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Who knew? My state’s vaccine personal belief exemption rate stinks!

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One aspect of my life that’s kind of strange is how I’ve basically ended up back where I started. I was born and raised in southeast Michigan (born in the city of Detroit, actually, although my parents moved to the suburbs when I was 10). After going to college and medical school at the University of Michigan, I matched at a residency in Cleveland (regular readers know that it was Case Western Reserve University), and then did a fellowship in surgical oncology at the University of Chicago. Finally, I ended up taking my first “real” (i.e., faculty) job at the Cancer Institute of New Jersey (now the Rutgers Cancer Institute of New Jersey), where I remained for eight and a half years. Here’s the weird part. After 20 years away from southeast Michigan, seven years ago I had the opportunity to return, and return I did.

One thing I noticed returning is just how politically conservative the state had become. There’s a huge Tea Party contingent, and unfortunately my state senator is among the wingnuttiest of the wingnuts. I sometimes joke that if it weren’t for Detroit and its surrounding suburbs and exurbs, Michigan would be largely indistinguishable from Alabama, particularly the western part of the Lower Peninsula. On the other hand, at least when I moved back, based on my then stereotypical view that antivaccinationists were primarily crunchy, New Agey people who leaned left politically, I figured that Michigan, at least, would not be as full of antivaccine loons as New Jersey was. And so it seemed at first.

No more. Or I was wrong. Or both.

In fact, we have a real problem here in Michigan:

Michigan is at risk.

That’s the warning from public health experts as more and more schoolchildren are not getting basic vaccinations to protect them — and all of us — from preventable disease.

Michigan makes it easy to avoid immunization and after years of increasing public concerns over side effects and government intervention, the rate of those going unvaccinated is dangerously high.

Nearly 45 percent of Michigan residents now live in counties at risk of disease outbreaks, according to an MLive analysis of state data.

The risk is not just theoretical. It is very real.

A recent outbreak in Traverse City shut down a 1,200-student charter school for a week, infected students at 14 other school buildings in the region, and has sickened dozens of people and forced hundreds into quarantine.

Traverse City is a lovely medium-sized city in the northern Lower Peninsula on Lake Michigan’s Grand Traverse Bay. It’s a big tourist destination in the state where I’ve stayed before. Now it’s the site of a substantial pertussis outbreak. Why? Do you really have to ask? Yes, it’s low vaccine uptake, as the story explains:

But Grand Traverse County has an undervaccination rate six times the national average. And nearly 1 in 5 of the kindergarteners (17 percent) at the charter school, Grand Traverse Academy, had parents who signed waivers exempting the children from required vaccinations.

This is not just a problem in Traverse City and environs, but in several other counties in Michigan, as shown in this searchable map and database listing vaccine exemption rates for different counties and communities. It lets you search kindergarten, sixth grade, and transfers, either individually or in a combination. Although it looked as though most of our schools were somewhere near the statewide average of 5.9% exemptions, I was a bit disturbed to see that more schools than I’d like to see in the school district where I live had exemption rates greater than 10%. In actuality, I was disturbed to see that the exemption rate was higher than zero in most schools.

It’s getting worse than just pertussis, though. At least, there’s a very worrisome recent development. Pertussis, you see, can produce outbreaks in even vaccinated populations because of complex issues of waning immunity that can leave adolescents at risk even though the acellular pertussis vaccine generally does work well. In any case, epidemics and outbreaks of pertussis are much, much smaller than they were pre-vaccine because, well, the vaccine does work.

Pertussis outbreaks are just one bellweather of impending disaster when vaccination rates fall. What is the other disease that is always lurking, always poised to come roaring back if herd immunity is compromised? Yes, you guessed it. The measles is back, too:

Last week, the other shoe dropped in Grand Traverse: Two residents were diagnosed with measles, the most contagious disease known to man and one that can have serious complications.

It happened in Traverse City. It could easily happen in communities throughout Michigan.

Exactly. It very easily could. It’s been 24 years since anyone died of the measles in this state, an 11-year-old girl named Tammy Bowman who died of the measles in 1990. It was in the middle of an outbreak in Wayland. A high school sports team had traveled to a competition in northern Michigan and brought back measles, which quickly spread among other teens. The Allegan County Health Department ended up pulling the records of older students and setting up a clinic to administer vaccinations to any who had no record of being immunized. It’s unclear that whether the girl had had her measles vaccine. The parents say that she had before entering a Head Start program, but there was no record of vaccination. The parents said that vaccination records were lost in a basement flood; so they signed a waiver to get their girls in school. In any case, Tammy developed measles before she could be vaccinated, and ultimately died. It was ugly; she developed a secondary pneumonia, was transported to Children’s Hospital of Michigan in Detroit, and was placed on ECMO for several days. The doctors at Children’s couldn’t save her.

It was part of a national outbreak that occurred between 1989 and 1991 that resulted in 55,000 cases of the measles, 11,000 hospitalizations, and 123 deaths from a disease that antivaccine activists will claim is not dangerous.

