Entitlement Is Infecting Us With the Measles

To date, the measles outbreak traced to Disneyland has led to 87 reported cases of the infectious illness. The measles virus causes symptoms including fever, cough, runny nose, red eyes, and a distinctive rash. Pregnant women who get measles are at risk for premature birth and low birth-weight babies. Children under 5 are the most vulnerable. Of 1,000 children who get measles, one or two will die, but many more will be hospitalized with serious complications including pneumonia and encephalitis, leading in some cases to permanent harm (including deafness and intellectual disability). It is an extremely easy-to-spread virus, airborne and capable of living on surfaces as long as two hours after contact with an infected person. People are most contagious before they know they are infected.

It is also nearly totally preventable through vaccination. Today’s measles vaccine is bundled with vaccines for mumps and rubella (also known as German measles), and sometimes chicken pox. It’s administered as a two-dose regimen, the first shot given at 12 months. Some four decades after the first vaccine was made commercially available, measles was declared eradicated in this country in 2000. It keeps coming back, though, whether brought in by unvaccinated visitors from overseas or—as is likely in the Disneyland outbreak—spread among children either too young to receive the vaccine or those whose parents have decided to delay or avoid vaccines entirely. According to health officials in California, where most of the patients live, of the 42 cases in which vaccination status is known, 34 were unvaccinated (the others were either fully or partially vaccinated).

So what makes parents refuse to vaccinate? For today’s American anti-vaccinators, many of them well-off and well-educated, there are a variety of narratives to explain their opposition. Probably the most commonly cited is the discredited, withdrawn, and denounced paper in a medical journal that introduced the idea of a link between the MMR vaccine and autism. No matter how many studies have disproven the theory, or proposed other explanations for a worldwide rise in autism diagnoses, the fallback anti-vaccine position is to incite fear of autism. Still, there are variations in the rhetoric: Some rail against thimerosal, others warn that vaccines themselves cause disease. Some dispute the notion of herd immunity, and assert that childhood diseases are either good for kids’ immune systems, or that they are easily prevented by a healthy diet and exercise. When scientific studies are cited to disprove their theories, many anti-vaccinators stand firm, questioning the validity of the scientific method itself, preferring to do “their own research” and avoid the propaganda put out by “big pharma.”

For many parents, it’s simply fear. “It’s important to acknowledge that not only is parenting itself frightening, everything about bringing your kid in for a shot just sucks,” says Seth Mnookin, whose book The Panic Virus looked at vaccines and the movement against them. “It’s hard for me to think ill of or demonize the parents who are trying to do what they think is best for their kids.” But, he says, doctors who pander to vaccine fears by advocating delayed or skipped vaccinations are another matter.

“I think what Jay Gordon is doing and what Bob Sears is doing is really unconscionable,” Mnookin says, referring to two prominent pediatricians known for their vaccine skepticism. “I think that they are violating their Hippocratic oath.”

Gordon talked this week on CBS about how freely he signs so-called “personal belief exemptions,” allowing parents to opt out of public-school immunization requirements. These exemptions, says Anna Dragsbaek, a lawyer specializing in public-policy development around vaccination and CEO of the Immunization Partnership, have gone hand-in-hand with higher rates of outbreaks in states that allow them.

Mnookin says it’s important not to overstate the size and scope of vaccine refusal. “Really, the huge, overwhelming, vast majority of parents do vaccinate their kids,” he says. “Sometimes the way the story gets covered gives parents the impression that it’s like a 50-50 split, and the reality is that parents should feel secure when they vaccinate that they’re making the same good choice for their children as the overwhelming majority of their peers are.”

Still, Mnookin goes on, the Disneyland outbreak “is a good illustration of how even a relatively small number of parents who are not getting their kids vaccinated can have a really significant effect.”

It’s no accident that the current outbreak is taking place in California, a state with historically high levels of vaccine refusal—not necessarily statewide, but clustered in certain school districts. At the Marin County school Carl Krawitt’s son Rhett attends, for instance, 7 percent of children are exempted from the immunization requirement because of their personal beliefs (or really, that of their parents). That’s a problem for Rhett, as he’s recovering from leukemia with an immune system weakened by chemotherapy. As Krawitt told NPR this week, though, some of his school’s fellow parents were upset that he asked them to immunize their kids to help protect his. 

This is what I find the most troubling: the notion that a small but very vocal minority of anti-vaccine activists have managed to sow so much confusion that kids are being put at risk. With its appeals to natural health and individual autonomy, vaccine wariness is as trendy as anything else you’ll find in the Whole Foods aisle (gluten bad! chia good!), but its impact is so much greater.

Part of the problem is that most of us who are parenting kids now have never seen any of these formerly common childhood illnesses. “For a lot of our peers,” Mnookin says, “these diseases seem kind of notional.”

And then there’s the deeper question—beyond the pseudo-science, the mistrust of authority, the faddishness—of just what we feel we owe one another in the society. The thing I’ve found most disturbing about the hard-core anti-vaccine arguments is the way they center on the rights of the individual parent to make choices for his or her child, ignoring (most immediately) the rights of that child as well as the collective rights and health of the community. The Onion ran a brilliant parody this week in the form of an op-ed arguing the parental rights line when it comes to vaccines:

“I am by no means telling mothers and fathers out there what to do; I’m simply standing up for every parent’s right to make his or her own decision. You may choose to follow the government-recommended immunization schedule for your child, and that’s your decision as a parent. And I might choose to unleash rubella on thousands upon thousands of helpless people, and that’s my decision as a parent.”

What I find amazing, and incredibly sad, is how similar this sounds to a nasty quote I pulled from an article about the current measles outbreak on an anti-vaccine site:

“It was not ever, is not today, and will not be tomorrow my child’s job to protect your child, in any way, shape, or form. That is the parent’s job.  Period.”

When we are talking about the life of our children—all of our children—the bar needs to be higher. “I have talked with parents whose children have died of vaccine-preventable diseases,” Mnookin says, adding that these parents would do anything to get back what they have lost.

“We can have a philosophical discussion about individual rights versus community rights, and where one ends and the other begins,” Dragsbaek says. “In the cases we’re seeing now, especially for babies under the age of one who are not old enough to be immunized, it’s the people who are most vulnerable in our society who we aren’t protecting. And I think we have to ask ourselves as a community, are we okay with that?”