The Breeding Ground: Vaccine Wars

How Orange County, Calif., became the epicenter of a vaccine war most people thought already was won

In February, a month after the news broke that Disneyland was the epicenter of a measles outbreak that would result in 35 cases in Orange County and 121 more across California and seven other states, a South County mother got some upsetting news. She and her 4-year-old son, whom she has decided not to give the MMR vaccine that protects against measles, had been banned from two local playgroups.

“They posted something online, saying that if you’re not up to date on your vaccinations, please don’t come to our next meet-up,” says Nicole, who’s in her mid-30s and asked that only her first name be used to avoid additional shunning of her family.

It was a daunting rebuff. No more bayside walks? No more communal visits to the Playland Cafe, a trendy Irvine hangout where young moms sip exotic teas while their offspring cavort on equipment designed to develop kinesthetic skills? But it wasn’t enough to make Nicole return to the pediatrician who, as she tells it, had dismissed her concern about whether vaccines carried the risk of causing her son to develop autism, which she’d read about on the Internet. To Nicole, vaccines sound too dangerous, no matter what the U.S. Centers for Disease Control and Prevention, the American Academy of Pediatrics, and myriad medical journal articles say.

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But the shunning stung. “It’s like, keep your unvaccinated kids away from our vaccinated kids,” she says, bristling. “But if you’re determined to vaccinate because you think it’s going to protect them, then why are you worried? You’re supposedly immune now. It doesn’t make any sense.”

Medical experts say Nicole and others like her are endangering their own kids and jeopardizing the health of vulnerable members of the community—infants, cancer patients, and the sick and frail who can’t be immunized—and possibly causing future epidemics by threatening the herd immunity necessary to prevent diseases from spreading. But Nicole is undeterred and passionate about the cause. She formed her own playgroup, which welcomed other like-minded moms and their unvaccinated offspring. And as the kids play together, the moms talk.

“We’re consumed by the research,” she says. Granted, “a lot of people are questioning us, saying, ‘You guys are cracked, you’re crazy.’ (But) I’m a stay-at-home mom, and I’ve dedicated so much time to this. I’m up in the middle of the night. I wake up thinking about it. I have nightmares that somebody vaccinated my child.”

 

Orange County might seem an unlikely hotbed for the anti-vaccine movement. The stereotype of vaccine skeptics is that they’re affluent, presumably left-leaning New Age dilettantes, the sort you might run into at a health-food emporium interrogating a hapless clerk about the chlorophyll content of the house-brand wheatgrass. While some Hollywood A-Listers might fit that description, a recent YouGov poll showed that political conservatives are more likely to embrace the idea of a link between childhood vaccines and autism.

While the majority of Orange County children are getting their shots, compliance with the CDC’s recommended schedule of injections is slipping. In 2013, the most recent year for which data was available, just 73.6 percent of the county’s 2-year-olds were up to date on their vaccinations, according to a report released by the Orange County Children’s Partnership. That’s down from 81 percent in 2009.

Among older kids, the numbers are better. But there are pockets of low compliance, most in upscale South County. In the Capistrano Unified School District, 8.6 percent of unvaccinated students are attending classes thanks to waivers that parents can obtain—more than three times the state average. In some private schools, the vaccine waiver rates are even higher. As The Orange County Register reported in September, at Journey School in Aliso Viejo, 60 percent of the kindergarten class for 2013-14 had skipped at least some vaccinations.

An article published in March in the Journal of the American Medical Association Pediatrics concluded that “substandard vaccination compliance” was a likely reason the Disneyland outbreak spread so easily, and said that it “shines a glaring spotlight on our nation’s growing anti-vaccination movement and the prevalence of vaccination-hesitant parents.”

