Central Illinois Medical Community Fights Skepticism Amid Measles Outbreak | WGLT

Central Illinois Medical Community Fights Skepticism Amid Measles Outbreak

May 23, 2019

Vaccination rates remain high in McLean County despite what the medical community says are efforts by skeptics to sow confusion over settled science, and they claim it’s putting our health at greater risk.

Health experts say skepticism about vaccines is a leading factor why measles is still spreading, 20 years after the highly contagious disease was considered no longer a threat in the United States. The World Health Organization lists vaccine hesitation as one of the 10 greatest threats to global health.

Illinois is one of nearly two dozen states to report a measles outbreak this year, and the number of cases nationwide is approaching 900.

Illinois Department of Public Health Director Dr. Ngozi Ezike said the department has reached out to communities which have experienced lower vaccination rates.
Credit Illinois Department of Public Health

It prompted the Illinois Department of Public Health to launch a public safety campaign. One component is to examine parts of the state where vaccination rates have fallen below 95 percent, what’s called herd immunity, a threshold that greatly limits the threat of an outbreak.

“Given the fact that we are at 98 percent as a (state), that tells us that there are small pockets here and there that are at risk,” said Dr. Ngozi Ezike, director of the Illinois Department of Public Health. 

Ezike said 9% of Illinois schools currently have vaccination rates below 95%.

“There are pockets throughout that are religious, faith-based, versus other reasons. It’s a multitude of different reasons as to why we are below our threshold in certain communities,” Ezike said. 

Illinois mandates children get the vaccines for the measles and a host of other diseases before they are allowed to enroll in school, but there are two exceptions for medical reasons and religious reasons. Parents can get a waiver from their doctor.

All but three states allow nonmedical exemptions. Oregon is looking to become the fourth state, after a measles outbreak sickened more than 70 people in neighboring Washington.

Based on data obtained by the Illinois State Board of Education, most McLean County schools have high vaccination rates well within the herd immunity range.

District 87 Superintendent Barry Reilly said the district must regularly address concerns about vaccines fueled largely by social media.
Credit Carleigh Gray / WGLT

“Because the vast majority of our students are immunized, we do not have a great concern,” District 87 Superintendent Barry Reilly said. “That doesn’t mean you don’t take precautions.”

The data shows District 87 had just one school fall below the threshold for herd immunity, only because it’s numbers were submitted to the state before all of its transfer students produced their proof of immunizations. All of them since have.

Reilly said it is on ongoing battle to combat skepticism about vaccine’s safety.

“Information that’s put out there whether it’s through social media or through other means to publicize or promote that, there’s a reason why people market it – whatever it is, because marketing works,” Reilly said.

Vaccination Rates
Infogram 

Social Media Skeptics

You can find plenty of skepticism about vaccines on social media. One of the most vocal skeptics is a Bloomington chiropractor.

“In the media they are making measles out to be the next deadly disease, and I just don’t believe that is true,” Dr. Susan Mitchell said. “If you look back in past years, we are all going to die of the swine flu, we were all going to die of Ebola, we were all going to die of West Nile virus, and it was all scary. Now this year (there’s a) big concern for measles.”

Mitchell acknowledged measles can be serious, but she suggests vaccines pose their own health risks for many, but doctors look past that simply so they can push more vaccines.

“No one blindly trusts our government, no one blindly trusts even the pharmaceutical companies and we have an opioid epidemic right now,” Mitchell said. “So no one trusts these organizations except when it comes to vaccines, which is just super interesting to me."

The World Health Organization reports 110,000 people died from measles in 2017, out of 6.7 million cases.

That's a death rate of 1.6%. Data from the Centers for Disease Control show the rate of severe complications and death from vaccines is far less, less than two one hundred thousandths of a percent [.0000015].

Mitchell said many doctors blindly give the vaccines they are told to give without examining the ingredients and the potentially harmful side effects, which she said several of her clients have experienced, and she claims in some case doctors ignored them.