The evidence is clear. Even though outbreaks can occur in vaccinated populations, that is not, as antivaccinationists would have you believe, proof that vaccines don’t work. The reasons are (1) no vaccine provides perfect protection and (2) simple math. Even though it might appear that equal numbers of vaccinated (or even more) vaccinated children catch the disease, when you take into account the percentage of the population that’s vaccinated versus unvaccinated and calculate relative risks, it’s very clear that the unvaccinated are at much higher risk of catching the disease. For example, children not vaccinated against pertussis are at a 23-fold higher risk of catching pertussis. During an outbreak, children not vaccinated against the measles are also at a greatly increased risk of developing the measles, in the same ballpark as for pertussis. At the extreme end, in a measles outbreak in the Netherlands in 2000, it was estimated that unvaccinated children were over 200-fold more likely to catch the measles than vaccinated children.

Depressingly:

Michigan has one of the highest vaccine-waiver rates for kindergartners in the country, three times the national median, according to the Centers for Disease Control and Prevention. And the number of kindergartners getting vaccine waivers is growing. In five years, it’s increased 23 percent, the CDC says.

This is, of course, a recipe for impending disaster. Remember when I said that when the outbreaks begin, they’ll start in California? Maybe I was wrong. Maybe they’ll start in Michigan. Or in California and Michigan. Actually, they’ve already begun in California and Michigan, all because of how lax both states are when it comes to granting philosophical waivers for school vaccine requirements. Herd immunity matters, again contrary to what antivaccinationists want you to think.

This lets parents like this opt out and thereby increase the danger of outbreaks:

Among those questioning the conventional wisdom on vaccines is Marcel Lenz, a Traverse City resident who is father of children ages 4 and 2.

Lenz, who has a doctorate in horticulture, said he had a “falling out with Western medicine” and is persuaded by the arguments of alternative-health advocates who say vaccines are potentially harmful.

“I haven’t seen the studies that convince me that vaccines are safe and effective,” Lenz said, adding that it is his belief that diseases such as polio already were already on the wane before the vaccines were introduced.

Based on his reading, he said, “the probability of getting one of these diseases is low, and even if you do get something, it’s probably not going to be that severe.”

By contrast, he said, “every vaccine has components in it that are toxic that you don’t want in the bloodstream.”

“There are pros and cons to everything,” Lenz said, “and I just don’t trust vaccines.”

Parents signing vaccination waivers say it’s their right to opt out.

“I don’t believe you can drug your way to good health,” said Sue Waltman of St. Clair Shores, who founded Michigan Opposing Mandatory Vaccines in 1994.

This is a toxic stew of ignorance. “I haven’t seen the studies that convince me vaccines are safe and effective”? Did Lenz bother to look? I highly doubt it, or if he did he didn’t understand what he found or instead found his way to antivaccine websites that confirmed his pre-existing bias against “Western medicine.” The evidence that vaccines are both safe and effective is so massive and overwhelming that Lenz’s failure to see it demonstrates that he is not equipped to evaluate scientific evidence, as does his spouting of antivaccine fallacies straight from the pages of many websites we know and don’t love, fallacies such as: the fallacious claim that diseases like polio were on the wane before vaccines due to better sanitation; the toxins gambit; and the like. It’s the same sort of misinformation that our very own home grown antivaccine activist Mary Tocco regularly spouts.

Come to think of it, I took MLive.com to task for giving Mary Tocco a platform back in August. I wonder if the backlash, much deserved, against MLive.com’s supplying such an antivaccine crank with statewide platform had anything to do with this story.

This story is definitely a major improvement, but it does fall a bit too much for the “tell both sides” fallacy of pseudoscience. On the one hand, there’s Paul Offit and a local pediatrician named Allan LaReau discussing the actual science showing vaccines to be safe and effective. On the other side, there’s an antivaccine parent Marcel Lenz, whose inclusion can sort of be justified as a way of showing how parents are deceived by antivaccine pseudoscience (although that’s not really how MLive used him) and an antivaccine activist crank named Sue Waltman who’s been at it for 20 years with her organization Moms Opposing Mandatory Vaccines which is chock full of antivaccine pseudoscience and misinformation and cites a veritable panoply of antivaccine websites as resources for “research,” including Mercola.com and Barbara Loe Fisher’s Orwellian named National Vaccine Information Center. It even contains a direct link to the form that a parent has to sign to obtain a philosophical exemption for her child. It’s very simple, perhaps even simpler than the California form.

The article makes a good point near the end, quoting Mark A. Largent, associate dean of Lyman Briggs College at Michigan State University and author of the 2012 book Vaccine: The Debate in Modern America:

While there are some parents who are anti-vaccine, “the bigger chunk are vaccine anxious,” Largent said.

“We don’t want the vaccine anxious to find refuge in anti-vaxers. We want to help parents feel the authorities are speaking to them, not at them,” Largent said.

This is why I’ve always said that I am not writing to try to change the minds of antivaccine activists. That is a lost cause. They are too far gone. The chances of changing their minds is minuscule, and it is rare indeed for leaders of the antivaccine movement, like Mary Tocco and Sue Walton in Michigan, and hard core antivaccinationists, like Marcel Lenz, to become pro-vaccine (or even no longer antivaccine). The Dunning-Kruger effect is just that strong. For the, refutation and (sometimes in carefully selected cases) mockery are appropriate. We have to go after the fence sitters, the parents who are anxious about vaccines, not sufficiently knowledgeable about science, the immune system, and infectious disease to recognize the fallacies inherent in the arguments of antivaccinationists and provide them with the knowledge and tools to recognize antivaccine rhetoric for the BS that it is.