AntiVaxMap

1) La Habra: 1.6% 2) Brea-Olinda: 4.7% 3) Buena Park: 4.2% 4) Fullerton: 3% 5) Placentia-Yorba Linda: 7% 6) Cypress: 8.1% 7) Centralia: 5% 8) Savanna: 12.1% 9) Magnolia: 4.9% 10) Anaheim: 3% 11) Orange: 7.7% 12) Los Alamitos: 4.2% 13) Westminster: 3.1% 14) Garden Grove: 3.9% 15) Santa Ana: 5% 16) Tustin: 7.8% 17) Irvine: 8.7% 18) Ocean View: 7.2 % 19) Huntington Beach: 13.4% 20) Fountain Valley: 5% 21) Newport Mesa: 14.9% 22) Laguna Beach: 16.2% 23) Saddleback: 13.2% 24) Capistrano: 16.2%

What the numbers don’t convey is the complex nature of vaccination resistance in Orange County, which combines a preference for alternative medicine and organic diet with a libertarian belief in personal freedom and a mistrust of government, with a touch of religion thrown in.

“I feel God built our bodies to heal themselves,” says Kelly Grijalva, a 30-something Costa Mesa mom who says she and her husband were denounced by their pediatrician as “bad parents” when they declined to vaccinate their son, now 11. She proudly notes that since then, he’s never been sick, and she credits organic vegetables and exercise, along with regular chiropractic adjustments. “Some of us die of cancer, some of us die of heart disease,” she says. “Whatever the path is for my son, I want to follow the natural, holistic route. It’s not like my kid is going to die if he gets the measles.”

Actually, people used to die of the virus or its side effects. According to CDC statistics, in 1963, before the nationwide vaccination program started, about 3 million to 4 million Americans got the measles each year, of which 400 to 500 died, and 4,000 contracted encephalitis, a brain inflammation caused by the virus. Still, some parents see choice about vaccinations as a question of empowerment. Former nurse Dotty Hagmier of Dana Point now runs Moms in Charge, a nationwide support network of moms who strive for a mindful, organic family lifestyle. “We focus on the things within our control as moms to raise healthy, vibrant kids,” she says.

A latecomer to vaccine skepticism, Hagmier vaccinated her oldest daughter and son, but says she had an epiphany when nurses at her pediatrician’s office gave her youngest daughter an extra dose of the Hepatitis B vaccine because of a records mix-up. “I was speechless,” she recalls. She decided to take control by declining more shots, and trying to protect her kids from illness with diet and lifestyle changes.

“I decided for my family that I’d had enough,” she says. “I felt that with what I was doing for their immune systems, if they got mumps, it was not a death sentence.” As she read about cases of children injured by adverse reactions to vaccines—events that doctors and public health officials point out are statistically rare—her conviction became stronger. Skepticism about vaccines, she says, “is a civil rights issue” about parents’ ability to choose what’s best for their children.

 

In the aftermath of January’s measles outbreak, this sort of anti-vaccine obstinacy ignited a powerful backlash, and it got personal quickly. “Thank God I don’t live near you and that my doctor requires anyone visiting to have had (their) vax,” one Fullerton mom railed on Facebook. “I’m glad my children won’t be going to school with yours.” On the Register’s editorial pages, where personal freedom traditionally is sacrosanct, columnist Ben Boychuk castigated the resisters, even as he defended their right not to vaccinate their kids: “How many more epidemics will it take before this wretched belief recedes to the fringes, where it belongs?”

The anti-vaccine movement alarms many local doctors. “We’ve had patients very concerned about having anyone in the office that wasn’t immunized,” says Katherine Roberts, a pediatrician who practices in Ladera Ranch. “The outcry has increased.”

One result is that she and her partners in a multi-physician practice—as in an increasing number of other pediatric practices—have decided to stop accepting patients who won’t allow their children to be vaccinated, a step she and her colleagues have been discussing for years. “We’re not just handing out notes saying, ‘Go away,’ ” Roberts says. “We’re trying to sit down with these parents to discuss their concerns. When families have the choice of going with their trusted pediatrician’s advice rather than their own fears, we’re hoping that they’ll go with our advice.”

Harry Pellman, a past president of the O.C. chapter of the American Academy of Pediatrics, belongs to a group that recently stopped accepting vaccine abstainers. He seems almost bewildered by the trend: “I’ve been around a long time, before vaccines were available for many of these diseases. We don’t see meningitis in the office anymore, but I used to get one of those a month. Childhood vaccines have made a tremendous difference in public health.”

