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The number of students with exemptions is more than six times the state average and puts the community at risk, health experts say.

This graph provides a comparison of Martha's Vineyard immunization exemption rates by school with the state average.The state average for students with exemptions entering kindergarten this year was 1.5 percent, according to a 2013 state report. — Graph by Nathaniel Horwitz

Martha’s Vineyard school children lag well behind state and national vaccination rates, according to Massachusetts Department of Public Health (DPH) figures. The failure of Island parents to vaccinate their children against a list of communicable diseases puts their children and the community at risk, state and federal public health experts said.

Recent publicized outbreaks of mumps, measles, and whooping cough across the country underscore the importance of vaccinations, medical experts said.

Children are required by state law to be vaccinated against 14 communicable diseases in order to attend public school. The law allows only for a medical or religious exemption from the vaccination requirement. Philosophical exemptions are not allowed.

The majority of Island parents who have failed to vaccinate their children claim a religious exemption. In conversations with The Times, school nurses and Island physicians said parents are claiming religious exemptions to mask their philosophical opposition to vaccinations.

Above average

“There aren’t many medical exemptions in our state, less than 1 percent,” DPH director of epidemiology and immunization Dr. Larry Madoff said in a phone conversation with The Times. “All of the others, the majority, are religious exemptions. These are the only exemptions allowed in Massachusetts.”

A religious exemption is allowed, the law states: “If a parent or guardian submits a written statement that immunizations conflict with their sincere religious beliefs.”

Martha’s Vineyard has six times the the state average and five times the national average of students exempted from required vaccinations. The majority of those are based on religious exemptions, according to data provided by Island school officials.

The state average for students with exemptions entering kindergarten this year was 1.5 percent, according to a 2013 report by the DPH.

According to the report, in the Cape Cod counties of Dukes, Barnstable, and Nantucket County (the report did not provide separate data for each county), the rate of exempted kindergarteners was 4.5 percent.

Data collected by The Times from the seven Island schools reveals the rate of exempted students is 9 percent on Martha’s Vineyard.

An exemption does not necessarily mean a student has no immunization, health officials said. Often, children with exemptions are missing only one or two vaccinations.

However, the rate of children with no immunization whatsoever, 2 percent on Martha’s Vineyard, is almost triple the national average of 0.78 percent.

Immunization school data

School nurses are responsible for compiling vaccination data. The following chart, compiled from data provided to The Times by school nurses, reveals that the Chilmark School, Martha’s Vineyard Public Charter School, and West Tisbury School have the highest number of students exempt from vaccinations.

School by school comparison.
School by school comparison.

*School population is based on the official October 1 census provided by the superintendent’s office (the number for the Charter School was provided by the school nurse). Attendance may vary slightly throughout the year.

^Tisbury school has 23 students with religious exemptions, 1 student with a medical exemption, and 1 student with both.

Herd health

“Vaccinating children according to the recommended schedule is one of the best ways to protect them from 14 harmful and potentially deadly diseases before their second birthday,” Centers for Disease Control and Prevention (CDC) spokesman Jason McDonald said in a conversation with The Times. “If enough children do not get immunized, it can break down ‘herd’ immunity and pose a danger to kids who are either too young to get vaccinated or unable to get vaccinated against the diseases, such as people who are immunosuppressed or are taking immunosuppressants for cancer treatment, as well as those people for whom the vaccine did not provide immunity, because unfortunately vaccines are not 100 percent effective.”

According to the CDC, there are currently outbreaks of measles in New York City, mumps at Ohio State University, and meningitis in Princeton, New Jersey, as well as several thousand cases of whooping cough (pertussis) nationwide. These reports come amid growing concern that falling immunization rates nationwide are leaving communities susceptible to potentially fatal diseases like polio that had been almost completely eradicated after the introduction of vaccinations, and are now returning.

“Immunizations are the most important medical advance in history,” Dr. Madoff said. “I can’t overstate how important they are. When a child isn’t vaccinated, they’re individually at risk, but they also put their community at risk. Even the best vaccination doesn’t cover everyone, so we need everyone to be vaccinated to stop infectious diseases from coming into contact with susceptible people.”

Dr. Madoff said pockets of exemptions heighten the risks. “For measles you need about 95 percent of the population to be vaccinated to prevent an outbreak,” he said. “Polio is less contagious, somewhere around 85 percent, and mumps is in the middle. Even then, however, the county rate, or the town rate, might be lower or higher in a small community. These are very serious diseases. Pertussis, whooping cough, requires around 95 percent. For babies, who may not have immunity, there’s a significant risk of death.”

He urged parents to think carefully about exposing their children to vaccine-preventable diseases. “There’s a lot of concerns and parents are sincerely worried about vaccinating their children,” he said. “I would urge them to compare the theoretical risk of vaccination with the very real dangers of these diseases,” he said.

He cited concerns about brain damage resulting from pertussis to illustrate his point, saying that the actual occurrence was statistically insignificant at 1 case in 1 million doses. “Anyone who is thinking logically, in the best interest of their children, should vaccinate them,” he said. “The benefits so far outweigh the risks.”

According to the CDC, serious side effects from vaccines are rare. The National Vaccine Injury Compensation Program, a branch of the United States DPH’s Health Resources and Services Administration (HRSA), established to compensate the families of children who have experienced damaging side effects from vaccines, has received a total of 15,100 claims since it was founded in 1988. Of those, 3,540 claims were deemed compensable, and the program has awarded a total of almost $2.7 billion in damages to claimants over the past 26 years.

