Vaccine rates, up in Valley, still lag

08/29/2013

San Geronimo Elementary parents leery of pharmaceutical companies and additives are far more likely to forgo immunizations compared to parents at other West Marin schools, according to data released by the state. Exemptions to vaccination requirements at the school, however, shrank for the second consecutive year.

Still, nearly half of San Geronimo students continued to abstain, and as the countywide exemption rate climbed last year to almost three times the statewide average, numbers remain far above what most health officials say is necessary to maintain mass immunity.

Students entering kindergarten are required to be vaccinated against a host of maladies like polio, measles and pertussis, but California allows parents to sign a waiver, called a personal belief exemption, if they oppose the shots. 

About 20 states allow philosophical exemptions, and every state except for West Virginia and Mississippi permits religious exemptions. 

Marin parents are increasingly taking advantage of belief exemptions—which are more common in affluent and well educated populaces—but a new law set to take effect next year will require a medical consultation before they can obtain a belief exemption.

In the 2012-2013 school year, 13 of 29 students, or 45 percent, of San Geronimo kindergarteners entered school without the typical suite of vaccines because their parents signed belief exemptions. That rate was even higher in 2011-2012, when 50 percent requested exemptions, and in 2010-2011, when 63 percent opted out. 

Students in other West Marin schools were more likely to enter kindergarten fully vaccinated. 

At Inverness School, three of 17 students had belief exemptions last year, as did one of 10 students at Lagunitas Elementary. No kindergarteners at Tomales or Bolinas Elementary had an exemption, although in 2011-2012, four of 15 Bolinas kindergarteners opted out (and three of 16 the year before). 

Countywide, the belief exemption rate climbed from 6.8 to 7.8 percent of kindergarteners last year, close to triple the statewide rate of 2.8 percent. “I was disappointed [in the increase],” said Sharayn Forkel, director of immunizations for the county health department and a registered nurse. Marin’s rate has climbed steadily since 2003, when it was at 2.8 percent.

The current county rate, and especially the rate at San Geromino, sits higher than what health officials recommend in order to maintain herd immunity, when high vaccinate rates allow little room for an outbreak.

“Without that kind of herd immunity, you start to develop… the environment for mini epidemics,” said Michael Witte, founder and medical director of the Coastal Health Alliance, which has sites in Point Reyes Station, Bolinas and Stinson Beach. 

Health officials say that vaccines are safe and that opt-out rates above five to 10 percent endanger not just the individuals with belief exemptions but other children who may not be vaccinated because they have compromised immune systems, as well as children too young to be vaccinated. In 2010, California had a major outbreak of pertussis, with 9,000 cases statewide—350 in Marin alone—and 10 infants died.  

Since January of this year, Marin has over 100 reported cases of pertussis—also known as whooping cough—according to Ms. Forkel. “That is considered high,” she said. The county does not currently track numbers by school but Ms. Forkel said there were some cases in West Marin. 

The primary reason parents opt out of vaccinations, Dr. Witte said, is a fear of preservatives or activating agents, such as aluminum or formaldehyde. Fears of autism—stemming from a since debunked 1998 study by a doctor who had his medical license revoked as a result—are less prevalent now, from what he’s seen. 

An innate distrust of the pharmaceutical industry and its billions in profits also informs the decision. 

San Geromino’s particularly strong opt-out rate did not surprise Dr. Witte.  “They don’t just accept things just because that’s what the conventional wisdom is,” he said. “I understand that, and I know that’s part of the culture, or subculture, of an independent rural community like this.”

Ms. Forkel said that any trace amounts of additives in vaccines either stop bacteria from growing in the vaccine or bolster the vaccine and are not present in amounts that would harm people. “It’s nothing that doesn’t already exist in the environment or in our own bodies,” she said.

Dr. Witte said vaccines have become safer in the past decade or so. According to the Center for Disease Control, one preservative that worried some parents, thimerosol, which contains mercury, is no longer present in vaccines recommended for children. There are minute amounts in some, but not all, flu vaccines.

Dr. Witte, who conceded that he harbored “no love” for the pharmaceutical industry and understood why people distrust it, argued, “These vaccines are some of the safest things they make.” 

Vaccines employ the basic homeopathic principle of similar—a tiny bit of the virus, which is often deactivated in the shot, jumpstarts the immune response to protect us from illness later on. Dr. Witte says that’s one of the ways he frames the conversations with parents—but only when they are open to a discussion.

It is not the health center’s job to be “foisting” vaccines, Dr. Witte said. If parents are adamantly opposed, he lets them know they can come to him for a conversation or with questions if they choose, believing that a heavy-handed approach will backfire.  “Our job is not to judge them,” he said, but to have a dialogue.

The law set to take effect next year that will require a medical consultation could sway parents on the fence, or those who may request exemptions simply because of busy schedules, Ms. Forkel said. She added that the county is developing a survey to better understand why Marin parents are increasingly likely to eschew vaccines. 

Although the state data on immunization rates does not break down by socioeconomic or ethnic background, Dr. Witte said West Marin’s Latino community is much more likely to vaccinate. As either recent immigrants or friends and family members of people living outside the U.S., many Latinos are less removed from disease. 

“They see it in their villages or in their own kids. They’re exposed to it… day in and day out, it scares them, and they see the benefit of being able to protect their kids and their families. Measles is not a trivial disease,” Dr. Witte said. 

But for parents who harbor distrust of the pharmaceutical industry, it can be difficult to combat deep-seated suspicions.

“I feel like our pharmaceutical companies don’t really have that much of a concern about the welfare of humanity,” said one West Marin parent who requested anonymity. The parent said diseases like mumps and measles were not deadly, and emphasized that first-world access to a nutritious diet also helped ward off disease. “I feel very strongly that our bodies will be able to handle quite a bit of these diseases,” she said.

Doctors who espouse the safety and efficacy of vaccines, she said, have been educated in the western, pharmaceutical model of medicine. “Why would they disagree? They’ve been programmed to believe that’s true,” she said.

She also expressed skepticism of the high numbers of the 2010 whooping cough epidemic, arguing that they could have been skewed to scare people into vaccinating—again, to build the coffers of the pharmaceutical industry. 

But other parents, like San Geronimo Valley resident Heather Richardson, have no reservations about vaccines. Ms. Richardson said there is no substantiated reason to renounce them, and questioned the logic of corporate distrust. “What about coconut water? That’s shipped like nine million miles” on a plane probably owned by a corporation, she said.