Last year, El Paso County saw 56 cases of whooping cough. By January, thanks to an outbreak at Disneyland, it also had a case of measles. And according to Dr. Bill Letson, medical director for El Paso County Public Health, we could keep seeing people contract diseases that are easily preventable with a vaccine.
Twenty states allow parents to opt out of vaccines for medical, religious and personal reasons, but Colorado is particularly lenient — parents just sign a form once, without additional requirements or renewals. That's why the Colorado Department of Public Health and Environment has asked the Board of Health to require renewals, and has also launched immunizeforgood.com to encourage vaccinations.
The Center for Disease Control's National Immunization Survey data shows that Colorado's measles immunization rate, 86 percent, is considered statistically no different from the national average of 91.9 percent. Meanwhile, in its own random survey of 350 kindergartners, the state found a measles vaccination rate of 81.7 percent, compared to a national median rate of 94.7. That comparison is only so useful, though, because each state uses its own survey methods.
One thing is certain: Fewer kids are getting vaccinated. Though Letson and other health professionals have tried to debunk fears about vaccines — including the discredited argument that they cause autism — he says of parents, "it's difficult to convince them."
In the mid-1960s, Dr. Donald Henderson led the World Health Organization's Global Smallpox Eradication Campaign. Henderson is credited with eradicating the disease worldwide — as in, he wiped it so cleanly off the face of the planet that we're not even vaccinated for it anymore.
Smallpox could be deadly, and there wasn't a lot of resistance to taking a vaccine for it up to 1972, when vaccination stopped. The disease was declared eradicated in 1980.
"We were able to get more cooperation than you might see with, say, an influenza vaccine," says the doctor and professor today.
After smallpox, Henderson worked on the campaigns that eradicated endemic polio (1991) and measles (2002) in the Western Hemisphere. Now in his 80s, and a dean emeritus and distinguished service professor at John Hopkins University, Henderson has lived to witness the return of major measles outbreaks in America.
He says that, in a way, it's predictable. Shots can seem scary, especially for young children, and we've lived without so many of these infectious diseases for so long that people have forgotten how bad they really are. But he remembers.
Henderson says he wonders how parents would feel if they refused to vaccinate their child, only to have the child get measles and die, or suffer one of the other possible consequences, such as the onset of an intellectual disability.
"One way [to get people to vaccinate] would be to show a child with severe measles, who's permanently handicapped or blind because of having measles," he says. "We need a visual picture."
As of July 2014, Colorado law requires schools to track what percentage of their kids are vaccinated, and to provide the information when asked.
School districts normally track two numbers: an exemption rate and a compliance rate. An exemption rate is the percentage of children who were exempted from vaccinations. A compliance rate includes exempted kids, vaccinated kids, and kids who are scheduled for vaccination. It does not include kids for whom the district doesn't have a proper record.
The vaccination percentage requirements for herd immunity vary by disease, but can be quite high. The CDC, for instance, has said that as much as 94 percent of the population must be vaccinated to prevent the spread of measles.
Concerns were raised recently when education news blog Chalkbeat Colorado published vaccination rates for all schools within the state's 20 biggest school districts, including Colorado Springs School District 11, Academy School District 20, and Harrison School District 2. Some schools, especially charters and alternative schools, had alarmingly high rates of exemptions.
Take Classical Academy College Pathways, in the D-20 area. It has an exemption rate of 37 percent. It does, however, boast a 100 percent compliance rate. D-11's Buena Vista Elementary, a Montessori school, has a 14.29 percent exemption rate, the highest in the district, and an 89.9 percent compliance rate. D-2 fares better: Giberson Elementary has the highest exemption rate in the district, at 4.11 percent, and the school has a 99.7 percent compliance rate.
Because exemptions can concentrate in certain schools, district-wide exemption rates tend to be lower. Districts also don't generally include the rates of charters in their districts that they don't license. (Some charters are licensed by a state agency.) So, for instance, D-20 doesn't have to factor in the high rates at the Classical Academy schools.
Overall, D-11 has a 2.33 percent exemption rate and a 91.6 percent compliance rate. D-20 has a 17.5 percent exemption rate and a 96.5 percent compliance rate. Harrison has a 1.7 percent exemption rate and a 91.31 percent compliance rate. Falcon School District 49 has a 5.14 percent exemption rate and a 98.5 percent compliance rate. Manitou Springs School District 14 has a 15.3 percent exemption rate, and a 98.4 percent compliance rate.
But the numbers don't tell the whole story. D-11 spokesperson Devra Ashby notes they're a snapshot in time. And Letson notes that even the kids who've been immunized may not have followed the proper schedule, meaning they may still be susceptible.
Henderson thinks some vaccines should be mandatory for children who are physically able to have them. (Uninsured and under-insured families can get shots at the county clinic, which gave 9,614 immunizations in 2013 alone.) One case of measles, he notes, could infect every unvaccinated child in a classroom — and not every child can be vaccinated.
"Of all the vaccines, measles is the one disease which spreads so well ... so this is really an alarm to say we've got a problem," he says. "And I think we also need to start thinking about whooping cough. We may also need to start thinking about diphtheria."
Henderson notes that studies have shown that kids who live through measles are more susceptible to other serious maladies for more than a year after. And these diseases come with suffering.
With whooping cough, he says, a child "begins coughing, and coughing, and coughing, and often they turn blue in the face. They are gasping for air and then suddenly — ooooooo — a very long inhalation, which is the 'whoop.'"
Why, he wonders, would parents want to risk that for their child? And is it really fair for one parent to put other people's kids at risk?
"The feeling is, you are part of a social community," he says, "and it's not just your child that's going to be affected."