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


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.


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.