James Cherry, a professor and specialist in pediatric diseases at UCLA, agrees. “Why do you vaccinate for measles? Because it’s a bad disease. It’s not as bad as it is in developing countries, where it’s exacerbated by malnutrition, but if you didn’t have vaccinations, a lot of people would die. One in 1,000 would get encephalitis, and some of them would get better. But others might get brain damage.”
Pellman thinks vaccines are victims of their own success, because most parents today are too young to have experienced the suffering and fear that outbreaks once caused. Instead, those parents focus on the rare adverse reactions, and on the discredited notion that vaccines play a role in autism.

Rob Ring, chief science officer of Autism Speaks—a group dedicated to funding global biomedical research into the causes, prevention, treatments, and a possible cure for autism—is unequivocal in a quote posted on the organization’s website: “Over the last two decades, extensive research has asked whether there is any link between childhood vaccinations and autism. The results of this research are clear: Vaccines do not cause autism. We urge that all children be fully vaccinated.”

Pellman says with a trace of exasperation in his voice that maybe it’s as simple as the perceived trauma of getting the shots. “I’m going to guess what happened is that people don’t like their children getting poked a lot.”

 

Those arguments fail to calm the vaccination resisters. They aren’t dissuaded by a massive 2011 meta-analysis of more than 1,000 scientific studies by the national Institute of Medicine, which found serious side effects from vaccines are rare, and that there’s no link between vaccines and autism. This was underscored in a study published in JAMA in April. That information comes from what the resisters feel is a government-funded pharmaceutical industrial complex that many anti-vaxxers see as corrupt and engaged in a massive coverup.

They’ve got their own sources, most notably Andrew Wakefield, the lead author of a 1998 Lancet article that claimed to show a connection between MMR vaccinations and autism. The Lancet retracted the article in 2010, after Great Britain’s General Medical Council found Wakefield had committed dishonesty and ethical violations in his research. The GMC also determined “Wakefield’s name should be erased from the medical register,” which bans him from practicing in Great Britain.

Nevertheless, Wakefield, who spoke at the California Jam health and wellness festival at Costa Mesa’s Segerstrom Center for the Arts in March, has supporters who believe his work was unfairly suppressed.

“They never showed his data is not true. They just went after him for other reasons,” says Mark Filidei, a Newport Beach-based physician who uses alternative therapies in his practice and grew more skeptical about vaccines after one of his sons suffered an adverse reaction to one.

Many also gravitate toward Dana Point pediatrician Bob Sears. He’s the author of “The Vaccine Book—Making the Right Decision for your Child,” a strong seller since its 2007 release. He also writes and edits for the popular pediatric advice website, askdrsears.com.

Sears’ Facebook page has become a magnet for vaccine skeptics. Some use his comment threads to rant about perceived enemies of the truth, such as Orange County Health Care Agency epidemiology chief Matt Zahn (“an equal opportunity fearmonger/vaccine pusher—he also talked about the need for more flu vaccines a few years ago,” according to one Mission Viejo woman). Vaccine resisters connect on Sears’ page with like-minded others to discuss school belief waivers. (“I received a letter from Capistrano Unified School District saying my child may be asked to stay home and that I had to provide up-to-date immunization records,” one mother wrote during the outbreak. “Basically until he was vaccinated he wouldn’t be able to attend school???”)

Sears, who frequently appears in media outlets ranging from CNN to the Los Angeles Times, has become a go-to guru for many who worry about vaccines, even though he tries to stake out the middle ground in the debate. As he recently explained in a radio talk show appearance: “I am pro vaccine, and I give vaccines in my office every day.” He added: “And I do acknowledge that vaccines work very well, and they do prevent a number of very severe diseases.” But he also tosses some bones to vaccine critics, saying that “we can’t prove that vaccines don’t cause autism with 100 percent certainty. We certainly need more objective research that will take a closer look at this.”

Sears’ book details an alternative, spaced-out schedule, which he says will “allow worried parents to vaccinate without overloading with so many shots at once.”

Sears’ alternative schedule doesn’t sit well with many pediatricians, who think it leaves children vulnerable to diseases for longer periods, creates more stress, and increases the chances that they won’t complete the list of vaccinations. “It increases susceptibility, increases needle phobia and stress with no benefit, and plays into the false notion that children can’t handle these vaccinations,” says Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia.