Island at risk

Island doctors said that parents who chose not to vaccinate their children create a pathway for infection that leads beyond their doorstep.

Dr. Melanie Miller of Vineyard Pediatrics says that the Island is at risk. “We don’t have herd immunity on the Island for certain diseases, most importantly for measles,” she said. “We eliminate diseases by vaccinating. No one has to get the smallpox vaccine anymore because we got rid of that disease. Vaccines did that.”

Dr. Miller questioned the number of people claiming an exemption. “It’s not their religion telling them not to vaccinate their kids, maybe it’s the Internet,” she said. “Most people don’t have a religious belief against vaccinating. They think it’s dangerous for their kids or a conspiracy between the government and pharmaceutical companies. There’s no evidence that they have a religious opposition.”

Dr. Miller said vaccine-preventable illnesses were once rampant. She said people have become complacent. “In the late 1980s, I saw a lot of measles,” she said. “I saw an 18-year-old die of measles.”

Longtime Island pediatrician Michael Goldfein of Vineyard Pediatrics is concerned by the high number of unvaccinated students. “Measles is extremely contagious,” he said in an interview with the Times. “If there were someone at the Chilmark school with measles, most of the unimmunized students would contract it very quickly. It’s disturbing, especially when measles is as close as New York City. People have become very cavalier, because so many people are immunized and you don’t often see these diseases anymore.”

Dr. Goldfein has little patience for parents who he said use the religious exemption to shield their philosophical views and skirt state law.

“It’s very irresponsible, parents taking advantage of everyone who has accepted the small risk for the health of the community. We’re talking about totally preventable diseases with a minimal risk. Why would you subject your kid to one of these diseases? It’s a disaster waiting to happen. Vaccinating your kids is a no-brainer.”

Dr. Goldfein said Christian Scientists are the only major religion with a legitimate excuse. “But these people who just put a religious exemption on a form have to play the religious card because philosophical exemptions aren’t accepted in Massachusetts,” he said. “All of the kids on the Island who are partially vaccinated or not vaccinated are probably playing that card.”

He blamed the problem on Island culture. “The kind of people who are attracted to living in a place like this, we have some counter-culture people,” he said. “There’s conspiracy theories, a lot of people are really paranoid, they think that there’s a plot between pharmaceutical companies and the government. But reactions to vaccines are very, very rare.”

He cited a discredited study in 1998 that linked vaccination to autism. “A lot of the paranoia results from a falsified study in Great Britain,” he said. “There’s no link between immunization and autism.”

Dr. Goldfein said the current system does not require a parent or guardian to specify their religious exemption. “The schools turn a blind eye,” he said. “If there’s some gumption you can challenge their religious exemption.”

Schools respond

Superintendent of Martha’s Vineyard Public Schools (MVPS) Jim Weiss said school officials are limited in their ability to test a parent’s religious convictions. Mr. Weiss said he was concerned by the number of religious exemptions, but disagreed with Dr. Goldfein’s assessment that the schools turn a blind eye.

“I would like to see all of our kids immunized,” he said. “But if a parent says they have a religious objection there’s not much I can do. I can’t question their religion. Are there some people who are untruthful? Probably.”

Martha’s Vineyard Regional High School nurse Linda Leonard said that parental dishonesty was unacceptable. “If a parent is saying, ‘no, my exemption is philosophical not religious,’ I would have to exclude their child from school,” she told The Times. “It’s the law.”

Ms. Leonard added, “As a nurse, I can’t question a parent’s religious exemption, but why wouldn’t you give your child a vaccine that prevents diseases?”

Parental concerns

School immunization statistics concern Eric Glasgow, owner of Gray Barn Farm and father of two children in the Chilmark school. “It’s a very real danger that so many parents choose not to immunize,” he said in an interview with the Times. “People don’t understand how serious these diseases can be, that not immunizing can have profound repercussions. It’s understandable that you might choose not to give your kid three vaccines at once, but having susceptibility to polio or whooping cough is crazy. These are terrible diseases, and if they get a foothold, it’s not only you who’s being affected.”

A West Tisbury mother, who agreed to speak candidly on condition she not be identified because her child is enrolled in an Island elementary school, said she claimed a religious exemption because philosophical exemptions are not allowed in Massachusetts, something she thinks needs to be changed.

“There is no freedom that is more fundamental than the human right to decide what risks we take with our children,” she said in a conversation with The Times. “It’s a difficult decision for some people. It wasn’t for me. After I weighed the pros and cons and gathered information from both sides I made an informed choice.”

The mother believes there are a host of risks associated with immunizations, including autism.

“The statistics are out there,” she said. “There’s no hiding them. People have had many accidents with vaccines. Plus, if you look at what an immunization is made of, it’s like, here you’re trying to feed your children healthy, and you wouldn’t feed them formaldehyde or aluminum phosphate or acetone, or cow pox pus or rabid brain tissue, which you inject into your kids.”

She said her daughter has never been really sick. “She’s only gone to the doctor for school physicals, what was required or suggested, in part because her health wasn’t assaulted from the moment she was born, and therefore she has less illness to deal with now,” she said.

“When you go into a doctor’s office, and you get a pamphlet on vaccinations, you’re led to believe that first of all you don’t have a choice, and that it’s in the absolute best interest of your kid. They don’t talk about how the pertussis vaccine creates brain damage.”

Asked if she would immunize her daughter under the threat of school exclusion, the mother said she would not. “The basic choices are either home school, or join an organized religion for that reason,” she said. “I don’t make fear-based decisions or comply with that kind of pressure.”