Measles

The MMR vaccine protects against measles, mumps and rubella.

THE ISSUE

An analysis by LNP’s Heather Stauffer of the numbers of vaccinated students found that only three rural counties have a higher rate of exemption from vaccination than Lancaster County. In order for a community to achieve what is termed “herd immunity,” at least 95% of the population must be immunized. As Stauffer reported, “Vaccination rates were above that 95% bar in the 2017-18 school year statewide, but below it in Lancaster County, where the overall percentage of students who were current on any given vaccine ranged from 86% to 93%.” Pennsylvania law allows parents to have their children exempted from vaccination for philosophical and religious reasons, as well as medical ones.

Let’s see if our state lawmakers can understand this simple math problem.

Subtract 6% or more from 100% and what do you get?

A population that’s more vulnerable to an outbreak of vaccine-preventable disease is what you get.

And peril for babies, for pregnant women, and for people whose immune systems are compromised by illnesses such as cancer.

Because in Pennsylvania immunization exemptions are handed out as if they were lollipops, parents in Lancaster County are seeking exemptions for their schoolchildren at alarming rates. Here, nearly 1 in 10 students has been exempted from some or all vaccinations.

And that is lowering our community’s defenses against diseases for which science and medicine decades ago provided the answer: safe, reliable vaccines.

This is deeply frustrating to physicians such as Shakthi Kumar, of Lancaster Pediatric Associates, who wrote in the March 10 Sunday LNP that it is distressing “to be distracted from new battles because we are still fighting old ones.”

Dr. Kumar wrote that she trained in India and has seen “the devastation caused by infections such as diphtheria, tetanus, whooping cough, polio, measles, mumps, rubella and meningitis.”

‘Brady Bunch’ vs. science

Yet in the United States, parents — sucked into the dangerous campaign of misinformation and quackery that is the anti-vaccination movement — blithely dismiss the danger of diseases such as measles, which can result in brain swelling, pneumonia, blindness and death.

Those possible outcomes were noted in an op-ed written in last week’s Sunday LNP by Dr. Joseph Kontra, chief of infectious diseases and director of infection prevention at Penn Medicine Lancaster General Health.

We’d rather heed Kontra than anti-vaxxers who — aiming to downplay the seriousness of measles — point to a 1969 episode of “The Brady Bunch,” in which the Brady kids become sick with the measles and revel in their time off from school. (Actress Maureen McCormick, who played Marcia Brady, has felt compelled to counter the anti-vaxxer narrative.)

Here’s the reality of measles: “Measles is the most contagious infection on Earth,” Kontra wrote. “It is so contagious that a full 90% of nonimmune persons, even when exposed briefly to a measles patient, will become infected. ... In the decade prior to the 1963 availability of the vaccine, an estimated 4 million people in the U.S. got measles each year. Out of the 549,000 average annual reported cases, there were 48,000 hospitalizations, 1,000 cases of brain swelling resulting in chronic disability, and 495 deaths.”

Declared to have been eliminated in the United States in 2000, measles is returning with a vengeance. According to the Centers for Disease Control and Prevention, the number of measles cases in the United States has reached its highest level in more than 25 years, with 1,001 cases in 26 states — including Pennsylvania — reported through Wednesday.

That owes significantly to the anti-vaccination movement.

Easy exemptions

We understand why parents would seek to exempt from vaccination a child with legitimate medical issues. Medical exemptions require a physician’s approval.

But as Stauffer reported last Sunday, “philosophical exemptions dominate in Lancaster County; there were 774 among the 11,788 county students in the 2017-18 school year, compared to 127 medical and 217 religious.”

To obtain a philosophical or religious exemption, all a parent needs to do is to sign a piece of paper, which offers only a single line for the parent’s explanation. That’s it.

According to data from the Pennsylvania Department of Health for the 2017-18 school year (the latest available), public schools in Lancaster County had an average exemption rate of 4%.

But private and charter schools had an average exemption rate of 12%.

And schools too small to be included in the state report had an astonishing average exemption rate of 45%.

“For the 2017-18 school year, 44 religious exemptions were claimed at private and charter schools in the county,” Stauffer reported. “Of that total, 20 were for a group of 47 kindergartners at Susquehanna Waldorf School in Marietta.”

Susquehanna Waldorf is not a religiously affiliated school. But a recent New York magazine article noted that the founder of Waldorf education, Rudolf Steiner, believed “vaccination could impede proper spiritual development.” Waldorf schools, with their emphasis on art and play and “countercultural wholesomeness,” that article observed, tend to attract parents who are overwhelmingly “white, affluent and well-educated.” Annual tuition for grades one through eight at Susquehanna Waldorf is $9,300 — and that doesn’t include hundreds of dollars in fees.

"A colorful, engaging, nurturing and natural journey of the senses, filled with wonder,” is how one parent describes Susquehanna Waldorf on its website.

We’re left with wonder, too: How can nearly half of a kindergarten class go to school without the required vaccinations? It doesn’t appear to be a matter of scant financial resources.

It’s mystifying. And worrying.

And Susquehanna Waldorf isn’t alone in its high exemption rate.

No theological objection

As Stauffer reported, four years of reports show an average exemption rate of 19% for kindergartners at Ephrata Mennonite School.

And one year of data from Shalom Mennonite School in Terre Hill shows a 35% exemption rate among seventh-graders.

As we noted in March, the Amish and Mennonite churches have no theological objection to vaccination.

A statement emailed to Stauffer from Shalom Mennonite School described an overall sense of “respect within our patron body for the individual choices of each family.”

Joshua Good, administrator of Ephrata Mennonite School, said this: “I feel that parents should be empowered to make the decisions that they feel are best for their children.”

What about other people’s children? What about the infant too young to be immunized? Or the parent undergoing chemotherapy and susceptible to illness?

Where has our sense of collective responsibility gone?

Matter of public health

And why aren’t Lancaster County lawmakers — who represent what is clearly an anti-vaccination hotbed, ripe for a disease outbreak — acting to eliminate personal-belief exemptions?

As Stauffer reported, Montgomery County Democratic state Sen. Daylin Leach introduced a bill last month that would end philosophical and religious exemptions.

We understand why Lancaster County’s state Sens. Ryan Aument and Scott Martin would be reluctant to co-sponsor a Leach bill. It was reported last week that an inquiry into sexual misconduct complaints made against Leach found a “lengthy pattern of troubling behavior.”

So propose your own bill, Sens. Aument and Martin. We implore you. We ask the same of the rest of the Lancaster County delegation to Harrisburg. And state House Majority Leader Bryan Cutler: You have the sway to fast-track such a bill in your chamber.

Lawmakers in other states are working to eliminate personal-belief exemptions because they pose a clear and present danger to public health. It’s well past time for lawmakers to act here, too.