None were willing to talk to GLT for this story for fear of public backlash, something Mitchell said nearly kept her from speaking to us.

“I’m not a popular person,” she said. “I’ve been called all kinds of names on social media. If I’m 100 percent honest, I almost backed out of (the interview) today because I am putting myself at risk.

“There are a lot of people out there that are so strong in their belief systems, which in my experience most people that are super strong in their belief system and really get super angry about it are the least educated about it.”

Mitchell’s two children, ages 16 and 19, were not vaccinated as children. She said as a Christian, she opposes the use of aborted fetal cells for some vaccines.

Religious Exemptions

Religious exemptions are the most common type of exemption in McLean County.

The two schools which fall below the state recommended 95% herd immunity are faith-based. Calvary Christian Academy, a K-12 school in Normal, has a 93% vaccination rate in the 2018-19 school year, while the lowest vaccination rate in McLean County is at Cornerstone Christian Academy in rural Bloomington.

Nearly 7% of its students have religious exemptions, lowering the school’s vaccination rate to 92%. That surprised Doug Pavey, who is head of the school.

“Day to day, you have so much on your plate, I tend to not think about these specific details sometimes until it’s brought to my attention,” Pavey conceded. “What I’d like to do is put our nurse on notice to track this percentage now that we know we are below that threshold.”

Schools don’t face any consequences for having low vaccination rates, and Pavey said the state hasn’t contacted them.

Pavey added he would like to see a greater percentage of students get vaccinated, but he respects that it’s a personal decision that families must make on their own.

“I wouldn’t be opposed to working internally to try to increase (vaccination rates),” he said. “In my mind, I’m not sure what steps we can take other than talk to the families and attempt to convince them to reconsider.”

Another common religious exemption doctors in Illinois see is from Orthodox Jews; some of them refuse vaccines because they are not kosher.

Doctors seem to largely support the need for vaccines, but like any profession, opinions run the gamut. Some doctors are more sympathetic to others when it comes to vaccine hesitancy.

Joseph Flint, a doctor who runs Delevan Pediatrics touts himself as vaccine choice. It says so on his website. It says Dr. Flint has a special interest in the role of natural and homeopathic treatments for common medical conditions. He declined to be interviewed for this story. 

The vaccination rate at Delevan Elementary School is 92.8 percent, according to the ISBE.

Many doctors struggle with respecting a family’s religious obligations while still upholding the Hippocratic Oath of "Do No Harm." But what’s to stop a family from claiming a religious exemption simply because they have a moral objection to the vaccine? Nothing.

Dr. Kimberly Marshall is a pediatrician with Advocate Healthcare in Bloomington. She was one of several doctors who told us it’s not a physician’s place to ask.

“It’s much easier when you have a group like some of the ultra-Orthodox Jewish groups that say that certain vaccines aren’t kosher,” Marshall said. “That’s obvious. That’s easier do document. Here you pretty much have to take their word for it.”

The Illinois Department of Financial and Professional Regulation licenses physicians in the state. According to the agency, doctors simply must explain the health risks of not getting the measles vaccine to the parent or guardian. It’s left up to schools to determine their validity.

IDFPR spokesman Paul Isaac said he’s not aware of any doctors failing to honor this requirement or if there are any consequences for not doing so.

“The doctor or caregiver provides such education based on the medical literature and professional experience, tailoring the presentation to the particular circumstances at hand. However, the doctor or health professional signing the form stating that education has been provided is not making any determination about the validity of the religious objection,” Isaac said in an email.

Mark Jontry, superintendent for the Regional Office of Education for McLean, DeWitt, Livingston and Logan counties, said his office will conduct random examinations of each school’s immunization records, but that’s simply to ensure that each student is accounted for and they have produced a waiver if they are not vaccinated.

There’s nothing more doctors can do to prompt a family to immunize, except no longer accept them as patients. And some do.

