Feb. 11 2015 12:00 AM

Disease outbreaks pit public health against personal choice

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The headlines stop you in your tracks.

“Spreading Measles Outbreak Also Takes Heavy Economic Toll,” Scientific American.


“Why the Next Outbreak Could Be Polio,” New York Observer.


“Measles outbreak spreads to three more states and Washington DC,” The Washington Post.


Since 2000 measles was a distant memory, banished like polio or smallpox. But the highly contagious airborne disease is making a comeback with more than 600 cases last year and 121 so far this year, according to the Centers for Disease Control and Prevention. Vaccinations provided a wall of protection, accepted as settled medical science. But it isn’t for some.


With fear whipping to a froth and resentment and blame aimed at anti-vaxxers — those who decline to inoculate their children — the issue comes down to free choice. Should vaccinations be mandatory? Should we offer philosophical objection waivers at all?


“If I had it my way I probably wouldn’t,” said Linda Vail, health officer of the Ingham County Health Department. “But we believe in civil liberties and freedoms in the U.S.”


MICHIGAN COUNTY IMMUNIZATION REPORT CARDS 


Childhood diseases nearly forgotten in modern generational memory like measles and mumps have returned to public attention. And while today’s cases of measles pale in comparison to before the vaccine in 1963 — three to four million cases a year with 400 to 500 deaths — officials today are sounding alarms that the unvaccinated will usher in waves of disease.


“We will see epidemics of diseases we haven’t seen in years,” Vail said.


The recent outbreak of measles started at Disneyland in California and reveals hot spots or leaks in the “herd immunity” chain that health officials seek for the general population. The concept is that if more than 95 percent of the population is inoculated such illnesses as pertussis (whooping cough), polio and measles, mumps and rubella (MMR) — even the weakest in the herd (infants, elderly, those with compromised immune systems) will be protected. But the more people in the “herd” who opt out of inoculation, the weaker the protection for all.

Weak links

Vail said the chain is weak in Michigan and Ingham County in particular, where the county ranks in the middle of the pack for waivers.


Indeed Michigan’s MMR vaccination rate has barely moved the needle over the last 20 years. In 1995, 77 percent of the state was vaccinated for polio and 86 percent for MMR. In 2013, 90 percent were vaccinated for polio and 89 percent for MMR.


Reasons for not vaccinating range from medical to religious to philosophical. Those who make it a personal choice cite side effects and adverse effects that even the CDC acknowledges, like fever, allergic reactions, bloody stool and on rare occasions seizures and brain damage.


Since 2000, when measles was declared eliminated in the U.S., the number of people each year reported to have measles ranged from a low of 37 in 2004 to a high of 644 in 2014.SMALL_SIENKO.jpg


An outbreak, according to Dr. Dean Sienko, associate dean for prevention and public health at the Michigan State University College of Human Medicine, is “one case more than you would expect to have.” So if there had been only 20 cases of a disease yearly and it went to 21 another year, it counts as an outbreak.


To curb the threat, Michigan tightened its rules effective this year to file for a philosophical waiver exempting a child from inoculations.


Barbara Skurnowicz, president of the HealthCare Professionals for Vaccine Choice in Franklin, Mich., calls the new rules “an obstacle course.” Parents have to go to their health department in person and arrange to speak to a health official to learn about the benefits of vaccination. It’s an “indoctrination course or video,” according to Skurnowicz.


Then parents must provide a written statement indicating their religious or philosophical objections and sign a form that says: “I acknowledge that I have been informed that I may be placing my child and others at risk of serious illness should he or she contract a disease that could have been prevented through proper vaccination.”


Vail said the change was needed to ensure that those opting out understand the risks to the health of their children and others. She said officials want those choosing not to vaccinate are not influenced by misinformation, myths or bad science.

Education is key

“I don't think the government has the right to tell people what they can and can't do with their bodies,” said Sybil Shelton Ford, lead toddler guide at Stepping Stones Montessori School in East Lansing. “However, I believe that parents should be well informed and look at all options to protect their children, such as not having multiple vaccinations at the same time. Many parents are talked into doing so and do not know that vaccinations can be broken up.”


“As far as school is concerned, I believe that parents have have the right to refuse or delay vaccinations. They need to understand the risks involved.”


Ford agrees with having philosophical waivers and educating parents about the risks.


Skurnowicz feels the new waiver rules amount to browbeating or shaming parents into vaccinations.


She referred to her organization as “proinformed consent, not anti-vaccine.”


It’s an advocacy group that is trying to remove mandates that health care workers be vaccinated. She said her twin daughters, now 41, got sick from vaccinations as infants that resulted in fevers and respiratory problems. Skurnowicz never took them back for more.


“I grew up without any vaccinations,” she said. “Up until 100 years ago, there were no vaccinations. How did civilization survive to that point in time without having vaccinations?”


The measles-mumps-rubella (MMR) vaccine is “three live viruses at the same time — an assault” on a baby’s new immune system, she said.