MLive promises more, including the policies that facilitate such high personal belief (philosophical) exemptions, more detail about Traverse City, and how the wealthiest county in Michigan has one of the lowest vaccination rates. Good. MLive.com might just make up for its having featured Mary Tocco last summer.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

140 replies on “Who knew? My state’s vaccine personal belief exemption rate stinks!”

Poor you Orac…and lucky me. I live in a *State which permits Religious Belief Exemptions. The case law in my State is replete with parents’ unsuccessful lame attempts to prove those non-vaccinating parents hold sincerely held religious beliefs.

* It must be true, because all the crank anti-vaccine websites have sample letter and hints for those parents to game the system…all unsuccessful because school district lawyers and the State Education Commissioner prevail.

You really should follow Hungary’s example. All common vaccines like measles and MMR are mandatory, exemptions are only given for real medical reasons. The result is on average less than five cases and zero deaths per 100 thousand people per year, and some very frustrated antivaxxers throwing entertaining temper tantrums.

The morons who try to game the system first face very hefty fines, then child protective services get involved, who have the power to take the kid for a forced vaccination. Theoretically they can even take children away from parents permanently for repeated offenses, though the media backlash caused by butthurt freedom fighters would be enormous, so that rarely happens anymore.

My government does a lot of stupid things but in this case I wholeheartedly support them.

” it is rare indeed for leaders of the antivaccine movement, like Mary Tocco and Sue Walton in Michigan, and hard core antivaccinationists, like Marcel Lenz, to become pro-vaccine (or even no longer antivaccine).”

I’m curious – has anyone like this _ever_ renounced their fervent antivax beliefs?

It’s a head scratcher. We had a nice discussion on campus. Our head for infectious disease really put things in s simple statement: you can’t fix stupid. All we can do is educate and follow evidence-based medicine with the end result being supportive care, trachs & ventilation, and finishing with ecmo. Sad.

At least you have some laws that one needs an exemption from. The previous Labour Government proposed a law to stop unvaccinated children from attending pre school/school unless vaccinated. T

At least in America you have laws that can be exempted. In Australia, the previous Labor government proposed a law that would have prevented children from being educated unless they were vaccinated. Alas the ultra conservative government now in place would never upset “the freedom of the individual to choose”. This means that the anti vaccers have free rein to poison the school yards of Australia.

One question that keeps eating at me, since we have this supposed push to exempt families based on their religious beliefs, at what point in time did God go out and tell everyone to try and kill their kids?

Well, Orac, when it gets too cold in MI, come visit me in AZ, where vaccine exemption rates are just as awful. Thanks to AV stupidity, I’ve learned more about pertussis than I ever wanted and a lot of children have learned more about what it means to cough miserably for months on end. And some really unfortunate newborns too young to be vaccinated and learned what it means to go to the intensive care unit..

Anti-vaccine activists are lower than scum.

@Zardas – can you provide a reference to the relevant legal provisions, even in Hungarian? I’m not doubting you, I’d just like to look and learn more about it.

@ MarkN

at what point in time did God go out and tell everyone to try and kill their kids?

Oi, careful here, that’s flame bait.

The Abrahamic god did ask, well, Abraham, to sacrifice his son to Him, although He stopped Abraham at the last second.
(as an aside, Dan Simmons in Hyperion posited that Yahweh was not the only one testing if he should trust the other one)
Since the whole sadistic event was a test of Abraham’s faith and acceptance to blindly follow God’s will, one can read too much into it – and in other mythological events – and decide that one should trust God with his/her life and those of their children, in all situations, including sickness.

In short, religious people don’t think of themselves as putting their children at risk, quite the contrary. They are doing that they think is good for their children.
They apparently didn’t read the biblical sidenote about not trying God’s will.

Personally, I see it as asking God to do your own work; that’s reversing who is supposedly the master and who are the servants in the relationship.
God helps those who help themselves and all that. Insert the fable about the guy sending away rescue teams and waiting for God’s personal intervention during a flood…

There are some places in the US where they do it right. According to previous posts, there are two US states (Mississippi and West Virginia, IIRC) which only allow medical exemptions. But some states have gotten far too lax about it.

I wonder how many of these upcountry anti-vax types are afraid of disease-spreading immigrants. Clue phone for those who are in both groups: vaccination will help prevent you getting infectious disease from other people, no matter where those other people come from. But I fear that rational argument with such people is about as useful as a bicycle for a fish.

The Abrahamic god did ask, well, Abraham, to sacrifice his son to Him, although He stopped Abraham at the last second.

One of Wilfred Owen’s poems tells that story, except that in the poem Abraham follows through with the sacrifice:

But the old man would not so, but slew his son,–
And half the seed of Europe, one by one.

Owen was referring to World War I, but if the anti-vax crowd have their way, it might apply equally to the results of their “success”.

I’m curious – has anyone like this _ever_ renounced their fervent antivax beliefs? I seem to remember reading something a “mom” blogger wrote about six months ago relating her shunning by former friends when she woke up, smelled the coffee, and got her children vaccinated. The name escapes me, though.

Catholics, Protestants, Jewish, Muslims, and even Jehovahs’, have all stated that they do not have a religious fundamental objection to fighting microbes (i.e. vaccines). If anything, have gone out of their way to keep their flocks healthy.

Do parents today love disease more than their kids?

I guess I don’t get it.

