference for natural living and, often, conservative religious preferences. Those who own a tie-dye T-shirt and drive a BMW (or have a “Deadhead sticker on a Cadillac,” as the song goes)—fit into the demographics of those who don’t vaccinate their children.

The 2014-15 season has resulted in 11,000 pertussis cases in California and four infant deaths.

Dr. Mark Lundberg, an M.D. and the public health officer for Butte County, gave his take on the matter during a recent interview: “When it comes to pertussis, we need it to be a better vaccine. The immunity does wane in its ability to protect a person. The vaccine works, but we need it to work better. We need to give the boosters.”

In Butte County, the numbers of reported pertussis cases have been climbing over the last three years. In 2012, we had three; 2013, 29; 2014, 34.

When asked how much of the pertussis outbreak can be attributed to the anti- vaccination movement and how much is because of problems with the vaccine’s effectiveness, Lundberg was blunt: “Outbreaks almost always start with unvaccinated children. In Butte County, we do seem to have more cases in the unvaccinated population.”

Pushback against vaccines, though a hot topic today, has a long history. The first “conscientious objectors” weren’t people who were opposed to participating in war. The term originates from mandatory vaccination laws against small pox back in the 1850s.

The disease killed more people up until 1977 (when it was declared extinct) than all the wars of that century. It wiped out whole tribes of Native Americans. The mortality rate for small pox was as deadly then as ebola is today. The only difference between ebola and small pox is that small pox, being airborne, spread very easily. It killed half a billion people.

The small pox vaccine that baby boomers received as a child in their arms was nasty, much more dangerous than anything given to children today. It evoked high fevers and malaise in most kids and killed about 1 in 1 million children. It left a scar—a badge that dates those who received it.

The waiting room at Oroville pediatrician Eric Neal’s office is home to signs warning of measles and whooping cough. Nature-themed murals cheer up the place. The 40-something Neal has a boyish quality about him. He smiles readily from behind his desk. On the wall are diplomas, photos of family and a picture of himself with a native tribe in Africa.

Neal has been a practicing pediatrician for 20 years. He has worked in Oroville since 2000 and, like most pediatricians, occasionally sees parents who oppose vaccinations.

“They usually have some story about an uncle or friend that had a bad reaction to the MMR vaccine, or they have read something on the Internet against vaccinations,” he said.

“I try to convince them to vaccinate,” he continued. “I tell them I vaccinate my kids. I tell them I vaccinate myself. I highly recommend vaccinating. I get the flu shot every year, and, despite being exposed a lot, I have never gotten the flu—except one year when I got the H1N1 prior to the vaccine being released.”

Neal has signed more than a few personal belief exemption forms, which require a doctor’s signature confirming that a child’s parent or guardian has been counseled on the value and risks of vaccines. He has been unsuccessful attempting to talk parents out of opting out.

In his 15 years of vaccinating an estimated 500 children annually, he has “never seen a major reaction from a vaccine. You might rarely see a fever, but I have never had to hospitalize a child for a vaccine reaction.”

Neal highly recommends the pertussis vaccine for his patients, as recommended by the CDC. He said it is a good one, despite its reputation for being less effective. So far this year, his practice has seen one whooping cough case—an 18-month-old who hadn’t been vaccinated.

While Neal is “for anything that will get the public to get vaccinated,” he hesitated when asked about SB 277. “Vaccines are totally safe and there is no reason to fear them. But taking people’s rights away, their choice, there just might be a backlash if we require all children to be vaccinated before they attend school.”

He fears that parents will pull their children out of public and private schools if the bill is passed.

Compulsory vaccination has been around for 230 years, ever since the practice of taking pus from a person infected with cowpox (a less damaging strain of small pox) to put on a sore of another person in order to help them initiate immunity. In 1777, George Washington, then-commander-and-chief of the Continental Army, instituted mandatory vaccination of his recruits after losing half of his 10,000 soldiers—and thus the battle of Quebec—due to small pox. Most Britains had already been exposed from prior breakouts in Europe. This crude inoculation worked, but at a price. The mortality rate was 1 percent. However, the practice saved Washington’s campaign from defeat.

Later, in the mid-1800s these sorts of methods of pus transfer and very crude vaccinations were used on the poor and, often, minority populations in order to protect the wealthier and more privileged. The vaccinations were compulsory and sometimes done at gunpoint. Keep in mind that this was prior to the introduction of sterile procedures.

Indeed, vaccines are much, much safer today. Last year in the U.S., tens of millions of people—children, the elderly, teachers, students, health care workers—all received at least one vaccine; of these tens of millions of people, 365 were found to have a serious vaccine injury adjudicated in the vaccine court of the United States.

Vaccination advocates who support Sen. Pan’s SB 277 point to this remote risk of complications. They also point to West Virginia and Mississippi, the only two states that do not have exemptions. As it turns out, they also have the lowest rates of measles and whooping cough in the nation. Recently, because of the measles outbreak, exemption-elimination bills were introduced in Oregon and Washington. However, a vocal anti-vax movement, and in the case of Oregon, lobbying by Robert F. Kennedy Jr., helped defeat them.

SB 277 just might suffer the same fate.

Lundberg, Butte County’s health officer, knows Pan and said the lawmaker is a great advocate for saving children’s lives.

“His prior bill to educate parents on vaccinations led to a decrease in the PBE [personal belief exemption] in Butte County, from 6.99 percent to 5.96 percent,” he said. “I think we need to look at this [ending the PBE]. For those who have closely held religious beliefs, I think we need to protect those. But I don’t know of too many beliefs that are that way.”

“I appreciate Dr. Pan’s effort to decrease the personal belief exemption,” he continued. “My own personal belief is that we need to carve out a way to respect people who have a closely held belief against vaccines.”

Yet Lundberg said he leans toward ending the exemption. He noted that some of the parents who opt out of the vaccine schedule are “conscientious and passionate.”

On the other hand, Lundberg continued, “I feel their fears are misplaced.”

Lundberg recalled his residency in San Francisco during the last measles epidemic in the U.S. “We admitted a lot of kids to the hospital that year. If you have ever seen measles and what it does—1 in 2,000 cases will die; 1 in 1,000 will have permanent neurological damage. Compared to that, the side effects from the measles vaccine are extremely rare and next to nothing.

“We need to have all our kids vaccinated to protect our own kids and to protect others. Our own success has become our failure. People forget what life was like before vaccinations. We can’t go back to the way life was like before them.”