The Trading Post in Paonia is the kind of place you might expect to meet people who don’t vaccinate their kids. There’s bulk quinoa on the shelves, local potatoes in baskets and all sorts of sugar and wheat free goodies for sale near the cash register. The whole place has a decidedly crunchy, alternative vibe, and that extends to medicine. The last time I went there, the first three people I talked to told me they didn’t vaccinate their children.
Liz Evans is one of those people. She has six kids, and had her first baby when she 23, right after she left the military. That child is fully vaccinated, she says, because she gave birth in a military hospital and did what she was told.
"My oldest probably received the most vaccinations but really by the time she was two and I was getting ready to give birth to my 2nd, that’s when I started to really say I don’t think we need this one. Does she have to have this one?"
Not so much with the children that followed.
"And so then with the other kids it got to that place, my 3rd daughter got maybe 2 vaccinations and then I was like, forget it, I’m not in this system anymore," she says.
Evans is part of a growing number of parents around the country who are choosing not to vaccinate their children. It’s happening right here in Western Colorado, where some school districts report that between 20 and 30 percent of their students are missing some or all of their vaccines.
Public health officials say it’s a worrying trend, because as the vaccination rate drops, there’s a higher risk of seeing an outbreak of vaccine preventable diseases like whooping cough or measles.
Sundari Kraft has spent a lot of time thinking about why parents don’t vaccinate. She’s a mom from Colorado who is part of the group Vaccinate for Healthy Schools.
"A big part of the issue with the rise in vaccine skepticism, or vaccine denalism, is that in some ways, vaccines have been a victim of their own success," she says. "If you talk to people in older generations, they remember polio. They remember what it was like for people to suffer serious complications from measles. But because vaccines have been so successful, we don’t see those results here in this country as much anymore. And so I think that allows anti-vaccine parents to kind of exist in a cocoon of believing these diseases aren’t that dangerous or severe."
Modern parents may not have experienced scary diseases like polio or measles, but they may have heard stories about kids who were injured by vaccines. After all, these stories are all over the Internet. And even though vaccine injuries are really rare, they may start to seem scarier than the diseases the vaccines were designed to prevent.
Dr. Saad Omer teaches Global Health, Epidemiology, and Pediatrics at Emory University in Atlanta. He says there are four main reasons why parents choose not to vaccinate their kids: the perception of how easy it is to contract a disease; the perception of how severe a disease is; the perception of vaccine efficacy; and perception of vaccine safety.
Concerns about vaccine safety, Omer says, tend to be the biggest reason why parents don’t vaccinate. That’s certainly true for Liz Evans, who first started questioning vaccines after other moms of young kids worried they weren’t safe.
"And then I would run into friends around the sandbox who were like, 'You would not believe what they’re putting into this stuff!' And it made me wanna really start to look. I guess I’m old enough to say you could start looking things up on the Internet when I had little ones. So that to me, probably the Internet was the biggest piece, cause there was this place you could go and look at both sides."
Evans says she read that autism rates seemed to be linked directly to vaccines.
"There were the stories of kids who had no health problems and now have some mystery disease or end up really sick and in the hospital as a result of what they’re given. Another thing that really concerns me is reading the list of things that are in the vaccines. There’s no reason in my opinion to put mercury and other things into something that’s meant to be good for the body."
If you’ve spent any time on the Internet researching vaccines, you’ve probably heard some of this before. Misinformation about vaccines is all over the place online, and it can be hard to separate truth from myth. So let’s set the record straight here, before we go any further.
"There is not a debate about vaccine safety or efficacy. It is not questioned among any respected physician or in any public health organization. And so it’s very clear that it is far riskier not to vaccinate your child than it is to vaccinate your child. People who choose not to protect their children with vaccines are placing them at risk," says Sundari Kraft again, the pro-vaccine mom from Colorado.
Like every single doctor or scientist I talked to, Kraft says there’s just no evidence that vaccines, or any of the ingredients in them, are linked in any way to autism, which is often a big concern for worried parents.
There was a lot of press a number of years ago and questions about whether there were toxicities associated with vaccines, and people claiming that their children had developed autism as a result of vaccination.
Irene Aguilar is a medical doctor and Colorado state senator from Denver. The press she’s talking about was mostly centered on this one study published in a British medical journal called The Lancet in the late 1990s. The study showed a link between the measles, mumps and rubella vaccine and autism, but no one has been able to replicate its findings. In fact since then, the study’s authors admitted their results were bad and one of them lost his medical license and was accused of fraud. And The Lancet actually retracted the paper.
Yet the myth has persisted.
"Unfortunately the public perception has not caught up with the science and there’s still a lot of people who choose not to take vaccines because there’s concern that there’s a risk," Aguilar says.
