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Uphill battle on vaccination education continues amid loud opposition

In Colorado, where it’s easy to opt out, vaccination rates are slowly rising after historic drop

Sundari Kraft is one of those crunchy granola moms.

She’s an urban homesteader in Denver growing organic food and raising goats and chickens in the backyard.

When it came to vaccinating her daughter, she thought she’d wait a few years after hearing tales from those who oppose vaccination.

“I kind of fell victim to the idea that where there’s smoke there might be fire,” she said.

But these days Kraft is helping lead the Vaccinate for Healthy Schools effort in Colorado to better inform parents about the truth on vaccinations. That’s the sort of turnaround that children’s health practitioners and others around the nation would like to see more of in a year when measles outbreaks hit several states and cases of whooping cough went up 24 percent in the first four months.

But it’s an uphill battle, with opponents ranging from those “crunchy granola” moms to anti-government activists. Ultimately, Colorado’s effort — originally similar to successful changes in Oregon and Washington — was watered down, as those from the left and right came together to oppose stricter opt-out requirements.

“There was already polarization on this issue politically,” said Dr. James Todd, director of epidemiology at Children’s Hospital in Denver. “It was sort of, damned be to science.”

Laws may vary

Colorado is one of 19 states that allow parents to opt out of vaccinations for “philosophical” reasons, and it’s one of the easiest states in which to do so. Parents need only sign a form saying they’ve opted out and submit it when their child enters kindergarten or day care.

In the 2012–13 school year, 4.3 percent of Colorado’s kindergartners were exempted from vaccines, most via nonmedical exemptions. But only 80 percent of kids ages 19 months to 35 months were up to date on their vaccines in 2012, Todd said.

That’s still a big improvement from 2002, when fewer than 60 percent of kids that age were fully vaccinated.

“In 2002, Colorado was ranked the worst in the country,” Todd said. “This sort of raised us out of complacency and caused action on a number of fronts.”

The state started collecting information through school surveys on vaccination, there were education campaigns, and the state improved public health programs for children. In 2005, the rate hit 80 percent. It dipped down to the mid-60s in 2009, then rose again starting in 2010.

Despite the improvements, episodes of whooping cough in the state erupt periodically.

“We see years in which we still have higher numbers of cases,” said Sophia Yager, immunization coordinator for Boulder County. “These past couple of years we’ve seen that in Boulder County, all over the state, across the country.”

Looking for a boost

In 2012 in Colorado, 414 children up to age 19 were hospitalized with whooping cough, the flu and other vaccine-preventable diseases, at a cost of $26.6 million. Five unvaccinated or partially vaccinated children died during the 2012–13 flu season, according to a report Todd co-authored.

That’s why Todd, Yager, Kraft and others testified in favor of requiring either a doctor’s signature or an online education video before parents could claim a personal-belief exemption from vaccinations. The measure also required public schools and state-certified day care centers to provide information about immunization rates of students in those institutions.

Oregon implemented a similar measure that took effect in March.

“In the past 10 or so years, our exemption rates have been increasing,” said Stacy de Assis Matthews, school law coordinator for Oregon’s immunization program.

Oregon’s rate of 6.4 percent of kindergartners opting out of vaccination was the highest in the nation in 2012–13, Matthews said. She hopes that will change this fall, as parents become familiar with new requirements and a series of videos required for parents who don’t have a doctor sign off on an exemption.

Todd said such programs make sense.

“Parents should be informed with what the state thinks is credible information,” he said. “Parents who do choose to vaccinate their children and send their children to a school or day care have a right to know what the vaccination rates are in that school or day care.”

When facts don’t factor in

But plenty of Colorado parents — and lawmakers — objected to requiring parents to get a physician’s signature or watch a video before opting out of vaccinations for their children.

Legislative hearings on the issue lasted hours as supporters and opponents debated. At one hearing, a mom characterized the effort as a move to “re-educate and scare me into compliance.”

Many opponents referred to harm that vaccines could cause.

“We still have about 10 percent of parents who read stuff on the Internet, which is false, but they believe it,” Todd said, mentioning the Jenny McCarthy impact.

That celebrity’s name is synonymous with objections to vaccines because of her conclusion that her son was autistic because of vaccination.

The study she cited was discredited and the doctor behind it had his license revoked. But that and other anti-vaccination tales have long lives on the Internet.

Anna Kata, a Canadian health researcher, examined the proliferation of websites offering disproven information about the harm that vaccination causes.

“There are credible websites and credible information, then there are the not-so-credible sites,” Kata said. “It’s hard for people to accurately determine credibility … With the Internet you can fall down the rabbit hole. All of a sudden you’re finding yourself in almost an echo chamber.”

That frustrates Todd and others who say it’s virtually impossible to sway the anti-vaccine crowd.

“If you take someone whose heart is set, giving them accurate data isn’t going to change their mind,” Todd said. “They believe the belief even more strongly. The people who are anti-vaccine people, you’re not going to convince them on what are clearly the facts.”

Those facts include only five children hospitalized for suspected adverse reactions to vaccines in Colorado in 2012, at a total cost of $88,274. None of them died, Todd said, and the numbers don’t compare to the 414 hospitalized because of vaccine-preventable illnesses.

“People overestimate really rare risks, and they underestimate really common ones,” said Sandra Bean, an Oregon doctoral candidate who has studied alternative care providers’ attitudes toward vaccines. “Babies die of pertussis.”

Short memories

Bean said another part of the resistance to vaccination in some quarters may be that there are now generations who don’t remember the severities of polio, measles and other diseases.

“The younger practitioners have not seen any instances of vaccine-preventable diseases, and neither have parents,” she said. “Because they don’t perceive it as serious, their perception of risk from the disease is not as high as their perception of risk from the vaccine.”

Even Bean had to persuade her grown son to get a flu shot last year, pointing out that if he got the flu he’d expose his children, who would then expose their classmates at school.

In Colorado and Oregon and elsewhere, success in improving vaccination rates may be incremental. The Colorado bill expected to be signed into law no longer includes more education for vaccine exemptions, and requires public schools and licensed day care centers to provide vaccination rates only upon request.

“It’s rather sad that the anti-vaccination people said, ‘No, we don’t want people to be fully informed before they make that decision,’” Todd said. “They convinced legislators that that was some sort of infringement.”

It’s that sort of information that convinced Kraft to get her daughter caught up on the vaccination schedule — and will keep her involved in trying to improve parent education.

“I began to realize that the anti-vaccine movement is not based on good science,” she said. “It’s based on fear-mongering … People who talk about two sides to it are not understanding how science works.”

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