Vaccination rate

Ingham County ranks 46th out of 84 counties for vaccination waivers. Eaton is 36th and Clinton is 57th.


“There are medical reasons to waive them sometimes, and religious reasons,” said Vail.


The third category is a philosophical exemption.


“We got kinda loose with this other category,” she said.


Ingham County has had no cases of measles through 2013 and a few cases of pertussis (nine in 2013). Kalamazoo, where Vail worked before coming to Ingham County, had an outbreak of pertussis in 2006 affecting more than 300 people, she said.


“Should our kids go through that if we can prevent them?”


Allison Singer, 34, of Lansing is expecting her first baby in April. Amid all the preparations with a midwife and obstetrician and planning a wedding, she’s also fraught over whether she will vaccinate her new child.


She said she’s leaning toward “a more conservative approach to the vaccination,” spacing them out. She said she wants to do a lot more research about what the vaccines contain, their efficacy and the side effects or adverse effects.


“On one hand I believe in freedom of choice and individual liberty and making informed decisions,” she said. “At the same time it is a public health issue. What people choose to do can affect the whole population.”


“If somebody has a concern, if their child is physically unable to get the vaccination due to a health reason that’s totally valid,” she said. “But if they oppose it on other grounds they need to take some social responsibility for the effects of their choice on everybody else. Society tends to be a bit too individual focused. Sometimes we need to be more community minded.”


Vail said she recently had an “ah hah” moment with a simple way to look at why vaccinations are important.


“If you can’t bring peanuts to school because you have allergies why can you bring your unvaccinated kid in? It’s like hello. Every now and then you have to grab onto these simplistic things.”

Personal choice

Jillian Bennett , 32 of Clare has chosen not to vaccinate her children six times over.


She believes she should be able to choose what’s best for her six children, ages 10, 8, 6, 3, 2 and 6 months.


But the conversation about that choice has been hard, “hurtful and hateful” she said.


Social media posts are heated. She said anti-vaxxers are being blamed for “bringing back measles.”


Bennett, who is training to be a midwife, said she used to work for her local health department.


She said she was judged by her co-workers “negatively for our life choices. It was not a very respected decision there for sure.”


She said a nurse looked up her family’s vaccination records through the Michigan Care Improvement Registry.


“It was just her being nosy,” she said. “She was concerned I would tell my clients not to get vaccinations.”


But Bennett said she’s not an antivaccination evangelist.


“I am personally offended by trying to sway someone’s opinion on either side,” she said. “I don’t think the government should have their nose in what we do and how we raise our kids.


Bennett said her children are healthy. She home schools them. She won’t teach them vaccines are bad. She will allow them to make their own choices, should they want to travel and need them.


But for now, as the guardian of their safety and health, she said she’s making the best decisions she can.


“The biggest for me is accepting a risk,” she said. “The efficacy (of some vaccines) is not that great. If I were to take that risk for my kids I want assurance it’s actually protecting them.”


An example of a vaccine with waning efficacy is for pertussis. Even the CDC acknowledges the vaccine loses effectiveness after a year. And while no vaccine offers 100 percent immunity, health officials say they are major weapons against some of the most contagious diseases we know.


Vaccinations have done more good than harm, Sienko said.


He said vaccinations “prevent 322 million cases of illness and 732,000 deaths a year.”Rubella_card.jpg


“We have eliminated a lot of human misery and death because of vaccinations,” he said.


Just like covering our mouths when we cough, immunizations are a courtesy to our fellow man.


“We need to have a conversation about what is out social obligation to one another,” argues Sienko, former medical director of the Ingham County Health Department who retired last month as commander of the U.S. Army Public Health Command. “What is our community responsibility here? I feel as a public health physician we have an obligation to one another. Not only to vaccinate to protect yourself but you vaccinate to protect others in your community.”


“Those with medical risks, we have to protect them. They have no choice. If we choose not to immunize we put others in the community at risk.”

Temperatures rising

Sienko said we need to strive for health in our conversations as well.


“I’ve read some of these new articles and you read the comments afterward,” said Sienko. “It is very heated. It is very emotional. I think we have to sit down and have a rational discussion about this. We as Americans need to understand science better. We need to understand how the scientific process works. So, for example, you have Rand Paul making comments like, ‘I’ve known a lot of people that have had sick kids after they’ve got their shots.’ Well that might be a temporal association, in other words two things happening at about the same point in time. But that doesn’t imply cause and effect. There are ways that we look at what demonstrates cause and effect versus two things just kind of happening at the same time. So for a guy who’s a physician, and he’s a U.S. senator, to make a statement like that, it boggles my mind.”


Agreeing and disagreeing is hard. Voices are sounding off across the country, including the White House, advocating to vaccinate. Those who are choosing different paths can feel assaulted.


It’s a slippery slope, Ford said, when everyone feels they’re doing the right thing.


