A needle pokes through the protective film of a vaccine vial, while a hand simultaneously pulls up on the needle’s handle, sucking in an engineered cocktail that includes elements like gelatin, phosphate, chick embryo cell culture, and human lung fibroblasts. As that needle next pushes through someone’s skin, it delivers a combination of substances designed to build up that person’s antibodies to measles, mumps, and rubella (MMR).
Those ingredients are only in one manufacturer’s version of the MMR vaccine and are listed on the Centers for Disease Control (CDC) vaccine ingredients list. DTaP (diphtheria, tetanus, and pertussis), HPV (human papilloma virus), polio, and varicella (chicken pox) vaccines are also on the four-page long list of inoculable items engineered to protect the world’s population from infectious diseases that health officials consider to be harmful to human health.
If at least 95 percent of a population gets the booster shots they’re supposed to, the community will have achieved something health officials refer to as “herd immunity.”
Basically, the thought is this: If enough people build up the antibodies needed for immunity from an infectious disease, then even the people who are unable to get the vaccine—say, because they’re too young (under the age of 1), they’re allergic, or they have other health issues preventing them from receiving a vaccine—will be protected from something like measles.
The recent measles outbreak stemming from Disneyland, and a series of 2014 outbreaks that caused more than 600 cases of measles in the United States, has concerned health officials, who blame the case increase on a growing number of parents—nicknamed “anti-vacciners” or “anti-vaxers”—who decide against vaccinating their children. The concern led California legislators to introduce a bill that would essentially prevent parents from making that decision for themselves.
On Feb. 19, state Sens. Dr. Richard Pan—a pediatrician—(D-Sacramento) and Ben Allen (D-Santa Monica) introduced Senate Bill 277, which would repeal the personal belief exemption that currently allows parents to opt their children out of the vaccine requirements for schools.
State Sen. Hannah-Beth Jackson (D-Santa Barbara) backs the bill and said it would make immunization from certain diseases, including measles and pertussis (whooping cough), a requirement for children, unless there’s a physical or medical condition preventing it. She said vaccines are helpful to both the individual and the community.
“There’s absolutely no medical fact to the contrary,” Jackson said. “You have to think of the common good.”
The common good in the case of vaccines would be “herd immunity,” Jackson said, adding that the law enabling parents to opt out of vaccinating their children due to personal beliefs is 25 to 30 years old and came about at a time when vaccine-preventable diseases were thought to be epidemics of the past.
“So they loosened the restrictions, and lo and behold, they’re back,” Jackson said. “Go back to the era of polio, which I remember. … People were absolutely panic stricken that their children would get polio.”
She said when the polio vaccine was licensed in 1955 it was a breath of relief to parents who were worried about their child getting the disease. In its most severe form, polio causes paralysis, difficulty breathing, and sometimes death. The CDC reports that between 1951 and 1954, an average of 16,316 people per year contracted paralytic polio with 1,879 deaths per year from the disease. The last case of naturally occurring polio in the U.S. was in 1979.
“People didn’t complain, they were grateful,” Jackson said. “Immunizing truly beats the alternative.”
Bills such as SB 277 are the kinds of laws that legislators are responsible for passing, Jackson said. She compared vaccines to seatbelts, which everyone in a moving passenger vehicle is now required to wear, saying there’s “no negative outcome.”
“It’s a win-win,” she said.
A different way
Medical issues, religion, and philosophy are the biggest reasons parents choose not to immunize. SB 277 would get rid of the latter two as viable options, which doesn’t sit well with people like Robin, whose name has been changed because she wanted to remain anonymous.
“People need to be able to make that choice for their family and not the government,” Robin said. “I don’t think the government should tell you that you have to vaccinate your children.”
She has slender hands that are animated when she talks. It’s clear that she’s thought a lot about her point of view, and as she puts her sentences together, she pauses, trying to give voice to the description that exactly mirrors her thoughts. The Santa Maria-native has two children: an 8-year-old son and a 4-year-old daughter.
She said she’s not an anti-vaxer, but she does object to giving her children certain vaccines, and she doesn’t follow the recommended booster schedule, which advocates for infants to receive 10 immunizations before the age of 19 months. Robin’s preference is to wait until her children are at least 2 years old to start and to space out the vaccine doses.