One mom of unvaccinated kids who I tried to interview for this story asked me if I was going to include the science showing vaccines caused autism. When I told her that there wasn’t any, she said she didn’t want to talk anymore. She told me I was biased, and wasn’t considering both sides.
There’s one group of anti-vaccine parents I didn’t address yet: the conspiracy theorists. Michael Colby came up to me while I was recording at The Trading Post and wanted to tell me why he didn't vaccinate his kids.
"You look at this history of it, and it’s IG Farben, and Bayer, and the major Nazi war criminals who are behind the vaccines," he says.
He says he doesn't think vaccines have been helpful in eradicating diseases like polio.
"I see no legitimate evidence that those things are true. I think it’s circumstantial evidence that people are paid to alter in favor of the paymaster, whose usually the corporations who are paying for the research."
I don’t want to make it seem like parents who are concerned about vaccines are crazy, or wrong. They’re not. As Dr. Omer says, it’s totally reasonable to have questions about something you’re about to inject into your child’s body.
"Everyone is concerned about their child’s health. And being concerned about your child’s health and their well-being, there’s nothing wrong with that. What I encourage them is to get the information from qualified healthcare providers and reliable sources. Such as the Centers for Disease Control and American Academy of Pediatrics and so on and so forth."
Dr. Omer says it’s important to remember that vaccination is different from most medical procedures because it’s not just a personal decision.
"Our attitude and rightfully so, is one of live and let live in most situations. And it’s extremely appropriate in most situations. But in a way infectious diseases are a bit of an exception. Infectious diseases are just that—they’re infectious. And one person’s behavior or decision impacts another person’s risk profile."
So what happens when lots of parents decide not to vaccinate? That’s coming up next on this special edition of Local Motion on the anti-vaccine movement in Colorado and the nation.
[MUSIC--DO YOU WANT A FLU SHOT? BY THE REFUSERS]
That’s “Do You Want a Flu Shot?” by The Refusers. The band’s lead singer is a prominent vaccine skeptic who lives on Bainbridge Island in Washington State. Washington has one of the highest rates of vaccine exemption in the country, and Bainbridge Island’s rate is even higher. There, 8.5 percent of the students who go to public school aren’t fully vaccinated.
The situation is similar in Colorado. In 2012, 86% of kindergartners here got the measles mumps rubella, or MMR, vaccine. 85% got the varicella shot. For comparison, states like Mississippi are above 99.9%.
85 percent may still sound pretty good, but, depending on the disease, it might actually be low enough to compromise what’s called herd immunity. That’s the percentage of people in a community that need to be vaccinated to prevent a disease from making the rounds. Dr. Rachel Herlihy, the medical director of the immunization section at the Colorado Department of Public Health and Environment, explains.
"So we know that for instance for mumps, you may only need to have 75 or 80% of the population vaccinated to protect the community or the herd. But we also know that for other infections, for instance pertussis or measles, you might need to have vaccination rates of greater than 90% to really achieve that community immunity."
Having a high vaccination rate doesn’t guarantee that no one will get sick. Vaccines can fail, or their immunity can fade over time. But, Herlihy says, if almost everyone in a community is vaccinated, that disease is unlikely to spread.
Research has shown that unvaccinated people tend to live near each other, creating what scientists call “vaccine exemption clusters.” When that happens, there’s a higher risk that there will be an outbreak of a vaccine preventable disease like measles or whooping cough in that community.
"And what we know about vaccine exemptions is the statewide number isn't really what's important," says Sundari Kraft. "What’s important are these clusters of unvaccinated kids. And in certain schools, certain communities, there can be a cluster of unvaccinated children, which absolutely could cause an outbreak of vaccine preventable diseases. Which can affect the entire school, the young infants in the families that come to the school that are too young to be vaccinated. It can put immuno-compromised kids at risk. It affect elderly grandparents. There’s a lot of risk in having a cluster of unvaccinated kids."
One of the best ways to measure the number of unvaccinated people in a community is to look at vaccine exemptions in local schools. When parents enroll their kids in school or day care, they have to show proof of immunization. If they don’t want to vaccinate their kids, they must sign a form opting out.
In Colorado, there are 3 kinds of vaccine exemptions: medical, religious, or personal belief. The vast majority of people who opt-out do so for personal belief reasons. It’s pretty easy to do: You just have to fill out a form that says vaccination violates your personal beliefs or philosophy. Liz Evans did it with her kids.
A number of school districts in KVNF’s listening area have fairly high rates of vaccine exemption. Lake City is the highest, where 29 percent of students have personal belief exemptions to some or all vaccines. Ouray is next, with between 20 and 25 percent of students exempt. Then Ridgway, with just over 18 percent; Delta County with 15 percent and the West End with just over 14 percent. Montrose and Norwood have the lowest exemption rates, with 6.7 and 7.6 percent respectively.
