The Trust For America’s Health (TFAH) recently examined the nation’s ability to respond to public health emergencies. They tracked progress and vulnerabilities, and included a review of state and federal public health preparedness policies. In their report titled Ready or Not? Protecting the Public from Diseases, Disasters and Bioterrorism, they found that 26 states and Washington, D.C. scored a six or lower on 10 key indicators of public health preparedness.
As Every Child By Two continues to report on the State of the ImmUnion, we’ve asked Trust for America’s Health to elaborate on the vaccine section of their report in the following guest post co-authored by Dara Alpert Lieberman, MPP, Senior Government Relations Manager and Albert Lang, Senior Communications Manager.
The Importance of Vaccines Can Never be Overstated
“Some of the greatest public health successes of the past century — including the worldwide eradication of smallpox and the elimination of polio, measles and rubella in the United States — are the result of successful vaccination programs.”
Yet, somewhere along the way we lost our wonder in the awe-inspiring results vaccines produce.
A recent model estimated that, from 1994-2013, the Vaccines for Children program prevented as many as 322 million illnesses, 21 million hospitalizations and 732,000 deaths at a net savings of $1.38 trillion in societal costs. And, each year, we know that three million lives are saved because vaccines exist and are administered. According to the CDC:
- Nearly everyone in the U.S. got measles before there was a vaccine, and hundreds died from it each year. Today, most doctors have never seen a case of measles.
- More than 15,000 Americans died from diphtheria in 1921, before there was a vaccine. Only one case of diphtheria has been reported to CDC since 2004.
- An epidemic of rubella (German measles) in 1964-65 infected 12.5 million Americans, killed 2,000 babies, and caused 11,000 miscarriages. In 2012, 9 cases of rubella were reported to CDC.
If you think this is hyperbole, remember that we effectively eliminated measles in the United States in 2000, yet, since 2014, we have experienced a resurgent number of measles cases, largely among people who were unvaccinated.
In our recent report, Ready or Not? Protecting the Public from Diseases, Disasters and Bioterrorism, we found that just 10 states vaccinated at least half of their population against the seasonal flu.
We like to use this as a bit of a proxy indicator. Basically, if we can’t vaccine a large portion of the population for something that is more or less the norm, what are the odds we could quickly vaccinate a majority of the population during a pandemic. For example, if there was a vaccine for Zika, would the nation been able to dispense it?
Another lesson we can draw from vaccination rates: when we become complacent, our preparedness suffers. We can’t let vaccine complacency continue. To improve vaccination rates, TFAH’s report included policy recommendations such as: Read more…
What Have We Learned From Last Year’s Measles Outbreak?
Last year the United States experienced a large, multi-state measles outbreak that was largely responsible for 189 measles cases that spread across 24 states and the District of Columbia. It’s believed that the outbreak started from a traveler who contracted measles overseas and then visited the Disneyland amusement park in California while infectious. Widespread media coverage of the outbreak helped elevate public concerns related to the dangers of measles infection, the consequences of a growing number of school vaccine exemptions and the risks of disease among those who were too young or medically unable to be vaccinated.
At this time last year, it seemed as though we were experiencing a tipping point; a growing number of people were beginning to realize that vaccine refusal had consequences that could threaten our nation’s public health. The fact that the personal decisions of a select few people was able to threaten herd immunity and the health of many unsuspecting families and communities was worrisome.
It was believed that more parents (including some who had previously refused vaccines) were seeking and accepting vaccination for their children as a direct result of the outbreak. However, to determine whether clinicians were experiencing any real or lasting changes in vaccine acceptance, Medscape conducted a survey of vaccine providers to find out.
The survey, conducted in July of 2015, included 1577 physicians, nurse practitioners and physician assistants who worked in pediatrics, family medicine and public health. Responses confirmed that the measles outbreaks induced more acceptance of the measles vaccine and vaccines in general. The survey also indicated that, for some parents, a greater acceptance of vaccines was directly related to the fear of the disease, the consequence of being denied admission to schools, daycares or camps, and a greater knowledge about vaccines as a result of more reading on the subject. However, in some cases there was no change.
Every Child By Two also experienced a heightened amount of interest in the months during and immediately following the outbreak with a record number of inquiries from parents. Most were asking for information about the dangers of measles infection and for clarification of the MMR (measles, mumps and rubella) vaccine schedule. There were many parents who were specifically inquiring as to the possiblity of vaccinating their children before the recommended age in order to protect them during the outbreak. Shot of Prevention blog posts that included content specific to measles infection and MMR vaccination had record numbers of views in the early months of 2015, and personal stories relating to the outbreak, were widely shared on social media.
One story that drew a lot of attention was an open letter by Dr. Tim Jacks, whose two children had to be quarantined after they were both exposed to measles at a Phoenix Children’s Hospital clinic. His 3-year-old daughter Maggie had a compromised immune system as a result of fighting acute lymphoblastic leukemia (blood cancer), while his 10 month old son Eli had received all his recommended vaccines, but was still too young for his first dose of MMR vaccine. While neither of his children ended up contracting measles, the frustration he expressed in his letter entitled “To the parent of the unvaccinated child who exposed my family to measles” hit a nerve with a lot of people.
The Focus of Immunization Rates Fades as Cases Dwindle
In reaching out to Dr. Jacks this week, it appears that the attention on vaccinations that was raised during last year’s outbreak appears to have been rather short-lived. He explained,
“As a pediatrician, I regularly discuss vaccines, exemptions, and last year’s outbreak. The cold facts and data only reach so many, so my family’s story adds a personal angle to the issue that questioning parents rarely consider. After the media exposure, many families were aware of our situation. However today, the measles issue is not on as many people’s minds. Vaccine exemption is however a hot issue in Arizona. The Arizona political arena is considering avenues to encourage vaccination and I am hopeful that the coming year will produce progress in that regard.”
Today, a little over a year since the outbreaks began, the good news is that there have only been two reported measles cases so far in 2016. However, it also appears that history may be destined to repeat itself.
Consider, for example, the reports out just this week about a California charter school student who tested positive for measles after returning home from traveling overseas. With just 43% of kindergarteners at the Yuba River Charter School being up-to-date on their MMR vaccine, the California Department of Public Health has attempted to prevent a measles outbreak by first closing the school to all students, and then remaining closed to those without a measles vaccine until April 8 as long as no new cases are documented.
Despite overwhelmingly high vaccination rates across the country, with a mere 1.7% national vaccine exemption rate among kindergartener’s for the 2014-2015 school year, and a 90%+ coverage of MMR vaccine among 19-35 month old children, these small pockets of unvaccinated children continue to present a risk of future measles outbreaks. Read more…