When Parents Say No to Child Vaccinations

By DONALD G. McNEIL Jr.

ASHON ISLAND, Wash. — Kate Packard, the school nurse here, has a nightmare she sums up in five words: "measles coming across the water."

If measles did make the 20-minute ferry ride across Puget Sound from Seattle — hardly unthinkable, since a case occurred last year near a ferry terminal in West Seattle — public health officers say the whole Vashon Island school district could be shut down until the island's last case disappeared or an emergency vaccination drive took effect.

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Eighteen percent of Vashon Island's 1,600 primary school students have legally opted out of vaccination against childhood diseases, including polio, measles, mumps, rubella, diphtheria, whooping cough, tetanus, hepatitis B and chicken pox. The island is a counterculture haven where therapies like homeopathy and acupuncture are popular, and where some cite health problems among neighbors' children that they attribute to vaccinations.

Most families opting out of vaccination here have obtained "philosophical exemptions" from normal vaccination requirements — exemptions that in Washington and several other states, including California and Colorado, can be claimed simply by signing a school form.

Across the country, about 1 percent of all children are exempt from vaccination, said Dr. Walter A. Orenstein, director of the National Immunization Program at the Centers for Disease Control and Prevention. The agency's surveys suggest that more than 90 percent of all American children have had most shots, except for the new chicken-pox vaccine.

But from Vashon Island to Boulder, Colo., to towns in Missouri and Massachusetts, there are "hot spots" where many children go unprotected. In a 1999 survey, 11 states reported increases in exemptions.

Clusters of unvaccinated children are not only in potential danger themselves, health officials say, but are also a threat to the "herd immunity" that walls out epidemics, sheltering fetuses, infants too young to be immunized, old people with weakened immune systems and even vaccinated classmates who remain at risk because no vaccine is 100 percent effective.

When only a few parents use "herd immunity" to let their children escape the small risks of vaccination, the system still works.

But health officials become concerned in states like California, where it is easier for a parent to sign the waiver form than to have a child vaccinated. "People take the path of least resistance," said Daniel A. Salmon, a vaccination expert at the Johns Hopkins School of Public Health. "What I do to my child can put other children at risk." In 1989-90, measles broke out among unimmunized immigrant children in Southern California, causing 43,000 cases and 101 deaths.

Vaccine resisters cite an array of reasons. "Sometimes it's distrust in government, feeling it's in bed with the vaccine industry and `everyone's making money off our kids,' " Mr. Salmon said. Sometimes the objections are religious, as among Christian Scientists and some Amish congregations. Sometimes a community is scared when a child is truly harmed by side effects; the live polio vaccine, for example, is thought to cause about eight deaths a year.

Some parents are upset at the sheer number of injections a child must get — usually about 20 by age 2. Others are convinced — despite evidence to the contrary — that vaccines are highly likely to cause severe health problems, like seizures and autism.

Here on Vashon Island, a community of 10,000, word spread quickly when the 10-month-old baby of Gail O'Grady, a midwife who also works at Minglement Natural Foods, died unexpectedly in his crib in 1984 two weeks after his first immunization; when Pam Beck's daughter Rachel suffered four years of seizures that began minutes after her first whooping-cough shot; when Nancy Soriano's son, Alex, developed autism after tetanus and polio vaccinations.

Some doctors they consulted disagreed, but all three mothers were sure vaccines were to blame.

Alex, Ms. Soriano said, changed from "a bright-eyed, happy, beautiful kid" to a severely autistic 4-year-old who "lived curled up in a ball, screaming and screaming and screaming." She says she has nearly cured him by removing milk and glutens from his diet.

Public health specialists suggest that the resistance to vaccines is a consequence of the success of vaccinations: People, they say, no longer fear diseases they have never seen.

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"I remember how the fear of polio changed our lives — not going to the swimming pool in summer, not going to the movies, not getting involved with crowds," said Dr. Edward P. Rothstein, 60, a Pennsylvania pediatrician who helps the American Academy of Pediatrics make immunization recommendations. "I remember pictures of wards full of iron lungs, hundreds in a room, with kids who couldn't breathe in them. It affected daily life more than AIDS does today."