Susan Mitchell, the vaccine skeptic, suggested a more sinister reason some doctors are rejecting non-vaxxers; it could hurt their pocketbook.

Pediatrician Kimberly Marshall said she understands some doctors may fear someone spreading a highly contagious disease at their practice, but she also acknowledged doctors may have a financial incentive to keep non-vaxxers away.

“Unfortunately in my mind, over time as we change the way we are reimbursed for taking care of patients, certainly there are ways insurance companies look at how good of a physician we are and one of the (factors) can be the immunization rate of our patient base,” Marshall said. “That can impact how we are rated as a physician for that insurer, and that may affect our reimbursements.

“We would still do what’s medically appropriate, but I do think insurers and hospitals are looking more closely at things like immunization rates.”

For her part, Marshall said she’s currently not accepting any new patients, but she would not turn away a family because of their choice on vaccines.

“I personally, historically, have taken patients that don’t immunize because I feel like education is important and I would like the opportunity to discuss and build relationships with families so that over time, hopefully they learn to trust the word of their physicians and take our recommendation,” Marshall said, adding she has in some select cases converted families into believing in vaccinations.

She said in many cases, however, parents leery of vaccines will simply home-school their children.

“The problem we run into is the vast majority of the people that I have that don’t immunize don’t attend school,” Marshall said. “At least they attend school at home. I have very few patients who go to public schools who get exemptions.”

She knows of close to 20 client families who have taken the home-school option. 

Vaccination Rates - By School
Infogram

Doctors Opinions Vary

The medical community has largely unified around this vaccination campaign. Advocate Healthcare announced it was sending thousands of letters to pediatric clients across the state to urge parents to make sure their children are vaccinated.

Dr. Aaron Traeger said doctors helped contribute to uncertainty about vaccines by not speaking more forcefully about it when the measles was thought to be eradicated.
Credit Eric Stock / WGLT

Aaron Treager is a pediatrician with Advocate Children’s Medical Group in Normal and helped lead the effort locally.

Traeger said he sympathizes with parents whose child may have been injured or became ill after taking the vaccine. It does happen, though it’s rare.

“If the parents deeply believe their child was harmed by the vaccines, how can you not feel that? How can you not as a human being say I feel for that person and I don’t want that for my child as well,” Traeger said. “I understand where they are coming from. Having said that, the science is there.”

Data from the Centers for Disease Control show the most severe reactions to vaccines happen in one out of 667,000 patients.

Traeger partly blames some of the mistrust over vaccines on the medical community itself for sending mixed messages at a time when the measles were presumed to be a disease of the past.

“Parents would say, ‘What about this, can it cause these problems?' or something like that, and the doctors that I would work with would say, ‘You know what, we think if it’s safe but what if it’s not? But I still think you should get the vaccines.’

“That’s wrong, from the very beginning the American Academy of Pediatrics and the international scientific community said no, this isn’t right, (the vaccine) is safe,” he said.

Traeger’s experience illustrates the varying ways medical professionals wish to address the measles.

While Advocate has no formal policy regarding whether doctors may grant vaccine exemptions, Traeger said no doctors at Advocate BroMenn would grant an exemption, and he claimed there are only a few in all of Bloomington-Normal who would. However, data provided by Unit 5 schools shows 21 physicians in the Normal-based school system alone granted at least one vaccine exemption during the 2018-19 school year. 

Dr. Paul Pedersen, chief medical officer at OSF Healthcare in Bloomington, is president of the Illinois State Medical Society.

Dr. Paul Pedersen, president of the Illinois State Medical Society, said doctors have considerable leeway in deciding whether to grant vaccine exemptions.
Credit OSF Healthcare

“There are physicians who have their own personal opinions, as there are patients who have their own personal opinions about vaccinations,” Pedersen said. “The medical literature would suggest vaccinations are far and away more helpful than they are damaging.”

Pedersen said while the society’s stance is that vaccines are largely safe and effective to a large majority of the population, it’s not a punitive body that would take action against doctors who freely give out exemptions.

