Low rates and national outbreak lead to debate about vaccine requirements
With a multitude of schools in the Ithaca area reporting immunization rates for measles that are significantly lower than the state average, vaccination practices in Tompkins County have come under increased scrutiny and stirred a debate about the merits of vaccine requirements.
According to a database that draws its numbers from the New York State Department of Health (DOH), in the 2013-14 academic year — the most recent year data is available — eight schools in Tompkins County had measles immunization rates of below 95 percent. According to an article on Syracuse.com, which drew its data from the DOH, 96 percent of New York students were vaccinated against the measles.
The schools with below average rates are the Ithaca Waldorf School (72.1 percent), Lehman Alternative Community School (83.4 percent), Fall Creek Elementary School (84.4 percent), New Roots Charter School (88.9 percent), the Elizabeth Ann Clune Montessori School of Ithaca (91.6 percent), Maccormick Secure Center (92.3 percent), Beverly J. Martin School (93.7 percent) and Finger Lakes Residential Center (94.3 percent).
Theresa Lyczko, director of public information and the Health Promotion Program for the Tompkins County Health Department, said a 95 percent vaccination rate is important because it’s the point at which herd immunity is generally achieved. She said herd immunity is when enough of the population is immunized that the likelihood of an outbreak of the disease vaccinated against is minimal.
According to data from NY.gov, in the 2013-14 academic year, the Ithaca City School District had an overall vaccination rate of 95.2 percent and a measles vaccination rate of 95.6 percent. Lyczko said this makes the likelihood of an outbreak of measles in the area unlikely.
There has been increased attention on the issue of immunization following the highly publicized outbreak of measles in the opening months of 2015. The Centers for Disease Control and Prevention reported from Jan. 1 to March 13, 176 people from 17 states and the District of Columbia were diagnosed with the measles.
The majority of the cases, 118, were contracted by people from California. The outbreak’s origins have been traced back to Disneyland in Anaheim, California. In New York, there were only three cases of the measles during the outbreak, according to the CDC.
However, the presence of measles cases in the state has brought increased scrutiny on those who don’t vaccinate their children.
New York currently requires children enrolled in school or pre-kindergarten programs to receive a multitude of different vaccinations, including the measles vaccine. Per state law, parents can be exempt from vaccinating their children if they prove to the institution their child attends that either they or their child “holds genuine and sincere religious beliefs which are contrary to the practice of immunization.”
In addition, parents can request an exemption from the vaccine requirements if there is a valid medical reason their child cannot be immunized or if they can demonstrate their child “has documented immunity of disease through serologic testing.”
A bill that would have expanded vaccination exemptions lost steam in the New York State Senate in February. The legislation would have allowed children to attend school unvaccinated if their parents approved a state-written statement indicating their objection to having their child immunized for philosophical reasons. However, on Feb. 16, Capital New York reported the bill’s primary sponsor, Sen. Martin Dilan, a Democrat from Brooklyn, withdrew his support for the bill.
Sarah*, an Ithaca mother of unvaccinated children, said she believes New York needs a vaccination exemption based on personal belief because the decision whether to immunize should be made by parents, not the government.
“I think that it comes down to one of our constitutional rights to decide what goes in our body, and we shouldn’t be pressured,” she said. “There is no such thing as informed consent without being able to say no to a medical procedure.”
According to DOH data, exemption based on religious belief was the most common reason students at Tompkins County schools were not immunized. Sarah said she uses the religious exemption to bypass vaccinating her children. However, she said this is out of necessity, not belief.
“We had to get it,” she said. “There was really just no other one in New York State.”
Megan Powers, of Ithaca, said the number of people in the Ithaca area applying for vaccination exemptions based on religion concerns her. Powers, who vaccinated her child, said schools should ensure that people applying for a religious exemption actually hold sincere religious objections to the practice of vaccination.
“I feel if you’re making a religious exemption that you should really and truly have some religion that you’re associating it with and not use it as a cover,” Powers said.