Despite mainstream medical objections, some parents are opting for an alternative schedule. A 2014 study in The Journal of Pediatrics found that in parts of New York state, about one in four children follow alternative schedules. A 2013 Institute of Medicine report noted that while there’s evidence that the conventional CDC schedule works in reducing illnesses, deaths, and hospital stays, more research should be done on the number, frequency, timing, and order of the shots, and the age at which they’re given.

 

All of this has escalated the groundfire in Orange County’s homegrown vaccine wars. Sears has shifted from being an information provider to a defender of vaccine resisters’ rights. On his Facebook page and in a recent op-ed piece for the Register, he argued against legislation introduced by state Sen. Richard Pan, a Sacramento Democrat and pediatrician, and Redondo Beach Democratic Sen. Ben Allen. Their bill, SB277, would eliminate the belief exemption and prohibit public and private schools, daycare centers, and other institutions from admitting unvaccinated children unless they have medical justification.

“We shouldn’t wait for any more children to sicken or die before we act,” Pan said at a February news conference. Other states are considering tightening their rules as well, and Pan’s position has wide national support even though he became the target of personal attacks because of his position. A recent Reuters poll found that 65 percent of Americans think schools should be able to refuse admission to unvaccinated students.

Many anti-vaxxers see the bill as the first step toward a sort of pediatric totalitarianism in which the government might someday track down kids and inject them with serum. They’re joined in that fight by Robert F. Kennedy Jr., who, while in Sacramento to oppose the bill in April, linked the rise in autism rates to unsafe vaccinations, later calling autism an epidemic much like a “holocaust,” a word choice for which he later apologized. Sears tells Orange Coast he has stepped up his rhetoric because of the bill.

“That’s what you’re seeing as a shift in my role from objective informer to outspoken advocate,” he wrote in an email. “My information hasn’t changed. My pro-vaccine opinions haven’t changed. And I’m not shifting into an anti-vaccine position at all. But in order to fight legislation, I’m forced to present reasons why vaccines should be a choice for parents, why they should be given informed consent, and why vaccines shouldn’t be mandatory for school enrollment.”

Sears says he’s also taking a more strident line about the potential downside of vaccines, such as the nearly $3 billon that a federal compensation program has paid out since the late 1980s to victims who became seriously ill after vaccinations. In context, the incidence of such harm represents a miniscule portion of the number of vaccinations; for the MMR vaccine, for example, 87 patients were compensated for injuries between 2006 and 2013, out of more than 73 million who got the shots, or 0.0001 percent.

Even so, Sears doesn’t think it’s right that the medical establishment “can just simply ignore the fact that a very small percentage of people will be harmed after receiving vaccines.” To him, it comes down to personal freedom. “Who do you want making medical decisions for you and your children? You and your doctor, or your friendly neighborhood politician?”

 

Such rhetoric hovers like smoke above the Orange County battleground, alongside the March report’s conclusion that the Disneyland measles outbreak happened because vaccination rates are too low. Measles is extremely contagious and can spread through the air. The immunity threshold needed to protect a community is high; at least 92 percent of the population needs to be vaccinated to prevent its spread. Other diseases are less contagious; the threshold for polio, for example, is estimated at 80 to 86 percent.

But the outbreak might be the canary in the coal mine, a sign that hard-earned societal protection is waning. There also has been a resurgence of whooping cough, a highly contagious disease that’s potentially lethal to infants, with the number of cases increasing sixfold since 1990, according to CDC data. A 2013 study in JAMA Pediatrics found that undervaccinated children are as much as 28 times more likely to contract it. Even so, “I think you would probably have to get much more erosion, maybe down under 70 percent, to see polio or diphtheria make a comeback,” says Offit, of the Vaccine Education Center in Philadelphia. “Hopefully that won’t happen.”

In the meantime, battle lines continue to form between the pro-vaccination majority and dissenters such as Nicole. She recently had her second child and has been investigating another option for protecting against measles—homeopathy, an alternative healing method that involves putting drops or tablets under the tongue. “They take the mucus of someone with measles, and break it down into minute amounts, and put it into the pellets,” she says. The National Institutes of Health website warns there’s little evidence that homeopathy works, and that it shouldn’t replace vaccinations.

Nevertheless, Nicole suspects it might somehow be safer than the chemicals in vaccines, adding, “I just started researching it.”

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