Thankfully the rate of vaccine refusal where I’m at is small – but there are cases of measles and pertussis in the city. Not surprisingly, 95% are in unvaccinated folks (normally kids under the age of 15 months, which is when the first MMR is given here).

Eric Lund @12

There is a great reading of that Wilfred Owen poem done by Joan Baez with music composed by Peter Schickele (better know for PDQ Bach).

@ lilady:

I g—gled ( actually Binged) images of different state maps by county similar to what Orac has displayed for Michigan. Whilst I wasn’t able to find a good one for New York I did come up with a 2012 pertussis rate map and wouldn’t you know- those Hudson Valley hippies had high rates. Alas, they didn’t give figures for Crooklyn – where I suspect more cases as well.

[email protected]: I wasn’t aware of that version. The recording I have is from Benjamin Britten’s War Requiem, which uses this poem in the “Offertorium” movement. To devastating effect, Britten paired the last line of Owen’s poem with, “quam olim Abrahae promisisti et semini ejus” (roughly: as Thou didst promise Abraham and his seed).

From what I’ve seen of the states I’ve lived in, generally the blue is concentrated in the more urban areas and some of the college towns with the rural areas trending from red to very red.

So it doesn’t surprise me that Michigan would have a lot of conservative counties.

@Denice Walter:
The irritating thing is that it basically is, if you look at things like the Presidential elections. Unfortunately, we had quite a bit of a “red wave,” along with the rest of the country, in 2010, and the Teaparty people and Republicans took advantage of the census to gerrymander the state all to hell. I’m afraid we’re pretty much scrrewed until the next census, at least.

MarkN @14: The Jehovah’s Witnesses actually used to be anti-vaccine back in the day when they were even nuttier, and their “supplemental” magazine was called The Golden Age rather than Awake! (They were also against using aluminum cookware. F*** if I know.) I never believed in the JW stuff even as a kid, but I still had a certain lizard-brain fear of “what if they’re right about Armageddon?” until I deprogrammed myself, largely by reading a bunch of their early literature. They’re basically fundies now, but the founder, C. T. Russell, was into all kinds of crazy ish, like pyramidology.

On another note, I wonder how much adults keeping up with the shots helps with the situation? I think I was supposed to get booster shots back when I was 21 or 22, but for whatever reason (lack of health insurance at the time?) never got around to it. I did end up getting them back in May, when I spent a night in the ER after tripping and hitting my head extremely hard on some concrete steps. The bleeding was evidently spectacular and unstoppable and I kept repeating questions, so my friends brought me in to get checked out and stapled together. The nurses were like, “Well, you’re not going anywhere for a while, so how about getting your booster shots?”

(The craziest part of that night/day was that I had the oral portion of my qualifying exams the following day. I got out of the ER at noon, I felt okay, and my exams were scheduled in a couple of hours, so I took the bus straight to the department instead of home, unable to see just how gory the back of me was. Needless to say, everyone was horrified, and I was promptly sent home. Word had already gotten through the grapevine, anyway, and my committee had just sort of assumed I’d reschedule… everyone kept asking me how I felt for several days after that, too.)

@Denice (May I call you Denice?)

There is a misconception about the blueness of any state. Most that are labeled “blue” are so because of their largest cities, whilst the rural areas are very “red”. That’s even true in Oregon and Washington, and I would guess California as well. If it weren’t for Portland, Oregon would be as red as Utah. If it weren’t for Milwaukee and Madison, Wisconsin would be as red as Kansas, and if it weren’t for Detroit, as Orac says, Detroit’s red state (fate?) would be sealed. And God help Illinois without Chicago.

Faux News and it’s radio brethren have captured the (limited) imaginations of much of the rural population.

Dorothy @26:
Hey now! I grew up in a “town” of 200 people in rural Washington state, and I have a perfectly broad imagination, thank you.

(I know what you mean, though. I can’t even have much of a conversation with my brother at all, as he’s not really interested in much of anything as far as I can tell, outside of his truck, his job on the railroad, and going hunting and fishing. Whatever floats yer boat, I guess…)

As a Lyman Briggs graduate, it’s good to see a representative of the school supporting science against the wave of BS.

I couldn’t find county statistics for New Mexico, but at least the state has removed the philosophical exemption and is trying to stop parents using the religious exemption as a thinly veiled cover.
http://www.skepticalraptor.com/skepticalraptorblog.php/mexico-removes-fake-religious-objections-vaccine-exemptions/

Unfortunately, the latest statistics from 2011 still show a rise in exemptions.

Hey Orac. I got tired of reading your hateful political screeds contaminating sound medical rants and took a break for a few years, just decided to take a peek and see what’s up. Gosh darn it, you had to go and make nastiness about the “Tea Party” and conservatives in general in a confused garble of conflicting haughtiness right there in the first post. I mean, I grew up in Jersey and know how easy it is for it to infect your perceptions if not your accent, and I lived in MI for a few decades, and saw how those terrible T’s destroyed Detroit and Flint, so I can understand a bit how confused you are, but really, comparing Alabama and Grand Rapids is pretty delusional.

That being said, there are anti-vax folks on all sides of the political spectrum, but your map suggests the areas of the State infested with conservative values have the lowest waiver rate.

@ Dorothy:

Yes, you may call me that- practically everyone does except those required by law to refer to me exclusively as ‘Great White Queen’.
AND they’d better.

