Warning Shot

Texas parents have the choice to opt their children out of school vaccination requirements based on “reasons of conscience.” But what about the other kids around them?

Given the alarming number of pediatric fatalities from the swine flu—86 children died in the United States of the virus from April to October—I decided to bring my two-year-old in to the pediatrician’s office to get vaccinated. The shots were only being offered during limited hours, so I braced myself for a long wait, but the doctor’s office turned out to be empty. Had most parents already brought their children in for the H1N1 shot, I asked the nurse? “No,” she told me. “We’ve been really surprised by the lack of interest. Parents seem to be worried about vaccines these days.”

An excellent story in this month’s Wired magazine, “ An Epidemic of Fear ,” delves into the growing (and erroneous) concern that vaccines cause autism and auto-immune diseases—despite the fact that there is no credible scientific evidence to support such a connection. Writer Amy Wallace offers a devastating critique of the anti-vaccination movement, and explains how parents who oppose immunizing their children are endangering public health. (The article does not discuss voluntary flu vaccines, like H1N1.) Writes Wallace:

Consider: In certain parts of the U.S., vaccination rates have dropped so low that occurrences of some children’s diseases are approaching pre-vaccine levels for the first time ever. And the number of people who choose not to vaccinate their children (so-called philosophical exemptions are available in about 20 states, including Pennsylvania, Texas, and much of the West) continues to rise. In states where such opting out is allowed, 2.6 percent of parents did so last year, up from 1 percent in 1991, according to the CDC. In some communities, like California’s affluent Marin County, just north of San Francisco, non-vaccination rates are approaching 6 percent (counterintuitively, higher rates of non-vaccination often correspond with higher levels of education and wealth).

Wallace explains that even a small number of parents opting out is significant because their children “tend to be clustered, disproportionately increasing the risk of an outbreak of such largely eradicated diseases as measles, mumps, and pertussis (whooping cough).”

I thought of Wallace’s story as I looked around the empty waiting room at the pediatrician’s office. Voluntary vaccinations are one thing—but how prevalent, I wondered, has opting out of mandated vaccines become?

Texas does in fact offer parents the choice to opt their children out of school vaccination requirements. A state law that took effect in 2003 gave parents the right to refuse immunizations for their children based on “reasons of conscience.” (Before then, Texas law offered only medical exemptions, which required a doctor’s note, and exemptions based on religious beliefs.) According to the most recent data available from the Texas Department of State Health Services, the number of students who are currently enrolled in Texas public schools with “conscientious exemptions” has increased by a staggering rate since the law took effect six years ago. In 2003, there were 2,314 students enrolled with these exemptions. This year, there are no fewer than 12,633 such students.

If your children are up-to-date on their vaccinations, you may think that this is of no concern to you. But as Wallace explains in Wired, a 2002 case study of a measles outbreak in the Netherlands revealed that it is the overall rate of inoculation—not whether a particular individual has been inoculated—that is the most important factor in preventing infectious diseases. The study, Wallace writes, “found that the risk of contracting the disease was lower if you were completely unvaccinated and living in a highly vaccinated community than if you were completely vaccinated and living in a relatively unvaccinated community. Why? Because vaccines don’t always take. What does that mean? You can’t minimize your individual risk unless your herd, your friends and neighbors, also buy in.”

During the past six years, as the number of conscientious exemptions has risen dramatically in Texas, so has the incidence of pertussis—or whooping cough, which can result in death for infants. The numbers are startling: In 2003 (the year that the conscientious objection law was enacted) there were 670 cases of pertussis in Texas; to date this year, there have been 2,084 cases. In that time period, there were 24 deaths. However, the rise in pertussis cannot be directly attributed to parents opting out of vaccinations, cautioned Allison Lowery, a spokeswoman with the Texas Department of State Health Services. Pertussis testing, Lowery explained to me, is more readily available now than it was in the past, resulting in increased reporting.

What remains to be seen is whether the fear of vaccines becomes more prevalent across the state. According to a report that was released in early October by the not-for-profit media watchdog group Media Matters, there is plenty of reason to think that fear might win out over reason:

In recent days, both Glenn Beck and Rush Limbaugh have suggested that the H1N1 flu vaccine may be unsafe and questioned the Obama administration’s recommendation that Americans get vaccinated, with Limbaugh asserting that “[y]ou’ll be healthier” if you don’t believe what the government says and Beck suggesting that the vaccine may be “deadly.” However, health experts have repeatedly stated that the vaccine is a safe and necessary tool to combat the virus, and that, in CDC chief Thomas Frieden’s words, “This flu vaccine is made as flu vaccine is made each year, by the same companies, in the same production facilities, with the same procedures, with the same safety safeguards” and “[t]hat enables us to have a high degree of confidence in the safety of the vaccine.”

As for me and my son, we’ll be getting the flu shot.

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