VANCOUVER, Wash. — The Thanksgiving holiday, for some, may be conjuring up bleak memories of the COVID-19 pandemic. Not only was it harder to see loved ones during the thick of the outbreak, but it made us aware — perhaps for the first time — that gatherings of families and friends carried the risk of spreading the disease to more vulnerable people.
COVID-19 is still with us, but vaccines are at least widely available. At the same time, dissent that came to a head during the pandemic concerning perceptions of vaccine safety is perhaps being felt more keenly now than ever.
Pertussis, more commonly known as whooping cough, is a respiratory infection that spreads easily. It starts with symptoms that seem like a cold: sneezing, runny nose, low-grade fever and a mild cough. But within two weeks it can cause fits of coughing so severe as to make it hard to catch your breath — accompanied by the characteristic "whooping" sound that earned the bacterial infection its nickname.
As of Nov. 2 of this year, the state of Washington had reported 1,193 cases of whooping cough for the season, compared to just 51 by the same time the year before. Likewise, in Oregon, the state had 850 reported cases as of Nov. 19, compared to just 33 the year before.
Many of those cases, according to health officials, were among adults or children who were not vaccinated — despite the modern DTaP vaccine, which protects against pertussis, being available since at least the 1990s. Throughout the U.S., vaccination rates among young children have been waning, with vaccine exemptions reaching "the highest percentage ever reported" this school year, according to a study shared in a recent CDC report.
It's been a similar story with measles. Between the late 1990s and the 2000s, vaccines had all but eradicated measles in the U.S. But since the 2010s, localized outbreaks have started to crop up again every few years.
This year, the Oregon Health Authority tracked a measles outbreak centered on Marion County that grew to 31 cases, hospitalizing two people. Cases were overwhelmingly among young people, nearly half of them under the age of 10.
This was a larger measles outbreak than in 2019, then considered an outlier, when Oregon saw 28 cases linked to an even more widespread outbreak in Clark County.
These trends have local public health officials, like Clark County Public Health Director Alan Melnick, sounding the alarm.
"As a physician in general, it's really frustrating to see people get sick, have their lives disrupted, potentially die — and you know, we're talking about children here as well — from something that is very preventable," Melnick said. "There's no reason why we should be seeing these outbreaks and illnesses from something that is preventable with something that is so safe and effective and inexpensive as a vaccine."
Someone who has been vaccinated against whooping cough can still contract it, but Melnick's department said that it's not nearly as severe in those cases.
The reason why families choose not to vaccinate their kids can range. For some, there are barriers to accessing health care, or there may be religious reasons. But in many cases it's a matter of vaccine hesitancy, or perhaps resistance, among families who could otherwise seek vaccination but don't — and those numbers seem to be growing.
According to the OHA, only about 1% of kindergartners before the year 2000 had a non-medical vaccine exception. By this school year, that share had grown to 8.8%.
How to reach the vaccine hesitant
Dr. Ben Hoffman is a pediatrician and the director of two hospital programs focused on children. He's currently the national president of the American Academy of Pediatrics. We asked him why those numbers had been growing, and in Oregon especially.
"I think there are a lot of reasons," Hoffman began. "So first of all, there has always been an undercurrent of vaccine hesitancy in Oregon that's different than in a lot of other places. I practiced in New Mexico for 15 years before I moved to Oregon in 2011, and the concerns about vaccines and some of the beliefs about vaccines, they're very different in Oregon. I think some of it comes from the history of libertarian ideals; what I've learned to appreciate as the Oregon frontier spirit."
And then there are concerns that continue to percolate about a link between the measles vaccine and autism, Hoffman added, stemming from a single long-discredited study published in 1998. Despite the fact that the study's conclusions were never replicated or supported by other works, its influence is still being felt today.
"And so I think those two factors — the concern about the impact of vaccines and then the desire for personal freedom and even parental rights — sort of meld here in a unique way that we're seeing now, I think, a little bit more nationally, but has been a consistent issue here in Oregon for decades," Hoffman said.
As a pediatrician, Hoffman said that he knows vaccines are among the most effective ways to protect kids, families and communities from potentially deadly disease. But in Oregon, something like 10% of parents disagree.
In 2019, a bunch of those parents rallied at the Oregon Capitol, protesting a bill in the legislature that would have tightened the state's opt-out rules for kids in school, which grant exceptions for any self-proclaimed religious or philosophical belief. The bill died as part of a deal to end a Republican walkout.
The people who protested that bill said that they were not necessarily against vaccines, but they did not want the government forcing their kids to get shots. But at least some of those parents believed that they were protecting their children by not getting them vaccinated.
Reaching those people, Hoffman said, comes down to establishing trust.
"When we're talking about vaccines, really what we're dealing with is settled science, and the fact that fear gets interjected through rumors and social media and other issues makes it really complicated ... it can instill fear in families," Hoffman said. "I think that's why having a trusting, you know, long-term trusting relationship with somebody makes it a little bit ... it makes it easier to to have trust.
"If you've built trust over time — I mean one one of the ways, in conversations that I have with families, one of the things I assure them is I would never recommend for their child anything that I did not or would not recommend for my own child. And I promise you, all of my children have been vaccinated in accordance with the best practice recommendations."
Simply asserting authority — telling someone that you're the doctor and you know best — doesn't work, Hoffman said.
"That's never been my style. I was taught very differently — as I said, meeting people and families where they are, and that becomes easier over time as you learn to learn to develop mutual trust," he said.
Barriers and breaking them down
One of the things that's complicated the problem of vaccine hesitancy is the U.S. health care system itself. Visits to the doctor are becoming shorter and shorter, and in many cases harder to access, which makes it more difficult for health care professionals to establish a rapport with patients.
"We want a system that supports, that puts kids and families and communities in the center and provides for their needs in a way that is authentic and decreases barriers," Hoffman said. "So that, you know, if the biggest barrier to a family getting their child vaccinated are concerns, that we have an opportunity they can get to see me that we have time to sit down and have the conversation we need to have — meaning that I'm not being forced to move rooms every six minutes — that we can have the conversation in their language so that I can utilize, you know, adequate interpreter services. And then I have the ability to work with them to actually get that vaccine to their child in the most expedient, simple way. And that the system now is set up that there are so many barriers — the payment issues, the access issues and all of that."
The worst-case scenario is that there will be a tragic resurgence in preventable disease before vaccine uptake recovers. That's a new problem for health care professionals, because when many of these vaccines first came out there was much more awareness of the harm that the diseases themselves could cause.
"If you go back to the '50s around polio," Hoffman said, "you know the '40s and '50s with polio, people lined up in the streets (for vaccines) because everybody knew somebody who had been severely affected by polio and was in an iron lung or was, you know, was going to have lifelong disabilities because of that. We absolutely do not want to get back to that."
With diseases like whooping cough and measles on the rise, that scenario is what Hoffman fears most.
"It terrifies me," he said. "It terrifies me."
