The news of a measles outbreak in Southwest Washington started with the announcement of two children who had contracted measles.
It grew quickly, as outbreaks of infectious disease tend to do. To 14, 16, 19, 25 and now 30 confirmed cases as of Friday morning — nearly all of which involved unvaccinated children, according to the Clark County Public Health department. Another nine suspected measles cases are under investigation. And officials believe a Seattle-area man who came down with measles may have picked it up while visiting Southwest Washington.
On Friday night, health officials announced that the outbreak had reached Oregon with a confirmed case of measles in Multnomah County. It’s not a surprise, unfortunately. Even with decades of research showing the safety, efficacy and necessity of vaccines, Oregon parents are refusing to have their children immunized for vaccine-preventable diseases in record high numbers, weakening the line of defense that mass immunity provides. And similar to Clark County, many of those who are unvaccinated are clustered in schools or communities where a single measles case could multiply in short order.
The Clark County outbreak, like past outbreaks of vaccine-preventable diseases in Oregon and elsewhere, drives home the point that forgoing immunizations isn’t just a matter of personal choice. The long list of places where people may have been exposed to the virus — churches, schools, stores, high school basketball games, Portland International Airport — speaks to the broad reach of a family’s choice not to immunize a child. Refusing to vaccinate children puts not only them at risk but also the health of medically fragile individuals or those too young to be immunized. Oregonians and legislators must start treating our declining immunization rate as the serious threat to public health that it is and stem this backward slide.
Oregon requires that students be immunized for 11 vaccine-preventable diseases unless they have a medical reason not to be. But the state also allows exemptions for religious or philosophical reasons provided parents either speak with a doctor or watch a video about the benefits of immunization. While few people sought such exemptions 20 years ago, that number has steadily grown, with 7.5 percent of kindergartners now claiming a nonmedical exemption for at least one vaccination, the highest rate in the country, according to the Centers for Disease Control website.
It’s mindboggling that Oregonians who recognize the authority of science when it comes to climate change would mistrust the decades of research and immunization of hundreds of millions of people worldwide that attest to the safety of this vaccine. A study from the 1990s that claimed an association between autism and the measles, mumps and rubella vaccine has long been debunked and retracted, and its principal author, Andrew Wakefield, discredited.
Yet at the same time, the hesitance isn’t so surprising at a time when people eye institutions — governmental, medical and others — with suspicion. People dissect mandates for hidden agendas. Institutional failures, whether by error or intention, give people reason to doubt. And the Internet has made accessing information, even inaccurate information, easier than ever before. It’s no wonder we have a problem.
The World Health Organization’s declaration of vaccine hesitance as one of the top 10 global health threats should help spur physicians, public health officials and legislators to step up their game. For example, doctors should aim to have a direct and thorough conversation with parents considering opting their child out of vaccinations rather than letting parents watch — or claim to watch — an online video. Pediatricians share the same goal as parents of protecting their children, said Dawn Nolt, a pediatric infectious disease expert at OHSU. That’s a powerful bond that, if cultivated with time and respect for parents’ concerns, can help relieve fears about vaccines.
Public health officials also should look to increase targeted educational outreach to communities with low immunization rates. While health officials smartly focus their limited resources on providing vaccinations, they have a compelling story to tell that’s not being shared. Combatting measles has actually been “a great public health victory,” as Dr. Paul Cieslak, the Oregon Health Authority’s immunizations medical director, puts it, with very few incidents of a potentially-fatal disease that in pre-vaccine days hit everyone. It’s well worth the expense. Clark County has already spent more than $100,000 in the measles outbreak tracking down people, interviewing them about places they visited and people they’ve seen and monitoring potential new cases.
Parents, too, can play a crucial role in persuading other parents. One Portland-based nonprofit, Boost Oregon, aims to corral the power of peer advocacy to educate others on the safety and importance of vaccinations. The organization, founded in 2015 by attorney Nadine Gartner, holds workshops for parents and trains parent volunteers to share the facts on immunization. The group also counsels medical professionals on how to engage parents in a respectful, informative discussion that directly answers their questions and dispels myths.
Still, Oregon can’t afford to wait for public sentiment to catch up to where we used to be. Lawmakers should revive an effort first pushed by Democratic Sen. Elizabeth Steiner Hayward in 2015, to eliminate nonmedical exemptions. At that time, Steiner Hayward, a doctor, was concerned by the Disneyland measles outbreak that sickened 147 people in late 2014 and early 2015. But fierce blowback from anti-vaccination groups shut down the effort and so far, no one is taking on the cause this year.
As difficult as it may be, it’s not impossible. The Disneyland outbreak that spurred Steiner Hayward to action also emboldened California legislators to eliminate their state’s nonmedical exemption becoming the third state to permit only medically-necessary exemptions to immunization requirements. Oregon shouldn’t wait for its own Disneyland outbreak to become the fourth.