At the Ithaca Waldorf School, which had the lowest measles vaccination rate of the schools in the Ithaca area at 72.1 percent, 23.3 percent of students were granted a religious exemption from immunization.
The Waldorf school system is known for practicing a more alternative form of education. However, Erin Fitzgerald, director of school administration at the Ithaca Waldorf School, said she doesn’t believe the school’s nontraditional learning environment has anything to do with its low vaccination rate.
“We just have to follow the law,” Fitzgerald said. “So if families have questions about any medical concerns, we just ask them to go to their healthcare provider.”
Fitzgerald said the Ithaca Waldorf School has no opinion on the issue of immunization. She said the school leaves vaccination decisions to the discretion of parents and New York State law.
Lyczko said the vast majority of doctors and public health experts agree vaccines are safe and effective and the Tompkins County Health Department recommends parents vaccinate their children. She said despite this, there are a variety of reasons why parents choose not to vaccinate their kids, one of which is their fear about the safety of vaccines.
“They may have a perception or a misperception or belief that vaccinations can be harmful,” Lyczko said. “So they choose to act on those beliefs and perceptions and choose not to vaccinate their children.”
But Sarah said she doesn’t believe vaccines are sufficiently researched or tested. She said she is not opposed to all antibiotics and believes vaccines can be safe and effective some of the time, but that immunization should not be a one-size-fits-all approach to public health.
One of her concerns with immunizing her children is the large industry of pharmaceutical companies that make and sell vaccines, and the monetary connections she believes there are between these companies and the public health field.
“It’s kind of like an incestuous relationship,” she said. “If I can’t untangle the money, I don’t trust the whole process.”
Sarah said she has a brother-in-law who works at Pfizer, one of the world’s largest pharmaceutical companies. Her brother-in-law also refuses to vaccinate his kids, she said, which she believes is telling of corruption in the vaccine market.
She said the measles outbreak in California did not impact her views on vaccination, although it did make her more worried vaccine exemption laws would be struck down.
Dr. Stanley Schaffer, associate professor of pediatrics at the University of Rochester Medical Center, said one of the reasons pockets of California and Tompkins County have lower than average vaccination rates is the presence of more alternative, naturalist-type people who are opposed to antibiotics. He said this is a definite characteristic of the anti-vaccination movement.
“It’s easy to say ‘My child is healthy, I’m going to only feed them organic produce and I’m not going to allow them to get immunizations,’” he said. “It’s sort of a naturalist movement in a way. Feeling that whatever’s natural is best.”
Lyczko said people who don’t get their children vaccinated tend to have a higher degree of education and hold strong beliefs about immunization that are difficult to change. She said the Health Department does outreach to work with parents who are opposed to vaccination, which Lyczko said involves asking parents what their fears about vaccines are and explaining the value of getting kids immunized.
However, Schaffer said by itself, educational outreach is often ineffective. He said it’s difficult to change parents’ beliefs about immunization just by informing them about the scientific merit of vaccination.
“I’m not saying we shouldn’t educate, that has to be part of it, but it has to be more than just education,” he said. “It has to be an ongoing relationship and an ongoing explanation of why it’s so important to immunize.”
However, Dr. Suzanne Humphries, a medical doctor with a specialty in nephrology, said vaccines have not been proven to be safe and effective. Humphries is the co-author of Dissolving Illusions: Disease, Vaccines, and The Forgotten History, a book which in part argues advances in sanitation and isolation are largely responsible for longer spans and lower mortality rates from infectious diseases, not vaccines and other antibiotics.
Humphries said she uses the elimination of smallpox as an example of this argument. She said much of the world’s population never received the smallpox vaccine, so it would have been impossible to build up herd immunity to the disease through the vaccine. Instead, she said smallpox was primarily eradicated through better sanitation and removing infected people from the general population.
