Parts of the U.S. are seeing a drop-off in vaccination rates among young children. The falling rates don't necessarily track with poverty or other poor public health trends; in fact, a recent U.S. Centers for Disease Control and Prevention report flagged the poorest rates of kindergarten vaccination in relatively prosperous states, like Washington and Oregon.
Public health officials say they see this trend, which they call "vaccine hesitancy," often among well-to-do, educated parents. Private Waldorf schools, for instance, often have unusually high percentages of families who get exemptions from state vaccination requirements. In Seattle, exemptions are also high at some public schools, especially those with an alternative bent.
Jorge Gutman sends his child to Seattle's Thornton Creek Elementary, which last year reported a vaccine exemption rate of 18 percent. He says he's done a lot of reading about vaccines, and he doesn't like what he's learned.
"We have this medical-industrial complex that is pushing vaccination," Gutman says. "It's an enormous amount of vaccines. And I don't think it's justified."
From Shared Agreement To Individual Choice
Another parent at the school, Shawn Whatley, says he believes in vaccines and has his child get the full schedule of shots. But he shrugs off the presence of so many unvaccinated kids.
"Kind of exciting," Whatley laughs. "Our kids are part of the petri dish." He accepts that an alternative school is likely to have more unvaccinated children because families are here by choice.
And choice plays a big role in vaccine hesitancy, say public health experts. Parents today expect to weigh in on every health care decision involving their children, and that means picking and choosing vaccines.
Pediatrician David Grossman is medical director for preventive care at Group Health, a nonprofit health care system in Seattle. He recalls a time, not too long ago, when parents just accepted the full slate of vaccines, no questions asked.
"Everyone had this common assumption, this shared agreement that this is a public health good, that this is important for protecting not only my child, but also my neighbor's children and other children," Grossman says.
Not anymore. Now Grossman says parents often want to discuss every vaccine, just as they might discuss a surgery. Public health officials say this "vaccine optional" attitude is dangerous, not only for the unvaccinated kids, but also for people who have weak immune systems or can't be vaccinated for medical reasons.
Vaccine-preventable diseases are on the rise; Washington and California have seen outbreaks of whooping cough, with some fatal cases.
Hearing Out Concerned Parents
Some vaccine hesitancy is blamed on the 1998 British study that famously — and fraudulently — linked vaccines to autism.
But part of the problem may also be the ease with which some states grant vaccine exemptions. When parents are faced with a daunting immunization schedule, it's understandable that they might be tempted to go for the exemption and be done with it. So Washington state has changed its law; this school year, parents requesting exemptions have to get a note from a medical professional.
And Grossman wants to prepare pediatricians for the wave of parents who are now being forced to come in and talk about their vaccine fears. He's running a study that will equip local clinics with a "toolkit" of information about vaccines, and then compare their vaccination rates with those who aren't similarly equipped.
"I think the trick is really to listen," he says. Even if parents come in with debunked information that the doctor's heard before, he says, it's important to hear them out. "I think one of the most important reasons to listen is for parents to have felt like they've been heard," he says.
The study is funded in part by the Bill & Melinda Gates Foundation, which usually focuses on immunizations in the developing world. But officials there say this is a special grant, requested by Bill Gates' father, Seattle attorney Bill Gates Sr., who's concerned about the falling vaccination rates in his home state.
As a result, local doctors will be getting what amounts to cultural sensitivity training — in this case, sensitivity training for a First World culture of self-confident parents with easy access to the Internet.
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In some parts of the U.S., vaccination rates have been dropping. We're going to hear from Washington state, which has the lowest vaccination rate for kindergartners.
NPR's Martin Kaste reports on what public health experts call vaccine hesitancy.
(SOUNDBITE OF CHILDREN PLAYING)
MARTIN KASTE: It's back to school in northeast Seattle, a prosperous, well-educated neighborhood with below-average rates of child vaccination. Around here, it's not hard to find parents who are openly skeptical of vaccines - parents like Jorge Gutman.
JORGE GUTMAN: We have this medical-industrial complex that is pushing vaccination. It's an enormous amount of vaccines. And, you know, I don't think it's justified.
KASTE: At one private Waldorf school, almost half the families claimed a personal exemption to the state's vaccination requirements. And exemption rates are high at some public schools, too, especially those with an alternative bent. Thornton Creek Elementary, for instance, has an exemption rate of 18 percent.
SHAWN WHATLEY: It's kind of exciting. Our kids are part of the petri dish.
KASTE: Shawn Whatley is one of the majority of parents who still do the full immunization schedule, but he accepts unvaccinated kids as part of the territory at an alternative school.
WHATLEY: You come here by choice, not by force. And we tend to attract people that might think twice about vaccines for a whole variety of reasons.
KASTE: Choice is what this really all about. Parents today expect to have choices, and that includes picking and choosing which vaccines to get.
Pediatrician David Grossman, of the Group Health Research Institute in Seattle, says this choosiness is a new phenomenon. Parents used to just accept vaccines.
Dr. DAVID GROSSMAN: Everyone had this common assumption, a shared agreement, that this is a public health good, that this is important for protecting not only my child but also my neighbor's children and other children, and that we're all in this together. That assumption can no longer be assumed.
KASTE: Public health officials say this vaccine-optional attitude is dangerous - not only to the unvaccinated kids but also to people who have weak immune systems or can't be vaccinated for medical reasons. Vaccine-preventable diseases are on the rise. Washington and California have seen outbreaks of whooping cough.
(SOUNDBITE OF A CHILD COUGHING)
KASTE: This outreach video by Group Health shows a small boy doubled over, gasping for breath.
(SOUNDBITE OF A GROUP HEALTH VIDEO)
UNIDENTIFIED WOMAN: They have a spasm, and they can't stop. They cough, cough, cough; turn blue. And it can go on and on and on and on.
KASTE: Some vaccine hesitancy is blamed on the 1998 British study that famously, and fraudulently, linked vaccines to autism. But part of the problem may also be the ease with which some states, like Washington, have granted vaccine exemptions. When faced with a daunting immunization schedule, it's understandable that parents might just go for the exemption and be done with it.
So Washington state has now changed its law. This school year, parents requesting exemptions will have to get a note from a doctor, a doctor like David Grossman.
GROSSMAN: And I think the trick is really, to listen.
KASTE: So Grossman is researching how doctors should best handle parents and their vaccine fears. His study is partly funded by the Gates Foundation, which usually focuses on Third World immunization. But it turns out that even in First World Seattle, vaccination efforts require a degree of cultural sensitivity; in this case, for the local culture of self-confident parents with Internet access.
GROSSMAN: I think one of the most important reasons to listen is for parents - felt like they've been heard.
KASTE: Washington's schools are still processing this year's records. Once the numbers are crunched, public-health officials will know whether those doctors' office chats have had an effect.
Martin Kaste, NPR News, Seattle. Transcript provided by NPR, Copyright NPR.