Amid debate, doctors say it’s clear: Immunizations work

By Amelia Pak-Harvey

apak-harvey@lowellsun.com

LOWELL — Although concern is rising over a nationwide measles outbreak linked to a Disney theme park, kindergarten vaccination rates for Lowell-area schools remain high.

But the outbreak has sparked a wider-ranging debate over immunization, and how to strike a balance between parental rights and public health.

The Centers for Disease Control and Prevention reports 141 cases of measles in 17 states and Washington, D.C., since Jan. 1, an outbreak experts believe began at Disneyland in California.

The rising number of cases throughout the country has sparked debate over childhood immunizations, which came into the spotlight in 1998 after research — later discredited — claimed to link them to autism.

In Massachusetts, a state not yet affected by the outbreak, a vast majority of parents are still choosing to vaccinate their kindergarten-age children.

Yet the state Department of Public Health reports that the rate of vaccine exemptions has increased in recent years — and in Fitchburg-area schools, a small percentage of kindergartners still have a vaccine exemption.

Pediatrician Mark Gilchrist, chief of pediatrics at Lowell General Hospital, has also noticed an increase in people opting out of vaccines.

“Over the past 15 years, there has been an increase in the number of parents who are going against the recommendation of medical experts,” he said. “These parents have instead opted to delay or withhold immunization entirely. As a direct result of this decision, the measles outbreak has reached more than a dozen states.”

In California, parents can opt out of vaccinations for their child under a personal-belief exemption.

Massachusetts only allows medical or religious exemptions, although parents could effectively use the religious exemption to opt out of vaccines for personal reasons. Families don’t need to specify their religion in their note to their child’s school district.

“We have to go on the honor system — essentially, that the parent asserts a religious exemption,” said Kevin Cranston, director of the Bureau of Infectious Disease at the Department of Public Health. “And there’s not a mechanism for verification.”

Dr. Michael Grodin, a professor at the Department of Health Law, Bioethics and Human Rights at Boston University’s School of Public Health, said the dilemma creates a tension with parental authority.

“Parents have an authority to do all kinds of things with their kids,” he said. “They can determine a lot of things for their children until they become adolescents.”

But on the medical side, Grodin said doctors have an obligation to children and public health to try and get people vaccinated.

“The problem here is that the vaccine needs to be done as an infant, or a small child, who obviously can’t make any decisions on their own,” he said. “So they’re depending on their parent.”

The state requires that all students receive vaccines for measles, hepatitis, chickenpox and other diseases before entering school. In an outbreak of measles, mumps, rubella, or other diseases, schools can exclude students who do not have the necessary vaccinations.

Despite a noticeable increase in exemptions, rates for many Greater Lowell kindergartners range from only 1 to 3 percent.

In Lowell, nearly all public elementary schools have an exemption rate of zero, according to Department of Public Health statistics from the 2013-14 school year.

Lowell Community Charter School has 1.9 percent of its kindergartners exempt, while Lowell Collegiate Charter School has only 1.1 percent.

“Our compliance is very high,” said Lowell school nurse coordinator Lesa Gulbicki. “We have some students on a catch-up because they’re new to the country, but they still have to have the minimum shots in order to be entered in.”

In other towns, one to three elementary schools in each district had exemption rates that ranged from 0.6 percent in Wilmington to 3.3 percent in Chelmsford and Dracut.

Across the state, more than 90 percent of kindergarten students had the required vaccines in the 2013-14 school year.

“Overall, Massachusetts does extremely well in childhood immunization,” Cranston said.

With childhood immunizations, Cranston said the state has nearly achieved herd immunity — the point at which those who are not vaccinated can still be protected from diseases — across the board.

“It not only protects immunized children but it protects individuals who cannot be immunized, for example, the youngest infant or people with medical conditions that preclude them from being immunized,” he said.

Despite a noticeable increase in exemptions, naturopathic doctor Amanda Tracy, who practices in Andover, said she has noticed a decrease in a concern over autism throughout the past 10 years.

Tracy helps families with counseling on vaccines, which she said are not a “black-and-white” issue for some families.

“We do see children with multiple allergies in naturopathic medicine, maybe more so than in conventional medicine,” Tracy said of naturopathic doctors. “If they are reactive to chicken or eggs or dairy or yeast, they may have some concerns with some of the vaccination ingredients.”

She said she has recently seen fewer families that are against having all vaccinations.

“People are more concerned on individually what’s best for their family and their child and how to navigate that,” she said. “There seems to be less concern over vaccines as a whole, but people want to make the right decisions as they go through the process.”

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