@Shay and Dangerous Bacon – probably the best example I can give regarding someone who was truly antivax and has turned around is Shannon Des Roches Rosa at http://www.squidalicious.com/

Shannon has an autistic son, firmly believed it was the vaccines, didn’t vaccinate her youngest child for many years. She is now a huge proponent of vaccines. Reading her blog, as her beliefs have changed over the years, is fascinating.

Although I’m not sure how deeply he was into the anti-vax part but ( Dr) James Laidler bought into the autism woo and even spoke in support of it until he saw the light. ( see Autism Watch).

@MarkN
“Do parents today love disease more than their kids?”
No, that’s not why they refuse or delay their children’s vaccinations. Do you really think it’s possibly because they love disease more than their kids?

Even intelligent and educated young parents have a hard time grasping the levels of risk involved for vaccinations, but it doesn’t take a genius to know that the more of them you are giving to your child, the higher the probability of risk becomes.

In the end, nearly all parents, whether intelligent and well educated or stupid and ignorant, have to make a decision about vaccines for their children. Since the majority of people cannot simply read and understand the scientific literature on it. If they are rejecting vaccines for other than religious reasons and they aren’t reading the scientific literature, but the summaries of the studies produced for non-scientists, they are making their decision based on who they trust. If they trust anti-vaccine sites more than they trust the CDC (and clearly many do), that’s a serious problem that I think should be addressed independently of vaccine laws.

Juniper Russo at Voices for Vaccines.

My fears were a product of a potentially lethal combination of maternal panic and youthful ignorance. I was afraid. I was afraid of autism, of chemicals, of pharmaceutical companies, of pills, of needles. I saw medicine as an impersonal monolith of unpronounceable words and latex gloves, of figures and averages and data. I didn’t trust it with the pearl I guarded inside my womb. I wanted my baby to be safe—and safety, it seemed, could be promised by midwives and crystals, herbs and exercises. I didn’t trust science to provide it.

Juniper is now a very vocal advocate for vaccines and science.

Megan Sandlin at Voices for Vaccines: Leaving the Anti-Vaccine Movement

I now view the anti-vaccine movement as a sort of cult, where any sort of questioning gets you kicked out, your crunchy card revoked. I was even told I couldn’t call myself a natural mother anymore, because vaccines are too unnatural. That’s fine. I just want to be the best parent I know how to be, and that means always being open to new information and admitting when I’m wrong.

Megan’s story is worth reading in full.

Maranda Dynda at Voices for VaccinesI was Duped by the Anti-Vaccine Movement

My journey into the anti-vaccination scene began when I became pregnant with my one and only child. It all started when I watched the documentary The Business of Being Born and decided to pursue a home-birth midwife. After months of searching, I found one in my area who agreed to take me under her care.

At our first appointment, she asked me how I felt about vaccines. “I’m not sure what you’re asking me,” I responded, confused. She then told me about her experiences with vaccines and her seven children. She claimed her one son had a negative reaction, causing him to regress and become autistic. Now, she said, their family does not undergo any medical care except for chiropractic and homeopathics. I was fascinated, to say the least. The idea of not vaccinating was something I had never even heard of, let alone not taking your children to a doctor. But her kids seemed healthy, and she encouraged me to “do my research” on the Internet. And so I did.

Maranda Dynda is a former anti-vaccine mom turned vaccine advocate.

I don’t know much about Michigan, Doc Epador, but in my state, California, the urban areas with the highest rates of vaccine refusal are very much Democratic. The rural areas with high refusals are split between the pot-growing areas (one assumes, quite liberal) and the more conservative, “the government can’t tell me what to do” areas.

And I always thought that Michigan was a blue state.

Well, yes and no. State-wide it tends to vote Democratic, but if you look at the makeup of its contingent in the House of Representatives, you’ll see it’s heavily Republican, much, but by no means all of it, due to gerrymandering. Only five out of 14 of our Representatives in the current Congress are Democrats; the same is true of the next Congress:

http://www.politico.com/2014-election/results/map/house/michigan/#.VInTGYsfN6k

Four out of those five are from the Detroit area. The other covers a district around Bay City/Saginaw area.

Also, as I’ve pointed out time and time again over the years (something I’ve been consistent about over the years), contrary to the stereotype of lefty, crunchy antivaccinationists, antivaccinationism is the pseudoscience that does not skew strongly left or right.

http://respectfulinsolence.com/2014/06/04/the-daily-show-hilarious-segment-about-vaccines-not-so-hilariously-wrong-about-the-politics-of-vaccine-denialism/

http://respectfulinsolence.com/2013/12/18/why-are-antivaccinationists-so-at-home-with-libertarianism/

That is why it’s not surprising that several of the Michigan counties with high rates of vaccine exemptions are in solidly Republican districts. In contrast, then there’s Ann Arbor (quite liberal) with its high exemption rate and Grand Rapids (quite conservative) with its low exemption rate.

“Faux News and it’s radio brethren have captured the (limited) imaginations of much of the rural population.”

A sure sign of an ignorant and unimaginative person is that they write off broad swaths of the population as other and less than.

Recently the LA Times published a map of schools in the state with vaccination rates of each school. I noticed that “Waldorf” schools throughout the state have ridiculously high unvaccinated rates. Some Waldorf schools were approaching 50%.
Waldorf schools teach a quasi religion called anthroposophy and a kind of “spiritual science”. The curriculum is saturated with new age groovyness.

