Some years back, Ravalli County's longtime public health director, registered nurse Judy Griffin, posted a display in the hallway of her clinic. Under the banner "Remember These?" were images of childhood diseases that largely had been vanquished with vaccines: young faces distorted by mumps and aflame with measles and chicken pox, children with the crooked legs of polio, children wracked by the whooping cough of pertussis.
Not a lot of people do remember these diseases. Few young parents today had measles or mumps as children. Thanks to the development of the Salk and Sabin vaccines, few Americans born after the mid-1950s have experienced the horror of polio. Having largely forgotten "these" is one of the reasons Griffin cites for parents' refusal to vaccinate their children. It's also one reason why Ravalli County's vaccination rate is so low.
Griffin worries that Ravalli parents, grandparents and children will soon reacquaint themselves with one of the old scourges, pertussis. She's launched a public information campaign to convince people to overcome their skepticism about vaccines and immunize themselves and their children against this highly infectious bacterial infection, known by its more common name, whooping cough.
Pertussis causes violent, uncontrollable coughing and can last as long as six weeks. It can affect anyone of any age but is especially dangerous in babies, who have a higher risk of death from the disease than adults. Prior to the availability of a vaccine in the 1940s, pertussis was one of the most common childhood diseases and was a major cause of childhood mortality. Complications range from a runny nose and mild fever to pneumonia, convulsions and death.
Gallatin County recently experienced an outbreak of pertussis. With the student traffic between Bozeman and the Bitterroot, Griffin says it's only a matter of time before pertussis shows up in Ravalli County, even as she's battling a growing skepticism about vaccines.
According to the Montana Department of Health and Human Services, only 53.8 percent of children in Ravalli County ages 24 to 35 months are up to date with their immunizations. That compares to the national average of 76 percent and the statewide average of 66 percent, though that last figure is not precisely comparable since it includes children ages 19 to 35 months.
Parents cite religious reasons for not vaccinating their children, as well as skepticism of government, reluctance to submit their babies to the temporary pain of a needle and the discredited theory that ties vaccines to autism.
Other factors also come into play. It wasn't that long ago that anyone could walk into Ravalli County public health and easily obtain a vaccination, insured or not. Not so today, Griffin says. "Insurance has gotten complicated and it's a barrier. It's a big barrier."
On top of that are the big names that command a big stage and have used that stage to denounce childhood immunizations. "Oh boy, I'm glad you brought that up," says Griffin, animated now and warming to her subject.
She mentions presidential candidate and congresswoman Michele Bachmann, the Republican from Minnesota who, during a presidential debate in Tampa, Fla. last September, linked the HPV vaccine, which prevents cervical cancer in women and girls, to mental retardation. Bachmann's assertion is not supported by any evidence, but it does get attention.
No one gets under Griffin's skin, however, like comedian Jim Carrey and his former lover, actress Jenny McCarthy—both of whom, Griffin believes, exploited their own celebrity status to link childhood immunizations to autism; in particular, to McCarthy's son's autism. That such a link was discredited years ago makes no difference to some parents, Griffin says. Even though there is no evidence tying vaccines to autism, the connection still exists in the collective public imagination and is still embraced by some.
"Those two people have done more to harm immunization programs," she says of Carrey and McCarthy. "They've been preaching up and down how bad immunizations are. And people look at them–Jim Carrey and Jenny McCarthy!–like they're preaching the gospel."
Still, the worst offender, as far as Griffin is concerned, is the internet, where all information resides, good, bad or stupid. "Anything you want to know, you're going to find on the internet," she says.
Meanwhile, Ravalli County's unvaccinated citizens could damage public health by compromising community immunity. When a significant percentage of the population is vaccinated against infectious disease, most members are protected against the disease because the opportunity for an outbreak is reduced. Even people ineligible for vaccines–pregnant women, infants, immune-compromised individuals–are protected by their immunized neighbors.
Ravalli County's public health officer, Dr. Carol Calderwood, says different diseases require different vaccination rates to provide community immunity. For a community to be protected from measles, for instance, requires a community-wide vaccination rate of more than 80 percent. Pertussis, a highly infectious disease, has a 90 percent vaccination-rate threshold. That threshold is unlikely to be met, and it's why public health officials respond aggressively to stop an outbreak of pertussis before it reaches epidemic proportions.
The Centers for Disease Control and Prevention lists vaccines as one of the top 10 public health achievements of the 20th century. They may be a victim of their own success.
"It is almost unimaginable that anyone would fail to recognize the critical importance of vaccinations in our nation's history," says Dr. Marshall Bloom, Associate Director of Science Management at Rocky Mountain Laboratories, in Hamilton. "Vaccines may be taken for granted today. They have been so effective that people may have forgotten about serious outbreaks of polio, measles, chicken pox and German measles that terrified prior generations. As a medical student around 1970, I saw some of these cases and they are truly horrible."
Despite Ravalli County's ambivalence about childhood vaccinations, adult patients of public health have responded favorably to Griffin's pertussis campaign.
"It really is interesting," she says. Adults will vaccinate themselves against this latest public health threat, but still look askance at vaccinating their kids. "We find that to be really strange."