Measles outbreak sparks call to limit vaccination exemptions

Histopathology of measles
A histopathology of measles pneumonia is seen in a microscope image from the Centers for Disease Control and Prevention.
Getty Images via CDC 1972

Riding a wave of public anger over the nationwide measles outbreak, vaccine supporters are calling on state lawmakers to tighten or eliminate an exemption to Minnesota's vaccination rules.

Minnesota is one of 20 states that allow parents to opt out of vaccinations for their children, if they object to vaccines based on personal beliefs. Parents can do so by providing a notarized statement to their child's school in which they say the state's vaccination requirements are contrary to their "conscien­tiously held beliefs." Vaccine advocates say the philosophical exemption is overused and has made Minnesotans needlessly vulnerable to measles. A bill in the Legislature this session authored by state Rep. Mike Freiberg, DFL-Golden Valley, would require parents to consult with a medical professional before they could claim that exemption.

During the 2013-2014 Minnesota school year, 2.8 percent of kindergarten parents claimed the philosophical exemption for the measles vaccine. A decade ago, fewer than one percent of kindergarten parents used it.

"We actually suffer from this liberal exemption rule," said Dr. Robert Jacobson, a pediatrician at Mayo Clinic. "We could be doing better with our vaccination rates."

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According to state data, 93.5 percent of Minnesota's kindergarteners had received their required measles vaccinations in the 2013-2014 school year. That's considered a fairly good vaccination rate.

Jacobson and his organization are backing Freiberg's bill. He believes doctors could win over at least some anti-vaccine parents.

"To claim you have a philosophical basis for being against a vaccine really doesn't make sense," Jacobson said. "Vaccines work or not work not based on belief, not based on faith, but based on science."

Measles vaccine
In this photo illustration, a bottle containing a measles vaccine is seen at the Miami Children's Hospital on Jan. 28, 2015.
Joe Raedle / Getty Images

In the current debate over measles, no one has questioned the need for medical exemptions for immunizations. All 50 states allow them to be used in cases where children are allergic to vaccine ingredients or are unable to be vaccinated due to medical conditions.

Plenty of parents have doubts about vaccines. But some have changed their minds after researching claims that vaccines are not safe.

Among those is Ashley Shelby, of Hopkins, Minnesota.

When her children were born in 2007 and 2009 she was hesitant to immunize them. Other moms she knew had only negative things to say about vaccinations. And any time she tried to reassure herself by researching the topic online, her anxiety increased.

"I had a lot of questions and I was feeling swayed by the information that I found on the Internet," said Shelby, who blogs on the Moms Who Vax website.

But when the former freelance journalist applied more scrutiny to the vaccine safety claims, she started seeing flaws in the arguments. The idea that doctors, researchers and pharmaceutical companies were engaged in a profit-driven conspiracy to hide the dangers of vaccines didn't make sense to her.

Ultimately, Shelby concluded that much of what she had been reading online was inaccurate and false.

"I kind of got mad because I thought, you know, I could have put my children and other children at risk for absolutely no reason," she said.

Shelby started her pro-vaccine blog "Moms Who Vax" in 2011, about the time Minnesota was trying to contain a measles outbreak that spread among unvaccinated children in the Somali community in the Twin Cities.

While Shelby can relate to the worries of anti-vaccine parents, she also wants Minnesota to stop making it so easy for them to use the state's philosophical exemption.

That increasingly vocal pro-vaccine sentiment worries Wayne Rohde, co-founder of the Vaccine Safety Council of Minnesota. The group warns vaccines are not risk-free and therefore should not be required.

"Parents are in the best position to make the right decisions and not the government," he said.

Rohde said his 17-year-old son Nick had a severe reaction to the measles, mumps and rubella vaccine when he was 13 months old. Within 24 hours of receiving the vaccine, he said, Nick got a high fever and started screaming and arching his back. Rohde said his son was severely ill for two months. Nick's twin brother Austin, who received his MMR shot the same day, did not have any reaction.

Rohde said he's not claiming that the vaccine caused his son's autism, which was diagnosed later. But he does believe the vaccine overwhelmed his son's immune system and put him on a downward spiral.

"I don't believe that the vaccines are as good as they're being proposed," he said. "Parents are figuring that out and they're saying 'No.'"

Researchers say there is no evidence that the MMR vaccine impairs the immune system. Claims by a British doctor that the vaccine was linked to autism have also been debunked. The British medical journal that published Dr. Andrew Wakefield's 1998 study later retracted it and British medical authorities took away Wakefield medical license.

As with any vaccine, some people can have an adverse reaction to the shot. But the doctors at the Centers for Disease Control say severe reactions from the MMR vaccine are so rare — less than one of 1 million doses — that it is hard to tell whether they are even caused by the vaccine.

Terri Johnson, a former nurse and board member of Rohde's group, wonders that if the MMR vaccine hasn't injured anyone, why has the federal government paid victim claims through its National Vaccine Injury Compensation Program.

"The government programs themselves have established that children have been harmed by vaccines," Johnson said.

Dr. Mark Schleiss director of the Division of Infectious Diseases and Immunology at the University of Minnesota Medical School, said the federal Vaccine Adverse Event Reporting System should not be used to determine cause and effect. The database, he said, only flags possible adverse events related to vaccines.

"Show me the money, that's where the proof is, right? You know, if somebody paid, then it must have been the vaccine," Schleiss said the common claim goes. "I don't agree with that assessment."

Schleiss said compensation fund may pay claims when a timeline aligns with a vaccine reaction. But he said that also doesn't mean the vaccine caused it. It may be hard for non-scientists to understand the reporting system's nuances, but Schleiss said no one should interpret the data as a reason to fear the MMR vaccine.

"[The correlation of an adverse event] has to be balanced against the overwhelming positive benefits of vaccination not only for all of us in society, but for your own child," he said.

CDC officials say measles kills one to two children per 1,000 cases of the disease. Some children with measles lose their hearing. They can also develop brain swelling.

All babies are vulnerable to measles because they can't receive the measles vaccine until they are at least a year old. It wouldn't provide adequate protection to them prior to that age.

In Minnesota, 65,000 to 70,000 new babies are born every year.

Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said he believes in individual choice, but not when it comes to measles.

"There are sometimes when you can't just decide whether you want to obey a stop sign," Osterholm said. "You can't decide whether or not you're going to drive on the wrong side of the road. I don't think you can decide whether or not you're going to allow the community to be at risk because you won't vaccinate your children."

Jacobson, the Mayo Clinic pediatrician, said it would be ideal to ditch the state's philosophical exemption altogether, but he's worried that approach could backfire.

In 2013, anti-vaccine groups resisted attempts to update Minnesota vaccine requirements — to the point where Jacobson said some physicians were worried that they might face competing legislation that could mandate how they talk about vaccines.

"People were protesting saying they should be told of things or that physicians should make certain statements when providing recommendations about vaccine that were not science based," Jacobson said. "And with that pushback I think comes a nervousness that we should take this step-by-step rather than going all to one extreme, with the fear that the extremists on the other side might take us the other direction."

Shelby, the blogger who once doubted vaccines, also supports a go-slow approach in Minnesota.

"I have found that the vast majority of the people who don't vaccinate or don't vaccinate on time are not hardened anti-vaxers," she said. "They're actually vaccine hesitant like I was. They have questions. Those questions have not been answered adequately, or the information that they read on the Internet has dominated their decision-making process. And I think they're reachable."