“I think that if there is the consideration of refusing non-vaccinated children into a school, it could turn into a Scarlet letter thing,” she said. “The truth is the only children at risk are those who are not vaccinated. Sad but true.”

Accepting the risks

One Lansing mother said she’s accepted those risks.


Giving only her first name, Ashley, because she’s concerned her family and children will be judged, only her eldest child is vaccinated.


“Right now anti-vaccinators are in the spotlight,” she said. “Nobody supports the anti-vaccinators. Ultimately the government doesn’t support us.


When Ashley’s 7-year-old son was born, she said she didn’t ask questions and allowed the recommended vaccination schedule. Her son started to have health problems that she assigns to the vaccinations.


“Acid reflux, ear infections, constipation,” she said, were some of his ailments and they had all been listed on a risk pamphlet when her son got vaccinated. But she said she hadn’t read it  or been aware of.


Her son’s health problems didn’t surface immediately she said, so “all my concerns were poo pooed away.”


“I got into an argument on Facebook with someone who said she was a vaccine scientist,” Ashley said. “I said, ‘I don’t think I would ever put my kid at that risk again.’ She said they were normal signs. I’ll take my 2 percent risk of getting polio to the 100 percent risk of my kid being sick for 7 days.”


Ashley remains skeptical of all sources of information.


“I don’t think there will ever be actual true information because everyone has an agenda,” she said. “The government has an agenda. My personal jaded belief is that vaccines don’t help you get better, they harm your immune system.”


Would she feel bad if her kids got sick or other kids got sick because of contracting it from her children?


“I wouldn’t actually feel bad,” she said.


“I know that feels heartless. We have a responsibility as parents to make sure our immune systems are strong. When we see scary statistics, we need to take responsibility and take care of ourselves. They eat candy bars, pop tarts and McDonald's. We’ve allowed them to not take care of themselves. We’ve allowed that to be normal.”


Empathy should go both ways, she added.


“Someone else isn’t going to feel bad if my unvaccinated kid gets measles from the person who got the vaccine,” she said. “My kid is the one that they blame.”


Monica Pino, Haslett

I also am having my baby’s vaccinations delayed/spread out. I chose not to have him get the Hep B vac in the hospital because I think with the way that is spread, it's not a concern for my newborn. I think it's a harsh thing to add to the first day or two of life. So he has actually not gotten any vacs so far.MONICA_SMALL.jpg


My older kids go to public schools and are up to date on shots. We decline flu shots. It's interesting to me that people with an allergy to a certain ingredient in the shot can get one that is free of that ingredient, but if it's not a needed ingredient, why is it in the shot at all?

Allison Singer, Lansing

I am supportive of holistic medicine but I also recognize the place of modern medicine. I advocate healthy, natural living and breastfeeding but I also think that vaccinations have their place. Of course I recognize the inherent problem and contradiction of the medical industry in that people need to be sick in order for the industry to prosper and make money. The pharmaceutical industry is one of the top money-making industries in the world so of course I am skeptical about all the drugs they push, especially when they are only treating the symptom instead of healing the root cause, something I think holistic medicine, diet, lifestyle etc. is better at in a lot of cases (not all- some diseases, conditions, etc. require drugs). However, I still respect science and the progress that medicine has made. Especially for vaccinations stopping outbreaks and saving lives.


Now there is the question of what vaccines and when. I need to do more research but right now I'm thinking about a spaced out schedule with only the most pertinent vaccinations. There is a measles outbreak right now. I am not one to freak out about it or live in fear but I recognize that there are more vulnerable people in our society that this could seriously affect. I just read an article about a little girl with cancer who is unable to get vaccinated and got infected with measles by another child who's parents chose not to vaccinate. So I feel it is somewhat of a social responsibility to vaccinate if one is able in order to protect the most vulnerable who cannot- babies, cancer patients, older folks, etc.

Cheryl Knapp Overley, Lansing

I don't think “society” can talk rationally about this in this time of hysteria and scapegoating. The current climate reminds me of people freaking out about ebola in the US and post-9/11 when people were physically assaulting any men who looked vaguely brown and religious and some people in New Jersey were wrapping their houses.


I have had plenty of rational conversations with friends but wider than that, more often than not, the fear and coercion seems to override listening and nuance.

ANGELA CHELA ASHLEY, ONONDAGA

I never vaccinated my two children(in fact, I never took them to the hospital, they never had a physician). They have taken antibiotics once in their lives--for strep throat … I think it is vitally important to have this discussion in mainstream and to advocate vaccination research. There is much to learn. I have always felt that our society practices health-care on the basis of fear and intolerance. I would like to see a shift to faith, local agriculture, and nurturing a more stress-free lifestyle. Our children deserve so much better!

Allyson Green, Lansing

We get our vaccinations but I'm a delayed schedule I wasn't okay with Orion getting bombarded all at once so we do things more spread out I also am in the position where he receives care primarily from me and my mom so we don't have to worry about day care and the rampant cesspool of germs there