I asked Dr. Herlihy to help me make sense of those numbers. She said she had some questions about how schools collected their data. But she still found it worrisome that the rates were so much higher than the national average of about 1 to 2 percent of the total population that is unvaccinated.
"You know, no matter how the data’s being calculated, there’s a big difference between a 1% exemption rate and a 29% exemption rate. And so I think pointing out that that particular school may be at risk is truthful."
The high rates of unvaccinated kids in some schools in Colorado is worrying to people like Dan Pabon, a Colorado state representative from Denver.
"Three thousand kindergartners go to school each year unvaccinated in Colorado. And that has had huge issues in our schools. We’ve seen pertussis or whooping cough outbreaks at epidemic levels we haven’t seen in 50 years. We have kids who are getting immunized and following the rules still getting sick from these diseases. And they’re preventable."
This winter, Pabon introduced a bill that would make it harder for parents to get a personal belief exemption. He modeled the bill after similar laws passed in Washington, Oregon and California in recent years. Pabon’s bill would require parents to get a doctor’s signature or take an online class before opting out. And it would publicize the rates of vaccine exemption in every school, making it easier for parents to compare.
The idea was to make sure that parents have seen scientific, evidence based information before they decide not to vaccinate. Dr. Irene Aguilar, the bill’s senate sponsor, explains.
"Knowing one person that something bad happened to carries a million times more weight than 10 double-blind, placebo controlled scientific studies. So we'd really like to be sure people have gotten a balanced report on what the risks and benefits are. I think the people who strongly oppose vaccination are perhaps more swayed by some stories they've heard than what the research shows, what the data is."
By making it harder to opt out, Pabon and Aguilar hoped to lower Colorado’s exemption rate. And that has real effects on public health, says Dr. Omer, the epidemiologist.
"States that had personal belief exemptions had 50% higher rates of pertussis compared to states that had religious only exemptions. We also found that states that had easy requirements also had approximately 50% higher rates of pertussis, or whooping cough. So these policies, are not just in an abstract sense reducing vaccine exemptions. There’s an association with actual disease rates."
This March, anti-vaccine groups and individual parents headed to Denver to oppose the bill. Many of them wore stickers that said NO HB 1288, which is the bill’s number.
Theresa Wrangham was one of the opponents. She’s a mom, and the head of the National Vaccine Information Center, which encourages parents to question vaccination. She says the education requirement unfairly, and unlawfully, singles out parents who don't want to vaccinate.
"They’re not educating everyone, they’re educating parents who are making a different choice by assuming they’re uneducated and then foisting upon them their own brand of education and then approving. That’s not education. That’s coercion and harassment, plain and simple."
At the public hearing, parents of vaccine-injured children, like Susan Lawson, a veterinarian from Colorado, told their stories and asked lawmakers to respect their decision to choose.
"My daughter Julia, who is here in the audience, everyone probably heard her meltdown, was born a healthy child in December 2005. In December 2006, at just 1 year of age, she was severely brain injured from her routine measles, mumps, rubella varicella vaccine. Seven years later she still suffers from severe developmental delays, behavioral issues, and daily uncontrollable seizures," she says.
"When something that is this devastating happens to your children, you do research. With my medical training, I am able to decipher science from propaganda. I am able to make informed vaccine decisions for my children going forward. I do not need what I assume will be a one-sided educational presentation on the so-called benefits of vaccines."
After being passed back and forth between committees for a few months, Senator Aguilar dropped the education requirement from the bill. Now, all that’s left is the requirement for schools to standardize how they track vaccine exemption rates and to make that data available to parents if they ask for it.
Bill supporters say that will help parents compare schools and make an informed choice about where to send their kids. Opponents say it opens the door to identification, and harassment, of children with vaccine exemptions.
Governor Hickenlooper is expected to sign the bill on Wednesday, May 21.
Stay tuned for part 3 of this special Local Motion on the anti-vaccine movement. In part 3, we hear from Nathanael Johnson, a journalist who grew up off the grid in Northern California, eating organic food and forgoing vaccines. But when his wife was pregnant, he wondered whether the all-natural lifestyle was really the best thing for his child. To find out, he wrote a book called "All Natural: A Skeptic’s Quest to Discover if the Natural Approach to Diet, Childbirth, Healing and the Environment Really Keeps Us Healthier and Happier."
I started by asking him to describe his upbringing, and where he developed his skepticism of Western Medicine.
Please listen to the audio program to hear Emily's conversation with Nathanael Johnson.