Are low vaccination rates endangering Hudson Valley communities? Several recent measles outbreaks suggest the answer is yes—and the issue is becoming increasingly fraught, as alarmed public health officials and legislators clash with a vocal contingent of anti-vaccine parents over the best way to protect children’s health.
This year, the World Health Organization named ‘vaccine hesitancy’ as one of the top 10 threats to global health worldwide. The organization estimates that 1.5 million deaths each year could be avoided with increased vaccination rates.
The protection given by vaccines against contagious disease is not absolute. An individual who’s been vaccinated still holds some risk of contracting the disease; the rate of protection varies between vaccines. But when rates of vaccination are high enough in the community, a powerful phenomenon emerges: Herd immunity. Widespread public vaccination slows the spread of disease through a community to a crawl, and provides some protection to those who can’t be immunized: people with weakened immune systems, pregnant women, or babies too young to get the vaccine.
If less than 95% of the community is immunized, the CDC advises, vaccination rates will not be sufficient to provide herd immunity to those who have not gotten vaccines. As vaccine skepticism spreads in a community, rates of immunization drop—and outbreaks sometimes follow.
Some vaccine refusers have religious beliefs that prohibit vaccination. Others are skeptical of conventional medicine, or have been convinced by anti-vaccination activists and alternative health practitioners that vaccines cause more harm than the diseases they protect against—a belief unsupported by the scientific evidence.
In the past few years, New York State has seen several large outbreaks of measles, a once-common (and frequently fatal) childhood disease with a virulent tendency to spread through the air. Health officials blame low vaccination rates.
Most of the cases in the two New York State outbreaks this year occurred within Orthodox Jewish communities in Williamsburg and the lower Hudson Valley. Nothing in Jewish law prohibits vaccination, and like New York State parents in general, most Orthodox Jewish parents have their children immunized. But in the past several years, vaccine skepticism has been growing in Orthodox communities, aided by an anti-vaccine magazine launched in 2014 and several influential rabbis.
What makes Orthodox communities in New York State vulnerable to low rates of vaccination—and to the outbreaks that sometimes follow on their heels—is that they are tightly knit, set apart from the larger community by language and culture, and share values and beliefs. Vox reports that almost half of the measles outbreaks in the past five years have happened in communities like these:
These communities have become an urgent focus of health departments across the country, said Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention. When measles strikes, outbreaks in tight-knit groups tend to be “explosive” and more difficult to control.
According to CDC data, 12 of the 26 measles outbreaks in the past five years (involving more than five cases) centered on tight-knit communities, which Messonier defines as people of a similar background who share values and beliefs and interact often. And because these outbreaks have been bigger, they account for 75 percent of recent measles cases.
While the reasons for vaccine skepticism may be different in each of these communities, the groups themselves have a lot in common. They’re cohesive and conservative. They appear to trust each other more than outsiders. They also speak the same languages and read or watch the same news. “We think these communities are more alike,” Messonnier added, and their insularity helps “outbreaks escalate.”
Measles outbreaks this year have already infected at least 305 people in New York State, 158 in Williamsburg and 147 in Rockland County. The largest outbreak in the US in the past decade, with 383 cases, struck unvaccinated Amish communities in Ohio in 2014.
The Hudson Valley: Ground Zero
Vaccine conflict is playing out on a national (and even international) stage, as digital platforms like Facebook and Pinterest wade into the issue with policies designed to limit the spread of misinformation. Here in the Hudson Valley, and in New York State at large, vaccination has become an emotional and political flashpoint, as parents fearful of vaccines clash on policy with those who fear the spread of communicable disease.
In December, Rockland County health officials took the unusual step of banning unvaccinated children in several zip codes from attending any school where vaccination rates dipped below 95%. Vaccination rates at the Green Meadow Waldorf School’s elementary school, where 49 children were banned from attending, were 33% last year, and have since risen to just 56%, according to the Rockland/Westchester Journal News.
Parents of the affected Green Meadow children sought an injunction to allow them to return to school. Last week, a judge denied the injunction, making headlines around the nation and ensuring that the local battle would rage on.
Alarmed by the recent massive measles outbreaks, two New York State Democratic legislators are currently pressing for a state bill that would allow teenagers 14 and over to get vaccinated without their parents’ permission. Others are pushing to get rid of the religious exemption for vaccination altogether.
Meanwhile, in other states, the tide is flowing in the opposite direction. Anti-vaccine Republican legislators in Texas, which has seen 11 measles cases so far in 2019, are pushing for a suite of laws aimed at reducing vaccination, including bills that would make it easier for people to obtain “conscience” exemptions.
Vaccination rates are currently on the rise in places where measles outbreaks have occurred. The New York Times reports that in Oregon and southwest Washington, where measles has broken out, roughly three times as many children were vaccinated so far this year as they were during the same period in 2018. The tide may be turning in New York’s more vulnerable communities as well; according to recent data from the New York State Department of Health, vaccination rates in Williamsburg, the epicenter of one of this year’s ongoing measles outbreaks, rose sharply last fall after the outbreak began.
The community dynamics that drive people’s health decisions are complex, and often deeply intertwined with local culture and values. When investigating vaccination stories, reporters have a wealth of data to draw on from local and national health authorities, scientific papers and other public health information. But without deep, sensitive reporting at the community level, the picture is incomplete. These are the kinds of stories that we’re building a newsroom at The River to dive into: challenging, locally grounded, and important on a broader scale.