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Sharp rise in parents saying no to vaccine

08/26/01

WENDY Y. LAWTON

The number of Oregon children missing one or more vaccinations because of religious reasons increased sharply during the last school year.

For nearly a decade, the percentage of children with religious exemptions for immunizations hovered around 1 percent, according to the Oregon Health Division. This spring, the figure jumped from 1.4 percent to 2.7 percent. That's at least 3,600 kids.

But many families aren't finding faith. They're joining the anti-vaccination movement. Convinced that shots are dangerous, unnecessary or unhealthy, a small but passionate group of parents is using a broadly worded state rule to opt out of shots required for school and day-care attendance.

The choice is legal. Under Oregon's exemption rule, religion is defined as "any system of beliefs, practices or ethical values." Some parents do believe immunizations go against God's will. But a church letter isn't required. Parents simply sign a state health form. No questions asked.

Hank Collins, the health director in Jackson County, put it plainly: "That rule is so big, you could drive a truck through it."

Jackson County has one of the most persistently high exemption rates in the state. Ashland, in particular, is a hot spot. County figures show that an estimated 12 percent of Ashland children have religious exemptions for shots. At one preschool, the number of kids exempted runs as high as 34 percent.

Public health officials and pediatricians are taking notice. A health department draft plan for Jackson County calls for everything from focus groups to immunization fairs. Fearing disease outbreaks in the county and other places, advocates this fall will launch a statewide vaccine education campaign.

"Vaccines aren't perfect," said Dr. Mary Brown, a Bend pediatrician. "But the risks of adverse reactions are far less than the risks from the diseases themselves. I've treated children over the years who had seizures and hearing loss from haemophilus influenzae. My brother had polio."

But many parents -- and young doctors -- have never seen polio, measles or other illnesses that largely have been wiped out by vaccines.

They do, however, hear stories about kids who've had fevers, speech problems or other side effects after getting shots. Or they've read claims that vaccines cause autism, asthma, diabetes, brain damage.

"I'm not ready," said Victoria Johnson, a Medford mother, "to play that Russian roulette."

Fear and uncertainty aren't the only reasons Johnson and other parents opt out of shots. These families, on the whole, say they are health conscious. They breast-feed, buy organic, forbid junk food.

So the idea of injecting children with live or dead viruses, often mixed with chemicals such as formaldehyde, goes against their parenting principles. It also goes against their belief in the body's ability to protect and heal itself.

Take John Schmidt. The Silverton chiropractor has never vaccinated his six children, including two grown sons who contracted whooping cough as children. Schmidt said the boys nearly died.

"But today they're healthy," he said. "Statistically, I was better off with my decision."

Distrust grows Slapping themselves with labels ranging from pro-life Republican to environment-minded Democrat, these anti-vaccine parents don't like being told what to do. They distrust drug companies and federal regulators. They do their homework. And the more they read, the more they question.

The Internet offers plenty of fodder.

Some online information is true. Shots can cause fevers and, in rare cases, severe reactions such as seizures. Thimerosal, a preservative containing mercury that recently was phased out of vaccines, is under fire in Oregon courts and under study by the National Institutes of Health.

But other postings are not proved. Controlled research studies have not clinched a connection between vaccines and disorders such as autism.

Yet some possibilities are packaged as certainties.

There's no doubt, for example, that the number of children diagnosed with autism is increasing. At the same time, the number of shots in Oregon required to enter kindergarten has gone from 10 in 1997 to 15 today. Some families believe there's a connection.

Or parents have heard of -- or seen -- children falling ill after getting a shot. Was the vaccine the culprit?

There is always a chance, said Dr. Paul Cieslak, manager of the Health Division's communicable disease unit. But Cieslak said the environment, genes and general health also could be to blame.

"Too many people are making cause-effect associations that can't be supported," Cieslak said. "The science isn't there."

No absolute proof Science, however, is at a disadvantage in the brewing vaccine battle.

The Internet, where many safety claims crop up, is quick and cheap. Research, which tests such claims, is slow and expensive. Science can't give some parents what they're really after: irrefutable proof that shots aren't to blame for elusive and incurable conditions such as autism.

The research is reassuring, said Dr. Robert Chen, chief of vaccine safety and development activity at the federal Centers for Disease Control and Prevention. But it is always evolving.

"We don't use absolutes in science," Chen said. "We can't, because we're not God."

Improvements in vaccine study and surveillance are under way. The CDC will spend $1.7 million this year to start a national network of research centers that will train doctors to better spot and treat adverse reactions and investigate what role biology and genetics may play.

Barbara Loe Fisher, head of the National Vaccine Information Center, a watchdog group, said such an individualized study will go a long way toward addressing parents' concerns.

"For too long, we've focused on a one-size-fits-all approach," Fisher said. "But let's start looking at why some children don't handle vaccines. If you don't look for the answers, you won't find them."

Focus on today Public health officials aren't focusing on the future. They're worried about now.

Unvaccinated children weaken what's known as "herd immunity," a community's ability to ward off infectious disease when enough people are protected. Dips in preschool vaccination rates, for example, helped fuel a national measles epidemic between 1989 and 1991 that sickened 55,622 people, sent 11,251 to hospitals and killed 125 children and adults.

In Oregon, the viral infection gained its foothold in Jackson County. Dozens of cases were recorded, and hundreds of young people were sent home from schools. In Kennewick, Wash., two women died.

When outbreaks occur, kids who haven't been immunized are at much greater risk of getting sick. A study published in December in the Journal of American Medical Association showed that exempted kids were 22 times more likely to contract measles and six times more likely to get whooping cough than peers who had shots.

But outbreaks aren't common, said Nancy Church, manager of infection control at Providence St. Vincent Medical Center in Portland. And parents hear more about vaccine problems than they do about the diseases they prevent. Church said it's time for a reality check.

"Parents need to hear both sides of the issue," she said. "We need to get all the facts on the table."

That's why the Oregon Partnership to Immunize Children, the pro-shot coalition Church leads, will bring a CDC physician to Medford and Portland to speak in October. Health care providers will learn about the anti-vaccine movement and how to answer parents' questions with proven data.

At the meetings, and in the coming months, the coalition will distribute dozens of vaccine education guides. A video, "Vaccines: Separating Fact from Fear," will be sent to private doctors offices and public clinics.

The materials are unabashedly pro-vaccine. But the groups that created them don't take drug company money; that's a deliberate decision made to gain credibility with skeptics.

A handful of anti-vaccine advocates will continue their own campaign to change Oregon's immunization law. A bill to allow parents to opt out of shots for philosophical reasons died in the Legislature this year. Bob Snee, a Portland parent and attorney, plans to reintroduce the idea in 2003.

"If you decide to vaccinate, that's your choice," Snee said. "But parents who make another decision should have a choice, too." You can reach Wendy Lawton at 503-294-5019 or by e-mail at wendylawton@news.oregonian.com.

You can reach Wendy Lawton at 503-294-5019 or by e-mail at wendylawton@news.oregonian.com.