Missoula health officials argue that Montana’s weak economy might be partly to blame. Parents overwhelmed by multiple jobs or the stress of unemployment can forget to bring their children in for their shots, according to Vicki Dundas, Nursing Supervisor for the Missoula County Health Department. “Sometimes immunizations are the last thing on their mind,” said Dundas. Parents can also delay immunizations because of a lack of insurance or limited coverage.
However, a smaller number of Montana parents make a deliberate choice not to vaccinate. They are not alone: over one-quarter of Americans question the need for vaccinations, according to one children’s health magazine. A national debate has emerged over the safety of vaccines, and our own sparsely populated state is not immune.
As the number of unvaccinated children grows, industrialized countries are now facing the possibility of outbreaks of preventable diseases. Great Britain and Japan have both issued warnings of possible measles epidemics this winter due to low vaccination rates, and in Boulder, Colo., so many children are unvaccinated that pertussis (whooping cough) has once again become a widespread childhood illness.
The reasoning behind parents’ anti-vaccination choices is complex. Some have witnessed adverse reactions in their own or friends’ children. Heather, who lives outside of Missoula with her three children, ages 7, 4, and 14-months-old, had concerns when her oldest son became sick after his first round of shots. “I wanted to learn exactly why I was doing this to my child,” she said. She started reading, and eventually decided not to immunize her two youngest children.
She argues that contracting the disease is the best immunity for children in good health. Other anti-vaccination advocates agree. Jill (her name has been changed) purposefully exposed her three children in Missoula, ranging in age from 16 to 5, to the measles virus. She was vigilant about keeping the children home when they were contagious.
Heather also would prefer her children contract measles while they are young. “The only way to get 100 percent immunity is to get the disease. Measles for healthy children is not a big deal,” she said. Public health officials disagree. “Success has created complacency,” according to Brante Goode, Coordinator of the Missoula County Health Department Communicable Diseases Program. Because of vaccines, most people haven’t seen these diseases in their lifetime, and few people understand the risks, he said. “It might be useful for people to talk to their grandparents about measles,” Goode said. Before the 1960s, about 500 Americans died each year from the virus.
The choice to not immunize doesn’t affect just individual families. High vaccination rates protect unvaccinated children as well; when this “herd immunity” breaks down, epidemics can result. Infants and children with compromised immune systems are at the highest risk from an outbreak. “Our culture focuses on individual rights, but public health is often at odds with that,” said Goode.
Currently, Montana state law regarding vaccinations is stricter than in many states. Parents must obtain a medical or religious exemption for K-12 students or a medical exemption only for preschoolers. Less than one percent of school-age children in Montana receive a religious exemption, according to Joyce Burgett, Director of the Montana Immunization Program.
Both Heather and Jill were able to obtain religious exemptions from school for their children. A signature from a church official was not required.
In the meantime, drug companies manufacturing vaccines have addressed many of the concerns and issues raised by anxious parents. In 1996, the pertussis vaccine shifted from DTP to a new acellular version, DTaP, after finding that some children experienced adverse reactions to the original vaccine. The new version claims significantly reduced side effects.
Health officials have also started using an inactive polio vaccine instead of the live version, which had caused some children to contract the polio virus.
The best-known controversy involved Thimerosal, a mercury-containing preservative used in vaccines, which many anti-vaccination activists blame for rising rates of autism. The link between vaccines and autism has never been scientifically established, but over the last three years, Thimerosal has largely been phased out of use in vaccines.
Both Heather and Jill acknowledge improvements, and both intend to get the tetanus vaccine for their children. Heather is also considering getting the mumps shot for her son. Mumps can cause sterility in boys who contract the disease; tetanus kills 270,000 infants each year worldwide.
Both mothers also recognize the limitations and risks of not vaccinating. “Parents need to understand their children could die from these diseases,” said Heather. “Who are they going to blame then? I know people who aren’t vaccinating because it’s ‘cool.’ That’s not cool. You have to know all the dangers, and where the diseases are.”
But they remain skeptical about the number of shots young children receive. “In nature we would not get all those illnesses at once,” Jill said. “Our ‘fast food, one-size-fits-all’ medical system insists on all of them for 14-month-olds.”
However, vaccination advocates point out that the current array of shots contains fewer antigens than the single smallpox vaccine did in the 1940s. “The safety has improved greatly in the last 10 years. We see few ill effects,” said Dundas.
So are these parents sensible—or just selfish? It can be unclear whether newborns need this alphabet soup of shots or whether the drug companies are just trying to move merchandise. Regardless of which side of the immunization fence one resides on, all sides agree that the decision is motivated by parents’ concern for their very young children.
“It’s good and natural that parents know as much as possible about vaccinations,” said county nursing supervisor Dundas. “It shows they care about their kids.”
In her opinion, however, the benefits outweigh the potential risks. “What if your child decides to travel? Or someone comes to town with the disease? We don’t live in a bubble here. Meanwhile, they’re at risk.”
In Goode’s view, the issue comes down to protecting the health of the community. “The right to choose a religious exemption is fair, but they pose a risk to children who cannot be vaccinated for medical reasons…and you could very well have those two children in the same classroom.”