The discussion about vaccines is a difficult one, though, and Robin and her husband have spoken at length about the “right” way to do things for their children.
“Before I got pregnant, I was pretty sure I wasn’t going to vaccinate,” she said. “Once you have these precious beings, it’s like: ‘What if they do get it?’ or ‘What would I do?’”
They’ve decided to vaccinate their kids against what Robin considers to be more serious diseases: Polio. Tetanus. Diphtheria. She considers vaccine-preventable illnesses such as measles, chicken pox, and whooping cough (pertussis) to be relatively “benign” in terms of their impacts on overall health. Plus, she added, it’s about maintaining immunity into adulthood.
“Having these childhood illnesses can be a benefit for your whole life,” she said, arguing that immunity from a vaccine isn’t guaranteed, but immunity from having a disease and fighting it off lasts a lifetime. “I mean, I had chicken pox. I’m fine.”
She also believes that vaccines can weaken a child’s immune system. Her daughter received the pertussis booster when she was an infant, and Robin said her daughter has been sick way more often than her son ever was (he didn’t receive the whooping cough vaccine and didn’t get any boosters before the age of 2). Plus, she added, how is someone supposed to know if their child is going to have an allergic or adverse reaction to a vaccine until they get the shot?
Most of all, though, she said she tries to look at the whole picture, gathering together what’s she’s researched and experienced, to make an educated decision about which direction would be the most beneficial for her children. What she won’t do is vaccinate her children simply because she’s been “dealt the fear card.”
“You know, there’s always a risk,” she said, whether you get a vaccine or you don’t get a vaccine. “I’m not the kind of person that buys the party line; I need to do the research myself, and I need to know who’s funding the research.”
At the moment, her son is past due on the second round of boosters he needs for polio, diphtheria, and tetanus, which are recommended between the ages of 4 and 6. She said the last time her son went to the doctor for immunizations the nurse who gave him the shots accidentally gave him an extra dose. Robin left feeling like she couldn’t trust the doctor’s office, and she’s not sure her son will get vaccinated in the future.
“I’m not 100 percent sure that we will go down that road, but my husband wants to,” Robin said. “I want to do a little more research.”
Risky business
“Although vaccines are safe and effective, they are neither perfectly safe nor perfectly effective,” states a CDC publication about vaccine mandates. “Some persons who receive vaccines will have an adverse reaction, and some will not be protected. In developing vaccines, the challenge is to minimize the likelihood of adverse effect while maximizing the effectiveness.”
So what are the risks?
On the vaccine side: Sometimes people don’t build up the antibodies they should to a disease. People can be allergic to what’s in a vaccine and go into anaphylactic shock or develop more serious complications that include death. The U.S. Health and Human Services Administration has paid out more than $2.8 billion in almost 4,000 cases of injury or death connected to vaccines since 1988 through the National Vaccine Injury Compensation Program.
Between 2006 and 2013, more than 2.2 billion doses of vaccine were doled out in the United States. The compensation program is paid for through a 75-cent tax on every dose of a vaccine—so something like MMR would be taxed $2.25. The payouts were associated with a variety of vaccines.
On the non-vaccine side: Your child could get one of the vaccine-preventable diseases, which—and, of course, the effects depend on the disease—could lead to permanent injury or death.
“It’s kind of something that you have to look at and decide,” Robin said. “If you can’t handle your child getting chicken pox, then you should probably get your child vaccinated.”
But for health officials, some legislators, and most community members, it’s not about whether a parent can handle something. It’s not about the individual, but society as a whole. And it’s really all about the potential for permanent damage or death associated with these vaccine-preventable diseases and attempting to eradicate them from the face of the planet.
Between Jan. 1 and Feb. 13 of this year, 144 people in 17 states and Washington, D.C., were reported to have measles, according to CDC statistics. Approximately 80 percent of those cases are connected to an outbreak that started at Disneyland in late December. Dr. Takashi Wada, director of Santa Barbara County’s Public Health Department, said 20 percent of the current cases are ending up in the hospital.
“These can be potentially serious illnesses,” he said.