Orac,
I see that you other persona is becoming more deeply involved in outreach to government in order to affect regulatory development. I posted over there as well that these partisan digs that are completely unnecessary to the scientific topic will only lessen the effectiveness. You will be seen as yet another partisan trying to have things your way rather than as an objective provider of scientific information.

Your tea party rant was just that, a rant that provided no analysis of vaccine rates with partisan alignment.

Again, guess what? On this blog, I really don’t care, and it’s not as though I’ve been secretive about it, either. Read paragraph one here:

http://respectfulinsolence.com/2014/12/10/the-dublin-doctor-who-is-not-beating-cancer/

This is my hobby and my personal blog. If my little political rant pisses you off, I don’t care. (Note that I say this as someone who was more conservative politically than you could possibly know as recently as about 15 years ago.) In fact, Michigan is an excellent example supporting my assertion that antivaccine is the pseudoscience that knows no political boundaries. Indeed, I also can’t help but note that my little political rant was to set up why I was surprised that rates of vaccine exemptions in Michigan were so high, given the generally politically conservative political leanings of huge swaths of the state, which are only outweighed by the much larger population in southeast Michigan in statewide elections.

My other, not-so-super-secret blog is another issue.

@Mike:
I don’t know, I think it’s personally reasonable to think about why people don’t vaccinate, and ideology seems to be the driving force for a lot of people, whether it’s left wing or right wing ideology.

Orac,
I am not pissed off. You have changed my thinking that anti-vaccine was based on the hippy wing of the left. It is also in the libertarian/religious wing of the right.

JP,
You are right, but that was not part of the his post. It was just a rant disconnected by analysis to the antivaccine problems.

I had a job interview at Michigan Tech once. Even though I was unemployed at the time, I was relieved I didn’t get the offer and have to decide if the isolation of living in Houghton was a bearable price to pay for a tenure-track gig.

I see Houghton County is among the worst and wonder why. There’s not that people up there outside of Houghton, and MTU’s the biggest thing in Houghton (a town that literally had but one stoplight when I was there.) The area was settled mainly by Finns during a copper-mining boom. (MTU was originally the Michigan School of Mines). The copper ran out long ago, and the region is quite impoverished, though the Finns remain the dominant ethnicity among the locals.

I’m curious why Finns or faculty/staff families at a technical university would be vax-anxious. Could it be the poverty? The crushing boredom? But then why is the Kenewah worse than the rest of the UP? The lake effect snow? (Over 200″ /year).

Orac probably doesn’t know. Traveling by car, Detroit to Washington D.C. is fewer miles than Detroit to Houghton. Detroit to Houghton is 6 hours by airplane (only the tiny slow ones go there). Weird.

Rural culture in the U.S. is not one thing, and has also changed over times. Back in the days of ‘family farms’, farmers were a staple of progressive politics: e.g. The Wizard of Oz being a populist allegory where the farmers (scarecrow), and industrial labor (tinman) join with W. J. Brian (cowardly lion) to free America (kansas) from the gold standard (oz, yellow brick road). IRL there was the Farm-Labor Party in Minnesota, and The Non- Partisan league in North Dakota. Anyone who’s spent time in Iowa knows the phrase “West of Des Moines” — a polite term for wingnut-land. When Jesse Jackson ran for President in the 80s, he had a lot of support from farmers East of Des Moines in the caucuses.

Over the decades, though, the rise of corporate farming, the collapse of many small-farm-town economies, depopulation as independent farmers who can no longer make a go of it are forced to move to urban areas and different lines of work, and the weakness of poorly funded progressive organizers who can’t come close to matching the resources of Koch-backed influence groups, all have pushed a lot of rural districts towards the Right.

I suspect that there could be a couple of ideologies feeding into the antivax movement and they don’t all tend to be in the same political wing.

It is both man-made (crunchy granola left) so bad and gov’t says to do it (Don’t Tread on Me right) so bad.

Who posited that the political spectrum is a circle not a line and if you go far enough on the deep end from either direction you end up being more alike than the middle of the road left or right leaning folks.

@sadmar

Yeah, that area of the UP near Houghton really surprised me too. Why so much worse than the rest of the UP? As for living in Houghton, I just couldn’t do it. It’s too isolated, and the winters are just too brutal.

Sadmar,
I would suggest there are few other reasons for the urban rural divide. I had a career in Extension working with the family scale farmers. The political issues they mentioned the most included guns and environmental regulations, particularly a worry about fencing off streams which just happened this year in MD.

There is certainly populism in rural areas. there is distrust of big businesses. Currently the groups are squabbling over the beef checkoff, in part due to how much the Beef Board should work with packers, mostly 5 large businesses. That squabbling is so bad that the USDA is preparing to set up another Beef Checkoff so there will be two of them.

Such a joy to see this post today. Here I thought, smugly, all those west coasters not vaccinating their children, they are so far away, we are so safe. NOT. I have ‘liberal’ family/friends, and ‘conservative’. The ideologies they match up on? Anti-vaccine, or at least question vaccines. GMO’s.

