We can’t talk about the measles outbreak in Michigan without discussing the anti-vaxx movement.
And we can’t discuss the anti-vaxx movement without scrutinizing the specious premise that the measles vaccine is, on the whole, more dangerous than measles itself.
At this point, 39 people have been diagnosed with measles in Michigan, the highest number since 1991.
Three dozen cases may not seem like a lot for a disease once so ubiquitous that public-health officials assume anybody born before 1957 has already had it.
For most Americans of that generation, measles was a miserable experience – high fever, red eyes, ear infections as well as the tell-tale rash – but certainly not life-threatening.
But there’s a reason a measles vaccine was greeted with such excitement in 1963, especially among doctors. Measles can have serious complications, including pneumonia, encephalitis and hearing loss.
People can die. Before the vaccine became widespread, measles killed an estimated 2.6 million people a year worldwide. Most of the victims were children.
Even today, about 100,000 people die annually from measles. That’s not just in the Third World. Measles deaths have recently occurred in Israel, Italy, France. German health officials say about a fourth of their reported measles patients end up in the hospital.
These are preventable illnesses, preventable deaths. The vaccine works. Measles could go the way of smallpox – total eradication – if enough people get immunized.
Enter the anti-vaxx movement, which views the vaccine as its own health hazard.
Hundreds of Michigan schools and child-care programs are vulnerable to a measles outbreak because of the numbers of unvaccinated children, according to public health data.
Almost 400 public and private K-12 schools and 295 day-care programs had 10% or more of their students submit a vaccine waiver in 2017, state records show. More than 1,000 K-12 schools and 800 day cares have vaccine waiver rates of more than 5%, which is about a quarter of all K-12 schools and 22 percent of day cares. Experts say you need a vaccination rate of 95% to keep measles out.
2017 vaccination rates for Michigan public and private schools
This online database shows the 2017 vaccination waiver rates by school building. The numbers here are for kindergartners, seventh-graders and transfer students. The caveat: The number of children asked to provide records or a waiver is typically a relatively small fraction of the school population.
2017 vaccination rates for Michigan child-care programs
This database shows 2017 vaccination rates for more than 3,700 child-care programs in Michigan. The law requires those facilities to obtain vaccination records or a waiver from children newly enrolling in their program.
Quality of sources
When I first started reporting on vaccines and the anti-vaxx movement in 2014, I began with researching both sides of the issue.
Quickly, I found myself down the rabbit hole of endless arguments and counter-arguments.
To cut to the chase, I changed my focus from quantity of information to quality of sources.
Who are the top experts on each side? What do the peer-reviewed published studies say? Where do medical and scientific organizations stand?
With that, the fog lifted.
What I found: The global medical and scientific community is firmly, overwhelmingly, on the side of vaccinations. In the past five years, I have yet to come across a single, major mainstream medical organization anywhere in the world that endorses the anti-vaxx movement.
Not one.
Anti-vaxxers will tell you that’s because Big Pharma has bought off the American medical and scientific establishment.
But that doesn’t explain the global support of vaccinations -- in countries where Big Pharma has no influence, in socialized systems where the profit motive is a non-factor.
The consensus around vaccinations is particularly striking when you consider all the many, many, many ongoing debates in the medical community. The value of heart stents, back surgery, opioids, to name a few. The timing and frequency of mammograms and PSA testing. Last week, the American College of Cardiology and the American Heart Association announced they no longer recommend a daily aspirin to reduce the risk of heart attacks.
And those are just the disagreements within the United States. Globally, there are even more clashes about best practices.
Yet the importance of vaccinations unites medical establishments around the world, experts from different nations with different medical perspectives and traditions.
This map that shows 2017 childhood vaccine waiver rates at a county level, combining the numbers for K-12 school and child-care programs. You can click on a county to see the underlying data
To be sure, like any medical intervention, vaccines are neither foolproof nor risk free. There are cases of serious adverse reactions to vaccines. Some people who are fully vaccinated can still get the disease.
Moreover, there’s no question vaccine effectiveness and safety are important issues worthy of more research and study. A legitimate debate can be had about which vaccines should be mandatory and which pass a cost-benefit analysis.
But after decades of widespread immunization, there is overwhelming evidence the benefits of vaccines far outweigh the downsides.
Let’s look specifically at measles.
In the early 1960s, the U.S. was averaging 400,000 to 500,000 reported measles cases a year. By 1968, the number less than 25,000. Today, thanks to the vaccination, a once commonplace disease has almost been eliminated in America.
This graph shows the number of reported measles cases per year in the United States from 1954 to 2008. The measles vaccine was introduced in 1963. (Source: CDC)
Meanwhile, most American children have gotten the MMR vaccine to prevent measles, mumps and rubella, and studies show serious adverse reactions are very, very rare. How rare? From 2006 to 2017, more than 101 million doses of the MMR vaccine were administered in the United States. During that time, the National Vaccine Injury Compensation Program paid settlements on 120 claims for serious injuries involving the MMR – one settlement for every 850,000 doses.
To put the latter statistic in context: About one in 1,000 measles patients die, and that doesn’t include those who experience complications such as hearing loss or permanent brain damage. It also doesn’t include the deaths and complications related to mumps and rubella.
And realize without a vaccine, almost everyone would catch measles at some point; it’s an airborne virus and one of the most contagious diseases on the planet.
It’s no exaggeration to say just the measles part of the MMR vaccine has saved tens of millions of lives globally – and thousands in the U.S. – over the past 40 or so years. It’s very, very hard to argue that risks linked to the MMR outweigh that.
There’s a huge irony at work here. Unvaccinated Americans don’t see measles as threat because they live under the protective power of herd immunity. To get measles, you have to be exposed to the virus. When you live in a community where the vast majority have been vaccinated, chances of exposure drop significantly.
But the more anti-vaxxers convince others not to vaccinate, the more herd immunity breaks down and measles resurges. We’re seeing that in Europe, Israel and Japan. In the United States. In Michigan.
What’s happening in Michigan is not cause for panic. But it is cause for concern. We really don’t want to return to the days when measles ran rampant.
What we can do is push harder for global vaccination. The faster it happens, the faster measles will be eliminated and concerns about the disease -- and the MMR -- will become moot.
Julie Mack is a reporter for MLive’s Public Impact team. She is a 1981 graduate of Michigan State University, a journalist for four decades and has been based in Kalamazoo since 1990.