Vaccines: Not optional


We Vineyarders pride ourselves on our strong sense of community. It’s both a bulwark against our Island’s relative isolation and an antidote to the more urbanized lives many of us have left behind. We are mostly self-selecting immigrants choosing a high-octane but still small-town life, and our frequent remove from family, from off-Island friends, and from the broader resources off-Island can give us particular pleasure in acts of caring for and thinking about one another.

We extend our definition of caring to include a healthy respect for differing worldviews among neighbors. We may think others are careless thinkers, out of step, flat-earthers, or just plain wrong on the issues, but we comfortably coexist. Our genteelly bohemian tent is big, it’s welcoming, it’s respectful, and it’s ultimately enriching. So it’s an unwritten rule of Island life that we give a wide berth to ideas and opinions we may find disagreeable or uninformed.

We make a serious mistake, though, when our predisposition to tolerance causes us to turn our backs on settled science and state law regarding infectious disease immunization, and grant intellectual and moral equivalence to junk science.

The current national resurgence of measles demonstrates the consequence of this disregard. Measles all but disappeared in the U.S. 15 years ago because universal inoculation with the highly effective MMR (measles/mumps/rubella) vaccine meant that only rarely would someone become infected, and thus able to carry and transmit the disease. Absent near-universal participation, though, the entire prevention model will fail, and the risk of infection will pass from the few opting out to all of us, especially infants, the elderly, and those unable to receive inoculations such as pregnant women, and the immune system–depressed such as cancer patients.

The current reemergence of measles isn’t the result of diminished vaccine effectiveness, or a breakdown of compliance within less-advantaged communities. It is largely self-inflicted, a result of faddish, flawed thinking, often clustered in high social-status zip codes and neighborhoods. Jump-started by a single fraudulent research publication conjuring up a false link to autism, and fueled by Internet and talk-show hysterics, and the wish that somehow, healthy food choices and natural approaches to general health can ward off infectious disease epidemics, inoculation rates have fallen precipitously in many places, and the public health structure we depend on is at great risk.

If all this seems remote, it shouldn’t. Martha’s Vineyard parents seek and receive exemptions from Massachusetts law requiring vaccinations (including the MMR vaccine) against 14 communicable diseases as a condition of enrollment for children in public schools at an astonishingly high rate — at 9%, it’s six times the state average for students entering kindergarten, as reported in a Times story written by Nathaniel Horwitz (“Martha’s Vineyard students lag in required vaccinations,” April 16, 2014).

And while it’s true, as Horwitz wrote, that “an exemption does not necessarily mean a student has no immunization,” our very high rate of exemption allows the pool of those free to have their children forego regular immunization to be that much larger. Statistics — gathered in October of 2013, which remain about the same — bear out the consequence: Martha’s Vineyard schools reported children without immunization at a rate of 2%, two-and-one-half times greater than the national average. Up-Island, the extent of nonimmunization is much greater — 4% in West Tisbury, and 16% in Chilmark.

Nationally, all states allow medical exemption with clear and strict standards. All but two also allow exemption on religious grounds, with varying degrees of associated documentation. And some, but not Massachusetts, also allow exemptions on philosophical grounds.

At the heart of our noncompliance is the use of religious grounds as an umbrella for anti-vaccine sentiment, and our tolerance for granting unchecked and unquestioned exemptions, however unwittingly such tolerance harms the rest of us. On the Vineyard, parents can submit affidavits asserting their religious privilege, and as Dr. James Weiss, superintendent of schools, recently told The Times’ Janet Hefler, “We don’t question exemptions requested on religious grounds. I don’t feel it’s my place to.” Acknowledging the low rates of immunization we experience, Dr. Weiss said, “We really can’t force [parents] to inoculate their children if they’ve claimed a religious exemption.”

We understand Dr. Weiss’s reluctance to press this challenge to parental choice, but we disagree; many avenues to increased compliance could be and need to be employed. As Dr. Weiss points out, school nurses have been diligently trying to spread the message, but more public discussion is needed. And tougher enforcement of the religious-exemption procedure is also needed.

An interesting illustration of what can be done is found in two unlikely states: Mississippi, with no provision for religious exemption and a strict policy for medical exemption (only 17 students exempted statewide, compared with 12 on Martha’s Vineyard) has achieved inoculation compliance exceeding 99%. And the 191 religious exemptions granted by Vineyard schools should be compared with 468 religious and philosophical exemptions reported by the CDC for all of Alabama.

Public health is a fundamental component of a safe community, and participating in inoculation against dangerous communicable disease is one of the fundamental agreements we accept as part of living respectfully among our neighbors. However earnest and understandable the impulse to protect our children against any theoretical risk, in the end the facts are otherwise. School administrators have to do their job, and the community needs to make sure they get all the support they need.