My only guess about Michigan Tech area is maybe libertarianism? Yoopers are their own breed, for good or bad. They are an extremely independent bunch. And to choose Michigan Tech as your college, you have to be a pretty independent person. It’s far from anywhere. I was ASTOUNDED the Kent County area was low exemptions. But there is a pattern elsewhere, with Houghton/Midland/Ann Arbor/Traverse City areas? People with money? The Mackinaw City area was a shocker too.

/sigh Great. Another thing to worry about with my children. Thank you Orac. I shared this article in hopes someone might change their minds before its too late. But looking at this, sadly I think it is too late.

Mike:

Medical science is always constrained by social, economic and political contexts. Vaccination is a Public Health issue — what individuals choose affects everyone — and Public Health is a question of public policy and therefore of government and politics. Anyone who truly cares about rising VPD outbreaks and doesn’t look at the politics is being irresponsible.

Policy on vaccine exemption does not necessarily correlate to the ideological distribution among the vaccine-anxious. Remember, were talking about minorities among groups. A ‘liberal’ area with a 40% vax exemption rate still has 60% pro-immunization, and these folks aren’t one issue voters. The representatives they elect are far more likely to support Public Health initiatives with some teeth. Even if 95% of Tea Party ideologues vax their kids, their representatives are going to back pretty much any anti-guvment measure, especially one couched in terms of religious freedom and ‘family over state’.

Except, of course, that Baum did not concienve of orauthor the Wizard of Oz as a populist political allegory.

The idea that he did arose with the publication of an article by Henry Littlefield in the fall 1968 issue of the American Quarterly, but in an article pubklished 3 decades later (“The Wizard of Allegory”) admitted he created the theory simply as a device to teach his high school history students about the Populist movement, and that he never expected it to be taken seriously.

I have to say that I’m very disappointed in my fair adopted ciy, Ann Arbor. It’s even more shameful considering the caliber of the medical school here, and the general level of education. Geez, what is it, the hippies?

Not that one’s education level always makes a big difference, I guess. I was just at the department’s little annual holiday party, and at the “grad student” table, we somehow started talking about leeches, maggots and other fun things, and someone mentioned that maggots are actually used as a medical therapy sometimes, for necrotic wounds.

One of my colleagues said that she’d rather they use maggots than “some nasty chemical that’s going to give you cancer, or some kind of experimental plastic or something.” Um… first of all, I’m pretty sure nobody would ever wrap a necrotic wound in plastic, and secondly, I’d rather have someone use whatever would work best to save life and limb, myself. (I said as much.) Oh, the naturalistic fallacy…

“Just a city boy
Born and raised in south Detroit
He took the midnight train goin’ anywhere…
Don’t stop, believin’
Hold on to the feelin’…”

I am not sure what sort of believin’ Steve Perry was advocating in the song, but I doubt it was personal vaccine belief exemptions.

One of my colleagues said that she’d rather they use maggots than “some nasty chemical that’s going to give you cancer, or some kind of experimental plastic or something.”

Whiskey Tango Foxtrot. I would think that someone with a necrotic wound has more immediate worries than cancer. Deal with that first, please, and as you say, use whatever means works.

I’ve yet to come upon a single valid argument against compulsory vaccination with only exemptions based on genuine medical issues. I really don’t think your religion or your philosophy justifies putting me at risk. Or at the very least if you don’t get vaccinated and you get a contagious disease and spread it, anyone who catches said disease from you should have a legal claim against you. And certainly you should be subject to both wrongful death suits and criminal prosecution if anyone dies as a result of your lack of vaccination (this includes passing influenza to at risk populations due to failure to be vaccinated).

Denice,

And I always thought that Michigan was a blue state.

I know someone who was convicted, not too many years ago, of growing a few marijuana plants in Michigan (in an attempt to stop their teenaged son from going into Detroit to score weed) and got jail time. The judge said that he wished he had the power to give the death penalty instead! That’s about as conservative as it gets, in that one county at least (Livingston County, should anyone care).

JP,

Geez, what is it, the hippies?

From what I know and have seen of Ann Arbor, which I love, I’d say so.

Born and raised in south Detroit

There is no such place as “south Detroit,” at least no such place that locals refer to as “south Detroit.”

Ah, but at least in Ann Arbor you have Zingerman’s. I would probably commit a minor crime for a lifetime supply of their scones.

For a state that has a high level of science & education in it, and touted as a beacon of personal health and well-being, looks like my home state is also the pinnacle of really bad decisions on infectious disease:

http://www.kunc.org/post/colorados-personal-belief-exemption-target-new-report

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6341a1.htm

In fairness, I should correct my statements on religion in my state as they show much more responsible compliance (1% waiver) than the personal-exemption (94%). Considering I put in a lot of hours at one of the best catholic hospitals, they actually do have great people there that take community health as the highest priority. And, the children’s is really top notch. Surprising that the state sucks so much at the reality of infectious disease.

However, the Southeast, with all it’s mass of health problems, surprisingly shows pretty high compliance in taking on infectious disease. I really wouldn’t have thought that.

Parents of young children, aside from those motivated and competent to do their own research, make their choice based on who they trust. My daughter had to do this a couple of years ago, when she was pregnant. She an intelligent college-educated young parent.

She ended up giving up on learning enough about vaccines to make an educated choice. She complained to me about how the information she could both find and understand was biased and untrustworthy. She didn’t feel she could understand the scientific literature in a timely manner to make her decision, not to mention she didn’t want to commit that level of her time and intellectual energy to that decision.