Humphries also said the measles outbreak in California has been overblown and is being used by public health organizations to manipulate the general population into voting to eliminate vaccination exemptions. She said according to the CDC, as of Feb. 11, there were a total of 110 measles cases in California. Of those 110 cases, 49 were people who were unvaccinated, according to the CDC. However, only 28 of the cases involved people who were intentionally unvaccinated because of personal belief.
According to the CDC, of these 110 cases on Feb. 11, there were 13 in which the patient had received at least one dose of the measles vaccine. Additionally, according to the CDC, there were 47 cases in which the patient’s vaccination status was unknown.
Humphries said she feels the CDC is blaming the outbreak on people who were intentionally unvaccinated because of personal belief, but that as of Feb. 11, those people only made up 28 out of the 110 measles cases in California.
In medical school, Humphries said she was taught when vaccines were due and that they are safe and effective. Humphries, who graduated from Temple University School of Medicine in 1993, said there was no dialogue about the science behind immunization or proof of why vaccines are safe and effective.
“There was never any discussion about any potential harm, and potential risk, what the contents [of vaccines] are, what the history was,” Humphries said. “Zero point zero is what we got as far as discussion goes.”
But Lyczko said enough evidence has been gathered regarding the effectiveness of vaccines that there is not a disagreement in the medical world when it comes to the safety of immunization.
“There isn’t a controversy,” Lyczko said. “There’s enough scientific evidence that shows the value of vaccination and that they are not harmful.”
Humphries said she adhered to the medical community’s view on vaccines until she observed problems with her patients she believed to be related to vaccines. She said these issues, and the lack of attention paid to them by higher-ups at her hospital, spurred her to research the issue of vaccination. Through her research, Humphries said she arrived at the view that the science behind vaccination doesn’t add up.
“My statement is, look, ‘what you’re hearing from the pro-vaccine people is unscientific and that there’s still a lot of questions about the safety and effectiveness of vaccines and parents should be told what we don’t know and what we do know,’” Humphries said.
She said people need to be better informed about the science of vaccines, and not just told that they are safe and effective.
However, Schaffer said the medical community has to combat what he believes are misconceptions people have about the impacts of vaccines.
In 1998, a study was published arguing there was a link between autism and the administration of the measles, mumps and rubella vaccine. The study has been widely discredited as fraudulent by the medical community. In 2010, the study was retracted, and its author, Andrew Wakefield, had his medical license revoked.
Schaffer said some people still make a connection between vaccines and conditions such as autism. Lyczko said it’s unfortunate that many parents are fearful about vaccines, because she said immunization has saved countless lives.
“Immunization and vaccination is one of the greatest public health achievements of the 20th century,” Lyczko said.
However, Humphries said the Wakefield study is just one example of how those who question the safety and effectiveness of vaccines are treated by the medical establishment. She said many doctors are afraid to oppose vaccines, for fear of being discredited by the medical community.
“It’s a hot potato that a lot of doctors don’t want to touch,” she said of vaccination. “So a lot of doctors do know there’s a problem.”
Lyczko said an additional aspect of the vaccination debate is the protection of the overall population, not just the individual. Powers said this is one reason she has her child vaccinated and believes others should do the same.
“To the anti-vaccination people, I know they’re trying to do the right thing for their kids, but I would like to ask them that they think about other kids too,” Powers said. “Because they’re babies too young to be vaccinated, there are people who really can’t be vaccinated for medical reasons. And getting your kid vaccinated helps protect everybody.”
However, Lyczko said a lot of people have become complacent about vaccinating their kids because many of the diseases that used to afflict children, such as polio, have been wiped out in the United States. While she said the reason these diseases have been eradicated is because of vaccines, she added this has made parents more apathetic about immunizing their children and more unaware of the consequences if they don’t.
“A lot of times, parents today haven’t been exposed or heard about what can happen when someone has some of those diseases,” Lyczko said.
*Name has been changed to protect anonymity.
Evan Popp is a freshman journalism major who tries to use his fear of needles to get out of being vaccinated. You can email him at firstname.lastname@example.org.