Now, with the rare side effects of the live vaccine, "there's a risk of about eight kids a year dying, so people don't want to be vaccinated," he said, adding, "When polio was around, people gladly took that risk."

Rubella, Dr. Rothstein went on, "is, for the most part, a nothing disease" — the reason to keep vaccinating against it is to protect fetuses. "In the 1960's," he said, "50,000 to 60,000 babies were born with small heads, or deaf, or blind or with cataracts" because their pregnant mothers had been exposed to rubella.

All 50 states allow medical exemptions for children who are immuno-compromised or allergic to vaccines; 47 states — all but Arkansas, Mississippi and West Virginia — allow religious exemptions; and 17 allow personal or philosophical ones. But how many children receive the exemptions depends partly on how much red tape is involved, a study in the American Journal of Public Health found. In states where parents must go to a state office for exemption forms, get their signatures notarized or produce letters from a religious authority, exemption rates tend to be lower.

The only states with exemption rates greater than 2 percent, the disease center said, are Michigan, Washington and Wisconsin.

Still, health officials say that in recent years public sentiment has often run against vaccination. The news media publicize stories of autism, seizures and crib death that followed vaccination. More than a dozen Internet sites specialize in describing the dangers of vaccines.

Vashon Island is both a commuters' haven served by high-speed ferries to Seattle and a home to the counterculture — a place where the telephone company's garage features a mural of a Frisbee-catching dog. Millionaires have shore homes while the self-named Rainbow People live in tents in the woods.

In interviews, parents who have signed forms to exempt their children from vaccination appeared to be educated, attuned to their children's health and full of opinions about vaccines, though some cited "facts" that the disease center disputes. Most parents mixed unconventional therapies like homeopathy, acupuncture and chiropractic, and conventional medicines like antibiotics and painkillers, Most said they were suspicious of the vaccine industry.

"I consider well-baby care to be a capitalist plot," Maryam Steffen, a mother of four said only half-kidding.

If anyone would seem to be a living argument for tetanus vaccination, it is Camille Borst, 25. When she was 12, she stepped on a nail. Her mother, who opposes vaccination, did not take her to a hospital until her foot was so inflamed she could not stand on it. But Ms. Borst says proudly that she has not immunized her own children, Deven, 9, or Casper, 4.

Her mother, Adrienne Forest, 47, who is home-schooling her grandchildren in a neat, shingled mobile home in a clearing of fir and alder trees, said she was sorry she let the hospital give Camille other vaccines. "It was a moment of weakness," she said. The nurses who angrily told her that Camille could have died "totally freaked me out," she said.

From 1995 to 1999, said Ms. Packard, the school nurse, an epidemic here of whooping cough, which can be fatal in infants, hospitalized some infants and left some children with chronic asthma. Ms. Forest's grandson Deven had whooping cough two years ago and, she conceded, probably passed the disease to 10 other children, including an infant.

"Yeah, that bothered me," Ms. Forest said. "But I called everybody and we studied up on what you can do to build up the immune system."

The baby "did just fine," she said. "On Vashon Island, you have middle-class people who eat healthy and keep warm. If everyone was poor-poor, not breast-fed, not eating right — that might be a reason to vaccinate." But she and her daughter remain steadfastly opposed.

Meg White, 45, though, now somewhat regrets not vaccinating. Three years ago, her whole family, including her infant son Julian, had whooping cough "really, really bad" for more than three months.

"My son would turn all shades of purple," she said. "He stopped breathing several times and we took him to the hospital. My daughter was terrified of going to sleep because then it got worse. She would vomit all over the place. My husband cracked ribs from coughing."

Now, Ms. White said, she would advise other mothers to vaccinate against whooping cough, polio and tetanus, but only with the newest vaccines. She still has not vaccinated Julian, now 3, against measles, mumps, rubella or chicken pox.

Julian is in nursery school at Puddlestompers, whose director, Tressa Aspiri, also changed her mind about not vaccinating after her older children got whooping cough.

She makes no recommendations to parents when they fill out the school's vaccination form, she said, though she feels that vaccines are safer than they were when her children were born in the mid-1980's.

"I still feel strongly that it's the parents' choice," Ms. Aspiri said.