She and her spouse finally opted to follow the recommended schedule for her daughter. She made her choice based on trusting the people on the pro-vax side more than the anti-vax side.

I suspect this is what most young parents do. Certain ideologies, such as tea-party and hippies, have strong anti-government biases. If their motivation is based in ideology, I think that it is lack of trust in authorities that correlates with opting out of vaccines.

@Greg H “I’ve yet to come upon a single valid argument against compulsory vaccination with only exemptions based on genuine medical issues. I really don’t think your religion or your philosophy justifies putting me at risk.”

I’m opposed to making any vaccination compulsory on based on the privacy of personal health decisions. I don’t have a problem with the current system of making vaccines the normal and requiring people to ‘opt out’ of getting them. I think there are reasonable rules currently in place with regards to requiring non-vaccinated students to stay home during an outbreak, etc. If day-cares don’t want to accept non-vaccinated kids, I’m okay with that.

Making them compulsory with only medical exemptions just stomps all over personal privacy rights and the right to make personal health care decisions. In my value system, the risks – including the risks of outbreaks – are not worth the cost.

Among other costs, keep in mind that one cost of any law is people being killed in the course of enforcing the law. I just learned this principle as a result of discussions on the killing of Eric Garner for selling loosies. It applies to ALL laws.

A child’s parent might be killed if they stand in the way of their child being vaccinated. I’d far rather that family was allowed to home school their child if that’s how they feel about the matter and there are parents who feel that strongly about vaccinations.

Orac: “There is no such place as “south Detroit””

At least it sounds more real than the neighborhood that Paper Lace sang about in “The Night Chicago Died”:

“Daddy was a cop
On the east side of Chicago”

Daddy must’ve been a _very_ good swimmer.

Michigan needs at law like WA state enacted in 2011. For the 2010-11 school year, nine counties had exemption rate of 10+ % and 15 counties, including the most populous county (King) had rates in the 5-9.9% range. The law was enacted that year and now, for 2013-14 school year, it has changed dramatically. Now, we have four counties with higher than 10% exemption rate and 14 counties with 6-10% exemptions. Both the most populous counties lowered exemption rates. Only one county, Ferry, increased exemption rates.

I call this a success.

http://www.doh.wa.gov/DataandStatisticalReports/Immunization/SchoolReports#graph

My own county saw a decrease from having 10+% exemption rates to now being in the 5-10% range. We still have a great deal of work to do to make these rates decrease even more, but this is a start!!

Except that what authors think they’re doing, or say about it later, is completely irrelevant to what the creative work actually means. The question is not what Baum intended. It’s not even whether most contemporary readers saw only a childrens’ story free of any subtext. The question is whether the text itself does in fact function as an allegory of Gilded Age politics.

Dorothy is from Kansas. Her Aunt and Uncle are dirt poor farmers. A scarecrow is a symbolic farmer, warding off predators. Industrial workers were men made to act as machines. W. J. Bryan did talk big and act soft. Dorothy must travel to a big city on a path of yellow bricks fraught with dangers. The wizard is a fraud who scares citizens into submission. The magic shoes are silver.

To argue these things have no meaning is to bury your head in the sand.

I’ve read various attacks on ‘the Littlefield thesis’ published mostly by (conservative) regional historians, and they’re utterly unpersuasive. No allegory (intentional or accidental) is ever pure, and the many elements of WoO that deviate from a pure progressive line are just what one would expect in any popular text. Articulating the pure party line has no dramatic tension, and even intentional propagandists know they usually have to grant a certain credibility to the other side before cutting it down.

I remember one article said Oz references the White City, as if that somehow undermines any populist/progressive subtext of the story. But the Columbian Exposition was marked by the tension between the Arnoldian ambitions of Olmsted in the grandeur of the White City, and the more commericalized debauchery of the Midway — both seductive and spectacular, though at the same time the authoritarian implications of the former and the licentiousness of the latter also appeared quite frightening to rural Americans rooted in the Jeffersonian ideal of simple things and make-for-yourself and not yet ready for the power shifts brought by modernity and industrialization. Oz is both White City and Midway. It seduces, like any gleaming metropolis, but dangers lurk within, and there’s no place like home.

The populist movement in the agricultural Midwest is well established historical fact. The easiest way to reference the politics involved in terms contemporary readers can understand is via the Wizard of Oz, noting how Hollywood changed the slippers from silver to ruby.

There is no such place as “south Detroit,” at least no such place that locals refer to as “south Detroit.”

They call it Windsor, don’t they?

Ah, but at least in Ann Arbor you have Zingerman’s. I would probably commit a minor crime for a lifetime supply of their scones.

Zingerman’s is without a doubt the best deli I have been to on four continents. Now I’m hungry.

Those of you wondering about Houghton County: there’s a lot of Houghton County that ain’t Houghton, or Michigan Tech. There are people up in Calumet who haven’t ever been over the bridge, and I’m talking about the lift bridge between Houghton and Hancock, not the Mackinac Bridge. And in those areas there are a lot of very conservative, anti government people, who I think tend to see vaccinations as part of that government. And it wouldn’t surprise me if religion plays a role too. I’m not sure exactly how the Apostolic Lutherans view vaccination, though. Have to check up on that.

@Denice Walter

I didn’t know that they had delis in India.

I’ve been hearing about a new one there for years.

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