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Measles is spreading rapidly in several parts of the country, with more than 700 cases reported in 22 states. It's already more than in any other year since 1994 – and it's only in April.
In New York, the state with the highest number of measles cases, the virus has been on the move since last September, mostly among orthodox Jews, some of whom reject vaccines for unsubstantiated safety reasons. This epidemic triggered another outbreak in Detroit. In Washington State, where another major epidemic has just ended, mistrust of health officials and pharmaceutical companies has pushed parents to retreat. There are also measles clusters in New Jersey, Michigan, Maryland and California, among other states.
These outbreaks will cost the states and the federal government millions of dollars. They will turn away from other important public health programs. More importantly, they will put at risk those who can not be immunized – newborns, children allergic to the vaccine.
But here is the most frustrating part: all of this is totally avoidable. In 2000, thanks to the highly effective measles vaccine, the virus was declared eliminated in the United States. It is absurd that epidemics have reappeared.
However, there is a major reason for this: too many states make it too easy for parents to avoid vaccines on behalf of their children. In other words, measles is making a comeback because of a policy failure.
At present, most people with measles have not been immunized against the virus. And many live in places that allow for various non-medical exemptions (religious or philosophical) vaccines.
Epidemics generally began as follows: An unvaccinated American gets the virus while traveling to a country where measles spreads more widely and then returns it to his under-vaccinated and welded community of the United States. (The top three countries at the origin of measles cases in the United States were Ukraine, Israel and the Philippines.)
If these travelers and their families had been vaccinated, we would not have measles here. And when the ease of vaccine withdrawal is associated with the fact that there is a greater risk of contracting measles elsewhere, it is not difficult to understand why the disease is related again.
States give parents too many ways to avoid vaccines
To understand why it can be easy to opt out of vaccines, you need to understand our national vaccine requirements system. This is at best an exercise in federalism: there is a multitude of variations in the country with respect to individual immunization mandates.
It was in fact the measles outbreaks of the 1960s that prompted states to require children to be immunized before starting kindergarten. By the 1980s, all states had introduced mandatory vaccination laws. The idea of these laws was simple: almost universal vaccinations maintain the immunity of the flock.
However, even though each state has legislation requiring vaccines for students entering school, they almost all allow exemptions for people with religious beliefs against immunization and 17 states currently grant exemptions. philosophical opponents to vaccines because of personal or moral beliefs. (The exceptions are Mississippi, California, and West Virginia, where the country's strictest vaccine laws allow only medical exemptions.)
In these places, withdrawal may mean simply listening to a doctor or health official, explaining the benefits of vaccination or obtaining a signed statement of your notarial religious beliefs. In 45 states, even without exception, children can benefit from "conditional entry" to school by promising to be vaccinated, but schools do not always care to follow up.
We have a lot of evidence, covering more than a decade, that shows that when parents have greater ability to avoid vaccinations, vaccine exemption rates tend to be higher. The latest US immunization policy review in 2018 found that states allowing religious and philosophical exemptions – as 17 Member States currently do – were associated with a 2.3% decrease in vaccine vaccine rates. measles, mumps and rubella and a 1.5% increase in total exemptions and non-medical exemptions.
And many states with more permissive vaccine exemption policies, such as New York, Washington, and Michigan, are currently experiencing epidemics. California, home to one of the most dynamic epidemics at the present time, is an exception. In 2015, the state abolished non-medical exemptions, but the immunization mandate applied to school-age children and the epidemics that affected them mainly affected adults. Thus, even by closing vaccine gaps after generations of permissiveness, not all those who are not vaccinated will necessarily be captured.
Travelers bring measles back into very united communities where it spreads
Measles outbreaks have another thing in common: in 88% of cases, outbreaks occurred in what the Centers for Disease Control and Prevention call "welded communities" or people of the same origin who share values. and convictions and dialogue often.
This phenomenon is not specific to a religion or a cultural context. This year, measles has spread among orthodox Jews in New York and the Slavic community of Washington. In recent years, we have witnessed explosive outbreaks among the Amish of Ohio and the Somalis of Minnesota.
Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases, told Vox earlier this year that tightly knit communities have become a priority for the country's health departments. When measles strikes, epidemics in these groups tend to be "explosive" and more difficult to control.
Although the reasons for vaccine skepticism may be different in each of these communities, the groups themselves have much in common. They are cohesive and conservative. They seem to trust more than strangers. They also speak the same languages and read or watch the same information. This means that anti-vaccine rhetoric spreads easily, as do viruses. "We think that these communities are more similar," added Messonnier, and their insularity helps "the escalation of epidemics."
Thus, more than Facebook, the real social networks seem to turbolize the dissemination of anti-vaccine views and viruses like measles. But again, we would have few problems in these communities if it was not so easy to withdraw vaccines.
So what can we do to stop it?
During the current epidemic, states and cities have taken extraordinary measures to vaccinate people, ranging from a fine to those who do not wish to, through the obligation to vaccinate against the spread of the virus and shut down primary schools or quarantine students. The Washington State Senate has also passed a bill to eliminate personal and philosophical exemptions for measles-mumps-rubella vaccine. (It still has to be signed in law.)
But it is not certain that these measures of repression in the midst of ongoing epidemics will help. They are responsive and have a hard head – and they risk turning against them, causing the vaccines to worry. Especially when it comes to very close communities, public health officials need to build trust over the years, to get communities and community leaders on their side.
States must also find ways to make disengagement more difficult by taking measures such as conditional school entry or by introducing exemptions with regular renewals. These measures are more subtle than mandates or fines and may be more effective.
States should go fast. The percentage of people seeking non-medical exemptions – although still low – has also increased from 1.1% in 2009-2010 to 2.2% by 2017-18. Epidemics in recent years have also gained momentum, Vox earlier this year told Emory vaccine researcher Saad Omer. "It's the canary in the coal mine for me."
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