Dr. Gail Schonfeld gives an injection to a young girl. Photo by Michael Heller.
By Tessa Raebeck
The recent measles outbreak, which started in California, has evoked fear among parents, painful memories among doctors, and intense debate, finger pointing and even name-calling from all sides nationwide. The outbreak has fueled discussion on playgrounds, in waiting rooms, and on Facebook groups here on the East End, where an estimated 3 percent of school children are not fully vaccinated.
Largely centered on the M.M.R. vaccine, which targets measles, mumps and rubella, the debate has made unlikely bedfellows of those on the far left and those on the far right. A growing number of parents are choosing not to vaccinate their children for a growing number of reasons, ranging from their belief in holistic medicine, the power of Mother Nature and the natural strength of the human body’s immune system, to a general mistrust of government, injections and in some cases, science itself.
An airborne disease that is highly contagious, measles was declared eradicated in the United States in 2000, but experts believe recent outbreaks originated with international travel to areas that have low or non-existent immunization rates, like parts of Africa.
“There’s measles in the world, there’s international travel and when you get below a certain percentage of people who are adequately immunized, the disease will start to spread and it will come back, and that is exactly what has happened,” said Dr. Gail Schonfeld, an East Hampton pediatrician who has been in practice for 33 years.
Parents who choose not to vaccinate their children are often clustered in geographic hubs, making the disease’s spread more likely. The recent outbreak of measles in California, where a growing number of children are not vaccinated, has been linked to Disneyland, but originated outside the U.S.
Health experts believe outbreaks are limited when the population is above a certain immunization rate, due to a phenomenon called “herd immunity.” If a high enough percentage of the population is vaccinated, believed to be 95 percent for measles, the disease cannot spread to enough people during its incubation period to sustain itself, which is why recent outbreaks have been contained.
So, although recent outbreaks stem from international travel rather than non-vaccinated American children, if the numbers of unvaccinated children continue to rise, the disease will spread more easily the next time it comes to the U.S.
A measles outbreak in Ohio last June, connected to Amish missionaries returning from the Philippines, more than doubled in size in 10 days and eventually spread to 339 mostly unvaccinated Amish people, according to state health officials. Ohio granted more than three times as many religious and philosophical exemptions from vaccines to kindergarten students in 2013 than it did in 2000.
Unlike in Ohio and some other states, philosophical exemptions from vaccines are not permitted in New York, but the rate of religious exemptions has risen over the last decade, from 0.23 percent in 2000 to 0.45 percent in 2011, according to a 2013 study in the medical journal Pediatrics.
The current rate of immunization in the Bridgehampton School District is 98 percent, with all but three students fully vaccinated. Those children, the district said, are partially vaccinated, but have religious exemption from some vaccines.
In the Sag Harbor School District, 97 percent of students are vaccinated, with 3 percent exempt for religious and medical reasons, according to the district.
On Monday, February 9, the New York State Department of Health sent a letter to all school superintendents in the state reminding schools to follow the requirements for vaccinations.
“Given the recent media attention and the fact that DOH has confirmed three cases of measles in New York State, including New York City, we write to remind you to continue to take all appropriate measures to protect New York’s students through your responsibility to oversee children’s admissions to school,” said the letter.
Under state law, children must receive vaccinations before attending public or private school, unless a doctor confirms that vaccines will harm the child or a parent provides a written explanation of a “genuine and sincere” religious objection, which school officials can accept or reject.
Parties on all sides of the debate are guilty of fear mongering; Some M.M.R. opponents link the vaccine to autism, despite the fact that there is no scientific evidence to support their claim, while some vaccine proponents incorrectly assert that the instances of measles are testament to a rapidly approaching epidemic that immediately puts all American babies at risk. The extent of loud, often misinformed opinions on both sides can make researching vaccines difficult for the average parent.
Elizabeth Schmitt, an East Hampton mother who decided against vaccinating her eldest daughter Ruby, first became aware of the arguments against vaccines through an Internet message board, branched off of Parents.com. As she continued to “read around” online, the new mother quickly became “really scared.”
As Ruby neared kindergarten age, her younger brother, Cole, at the time about 15 months old and also not vaccinated, started to show strange symptoms: he stopped talking, started twitching and had a high fever.
“It was just all these really scary symptoms out of the blue,” said Ms. Schmitt, “and the funny thing was that all these symptoms were what people kept saying would happen to kids after the M.M.R., but he never had it, so that had me rethinking things really fast.”
“I was looking at a lot of different websites that, I guess in hindsight, aren’t as credible as I thought they were at the time, so then I started looking at the sources. If the site had an article about a certain study, instead of just reading the article, I started reading the study—and realized that the study didn’t say anything that the guy said in the article, and that was really aggravating,” she added.
Ms. Schmitt changed her opinion after further research, and now her children, Ruby, Cole, and 23-month-old Andy, are all fully vaccinated.
“Even the parents who choose not to vaccinate now, we’re all just on the same team, really, everybody’s just really scared about the whole thing,” she said, adding that the “real information” and scientific studies are far more difficult to find, read and understand than the anti-vaccine “sites that we have, like Natural News and the crazy stuff that’s not even true, but so user-friendly and so easy to read, that we didn’t find reason not to believe it.”
While Dr. Schonfeld said she understands “completely and absolutely where the misinformation is coming from and why people are saying and doing what they’re doing,” the pediatrician recently announced that families who choose not to vaccinate are no longer welcome in her practice, as she has “no question [that decision is] wrong on every level.”
“I think what people have to understand is the balance between personal choice and safety and social responsibility. This is the United States and we’re all about personal choice, but when your personal choice endangers the safety of your child and others around you, that’s the line you cannot cross,” she said.
Although she finds many parents’ fear of vaccines unfounded, Dr. Schonfeld’s experience practicing medicine before some of them were invented gives her a larger, more tangible fear: the return of measles and other preventable diseases.
“I’ve personally known and diagnosed children with several of the diseases that we now prevent with the vaccines, and I’ve seen some horrible, horrible things in my time—and I’ve seen the changes, so I understand it from a very different point of view,” she said. “I have very clear memories of the pain and suffering and death of these children and what their families went through…but I also have seen how it’s changed my life to not have these sudden life-threatening infections occurring in children. It’s very challenging to diagnose and treat them and have them survive.”
Although recent measles outbreaks in the U.S. are “horrible,” Dr. Schonfeld believes the incidence of measles is not high enough to justify a routine immunization at six months of age, rather than the standard 12 months.
“I am a firm believer of science and not emotion when it comes to the practice of medicine…When there is as much measles in the United States as there is in, say, parts of Africa where there is no vaccination, yes, we would go back to doing [immunizations before 12 months]—I just don’t think I could stand it if we got to that point,” she said. “I’m really thinking maximum one or two children dying, people are going to get it and stop doing this.”