Measles symptoms appear within seven to 14 days of contracting the disease, and they typically begin with a high fever, cough, runny nose, and red watery eyes. Within two to three days, tiny white spots appear in the mouth, and three to seven days after symptoms begin a rash breaks out. Complications could include pneumonia, encephalitis (swelling of the brain), and/or ear infections that could result in permanent hearing loss. CDC stats state that about one or two children out of every 1,000 who get measles will die from it.
Between 1958 and 1962, an average of 503,000 measles cases were reported per year, with 432 associated deaths each year. The vaccine was licensed in 1963, and measles was officially labeled as “eradicated” on U.S. soil in 2000.
The measles cases reported in the United States since then were brought in from outside the country, from places without widespread immunization practices, most recently from the Philippines and Vietnam.
Measles isn’t the only vaccine-preventable disease that health officials say is making a comeback. Whooping cough is another one. Wada said there were more cases of whooping cough in California in 2014 than there have been in 70 years. In 2014, Santa Barbara County had 114 cases of the disease, and in January 2015, the county recorded its first death ever from whooping cough contracted by a 25-day-old infant.
Balancing the herd
California health officials blame recent outbreaks on holes in the state’s herd immunity, pockets of people in communities that choose not to vaccinate. The California Department of Public Health tracks immunization rates of children through the school system.
Immunization rates in Santa Barbara County vary. In North County, in the Santa Maria-Bonita School District and the Santa Maria Joint Union High School District, about 99 percent of the student population is up-to-date on required shots.
There are pockets in the county, in more affluent areas and in private schools, where the immunization rates aren’t so high. According to Dr. Lynn Fitzgibbons, the county’s deputy health officer: “Unfortunately, we also have schools with personal belief exemption rates where a quarter of the school has students that aren’t up to date on their vaccinations.”
She pointed to a recent small cluster of pertussis cases at the Waldorf School in Santa Barbara; it’s an example of a school with lower vaccination rates that was affected by a vaccine-preventable disease. With whooping cough, about 92 to 94 percent of a population should be vaccinated in order for a community to achieve “herd immunity.”
“It’s not just the threshold for herd immunity,” Fitzgibbons said. “It’s also how infectious these diseases are.”
For every one case of whooping cough, about 12 to 17 other cases could result. For every one case of measles, an average of 12 to 15 other people could be infected. For a little perspective: Every Ebola case has the potential to infect between one and three people.
“We know the germ that causes measles is much more infectious than many other common germs,” Fitzgibbons said.
So, how quickly a disease spreads is almost as important as how much of a population is protected. The vaccine for a disease, say measles, isn’t 100 percent effective; about 5 percent of the people who get the immunization don’t develop the antibodies they need to protect them from the disease.
She said between 20 and 25 percent of the cases in the current measles outbreak are known to be vaccinated. So the point of achieving “herd immunity” is to make up for not only the percent of people who can’t get vaccines for medical or physical reasons, but also the people who don’t build up the antibodies they need, Wada said.
“The vaccine isn’t just protecting that one child who gets it, but is also protecting the community,” Wada said “There are a lot of vaccines given to children, there’s no doubt about it. … But it’s much better than the alternative.”
For adults
There’s a lot of data out there detailing the immunization rates of children, but what about adults? Santa Barbara County’s Public Health Director Takashi Wada said it’s hard to track such information for adults, because it’s not a prerequisite for most jobs.
He added that a high percentage of the cases in the most recent measles outbreak are adults who were either unvaccinated, not up-to-date on their vaccines, or didn’t know their vaccine status.
There’s also a percentage of the vaccinated population whose bodies didn’t develop the antibodies needed to be immune to the disease. Add to that the propensity for certain vaccine-driven immunities to wear off over time—Wada said measles is generally a life-long immunity, but whooping cough (pertussis) does eventually wane—and adults have a sort of immunity conundrum on their hands.
So it’s hard to know if, as an adult, you have those antibodies you need for protection against vaccinepreventable diseases or if you’ve received the vaccines in the first place.
Wada said adults can get a blood test to check their antibody levels—and, to be on the safe side, get a vaccine booster.
Contact Managing Editor Camillia Lanham at clanham@santamariasun.com.
This article appears in Feb 26 – Mar 5, 2015.