Public health experts have recently likened pockets of Wisconsin with high rates of unvaccinated children to cans of gasoline waiting for someone to drop a match.
It’s a dramatic analogy, but an appropriate one. Some parts of the state are outbreaks waiting to happen.
The measles virus is spreading throughout the United States at a rate not seen since 1994, with outbreaks in the states of Washington and New York leading Wisconsin officials to look at the state’s own levels of preparedness. Gov. Tony Evers has said he would sign a bill restricting parents’ ability to send their children to public schools without up-to-date immunizations, but some Republican legislative leaders have argued such legislation would infringe on parental choice.
The problem with that argument is that vaccines are only about individual freedom to the extent that an individual should be free to expect not to be exposed to preventable, potentially life-threatening illnesses when entering public spaces. Vaccination is part of our social contract. It’s part of how we protect the public good.
This public health effort has long been enforced by requiring public school children to show evidence that they have been vaccinated. All 50 states have laws allowing exemptions for medical reasons, and most states allow students to opt out for religious reasons. But Wisconsin is one of 18 states that also offer a “personal conviction” waiver. If parents don’t want to vaccinate their children, they can sign a form saying so, and that’s that.
About 90 percent of exemptions in Wisconsin are made under the “personal conviction” waiver — far outnumbering the ones made for religious or medical reasons. And Wisconsin’s exemption rate for all vaccines is about three percentage points higher than the national median of 2 percent, according to a Centers for Disease Control and Prevention report.
Even a 95 percent vaccination rate might sound like a high number, but Stephanie Schauer, immunization program coordinator for the state Department of Health Services, explained to me that overall numbers matter less than what’s happening locally — in a particular county, neighborhood or school.
“It’s important to remember that measles affects a community, and when measles is introduced, it’s really the vaccination rate of that community that determines whether there would be an outbreak,” Schauer said.
Wisconsin saw its last large outbreak in 1989 and 1990, Schauer said. In 1989, the state had 880 cases, five of which resulted in death.
“Measles is not a thing to take lightly,” she said.
Once a child is infected, it’s too late, said George “Chip” Morris, a Milwaukee neurologist and president of the Wisconsin Medical Society.
“Getting vaccinated early really protects children at a time when they’re the most vulnerable to diseases that could permanently injure them,” Morris told me.
Among doctors, a common refrain is that the medical community has become a victim of its own success. People who haven’t seen the effects of illnesses like measles, mumps and polio — thanks to the success of vaccines — might not see them as serious threats.
Couple that with the widespread proliferation of myths that have convinced some that a vaccination is riskier than the illness it’s designed to prevent, and it’s no wonder why some people doubt the necessity of immunization. When we’re not confronted with the harsh reality of these diseases, it’s that much easier for misinformation to prevail.
It’s the kind of climate that results in a state legislator like Rep. Jeremy Thiesfeldt — the chairman of the Assembly education committee — to say that, while he personally supports vaccines, it’s possible that some parents who choose not to vaccinate their children "know more than the doctors do."
Morris told me he’s sensitive to the fact that some people have received a large amount of misinformation on this topic. One thing he keeps in mind is that, as a doctor, his job is to educate patients about what’s best for them.
Sometimes, “what’s best” is something a patient isn’t enthusiastic about — eating better, exercising more or quitting smoking, for example. Vaccines can also fall into that category — but they can offer a lifetime’s worth of protection..
From an ethical standpoint, the responsibility is twofold, said James Conway, a pediatric infectious disease specialist and associate director for health sciences at the University of Wisconsin-Madison School of Medicine and Public Health. As a society, we have an obligation to protect children from debilitating and life-threatening diseases — but we also have an obligation to protect those among us whose own medical conditions prevent them from receiving immunizations.
That protection comes from something called “herd immunity.” Put simply, the more people in a community are immune from a disease, the greater the chances are that those who aren’t immune will be shielded from it.
To achieve herd immunity for measles, 93 to 95 percent of a population must be vaccinated. Wisconsin’s rate of measles vaccination — 91-92 percent — is concerning, Conway said. And there are pockets of the state where the rates are much lower. Last year, according to state Department of Health Services data, only 60.7 percent of children in Vernon County had received a dose of the measles, mumps and rubella (MMR) vaccine by their second birthday. In Taylor County, the rate was 65.7 percent, and in Lafayette County, it was 65.8 percent.
To bring rates up, experts suggest two things: making it more difficult to obtain a waiver, and making it easier to obtain vaccinations.
The state’s Vaccines for Children program seeks to help with this by providing vaccines for children who are uninsured, underinsured or covered by Medicaid. But more can be done to help ensure children can get vaccinated at a time and location that works for their family, Conway said.
He also recommends either tightening up or eliminating the state’s personal conviction waiver.
“It isn’t forcing people to vaccinate,” Conway said of efforts to do so. “It’s just saying, if you’re going to avail yourself of public schools, you have to be part of a community where everyone agrees we take care of each other.”
Assembly Minority Leader Gordon Hintz, D-Oshkosh, recently proposed legislation — for the second time — to eliminate the personal conviction exemption. The bill has bipartisan support, but Republican legislative leaders don't appear to be on board. Lawmakers should make it a priority to hold hearings on this bill and pass it, or something similar, for the sake of the state’s public health.
“We have an obligation to protect the public, and that’s really what this is about,” Hintz told me. “If we can do something to prevent human suffering and death, I think we should do it.”
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