“Physicians have wide latitude in their decision making, but certainly the Illinois State Medical Society would suggest in order to protect both the patient and the rest of society, it would be appropriate to make sure the patient has indeed a medical contraindication to vaccination.”

Doctors also have the latitude to remove or not accept families who refuse to vaccinate. In many cases, those families end up at the county health department.

Interim McLean County Health Department Director Tammy Brooks said the department has seen an increased number of families at its clinics because more physicians are refusing patients who won't vaccinate.
Credit Tammy Brooks

Tammy Brooks, the interim McLean County Health Department director, oversees the community health services clinics for the department. Brooks said county clinics have seen an increased number of families in their clinics, which she attributes to more doctors refusing to accept the unvaccinated.

“It is very concerning, especially to our most vulnerable population, very young children who have not been vaccinated yet, as well as anyone who might have health issues that would compromise their immune system and are not able to get the vaccines, it leaves them wide open to exposure,” Brooks said.

Brooks said she’s noticed an increase in skepticism about vaccines in recent years, which she said has added another layer of responsibility for the medical staff.

“Someone might think they just give shots, but they spend so much time providing education up front so that parents can make educated choices on what immunizations their child will receive and then if parents have questions, they go into extensive details,” Brooks said.

Sue Keam is an immunization nurse at the health department. She said the most persuasive way to encourage vaccination is to bluntly tell parents the risks of going unprotected. 

Vaccination nurse Sue Keam with the McLean County Health Department said nurses spend a great deal of their time educating families about vaccinations.
Credit Eric Stock / WGLT

“We tell them about things that can happen to their child and allowing them to make the choice. I think when you know your child (might) die from the disease it really hits home,” Keam said.

Universities

The recent measles scare prompted Illinois State University to alert its entire campus community about the threat, urging all faculty and staff to make sure they are up to date on their vaccinations.

Unlike students, university employees don’t need to show any proof of vaccinations, unless there was an outbreak, in which case anyone potentially exposed to measles – even being in the same classroom – would have to produce the papers or face quarantine for three weeks.

That poses a challenge on college campuses where in some cases faculty and staff got their shots many years or even decades ago and may not remember which vaccines they did or didn’t get.

Susan Rausch is a staff physician at ISU’s Student Health Services. She can speak from experience.

Dr. Susan Rausch of ISU's Student Health Services said university campuses could have heightened risk of a measles outbreak since faculty and staff don't have to show proof of immunizations.
Credit Eric Stock / WGLT

Rausch said she learned only a few years ago after an inquiry from her boss and a close examination of her immunization records, she never received the mumps vaccine, which a blood test confirmed.

“Even though I was born in the era that should have been exposed to mumps and I had gone through lots of higher education, it just so happened I was never caught in any of the school requirements because they became requirements after me,” Rausch said.

“There is a concern that employees on the campus, if they don’t know their immunization status, they may not be immune like they think they are.”

ISU reports its student vaccination rates have consistently surpassed 99 percent, even higher than the general population in Illinois. Rauch said that’s because the university is vigilant in making sure students prove they were immunized as children and if not they encourage the student to make the choice now that they are old enough to decide for themselves.

“I sometimes tell students who I meet who are not vaccinated, it doesn’t mean that your parent was a bad parent, your parent was doing what they believe was best for you, so we really do encourage students when we meet them to rethink that choice because it’s never too late to vaccinate.”

Students at ISU who fail to produce their immunization records within about a month of the start of classes face a $50 fine and would be banned from enrolling the following semester unless they get the required vaccines.

Illinois Wesleyan University reports it has two students returning for the 2019-20 school year who have religious exemptions. Heartland Community College in Normal is not required to maintain immunization rates since the campus doesn’t offer student housing.

Tammy Brooks with the McLean County Health Department said it’s become easier to downplay how serious measles can be since Americans have had so little exposure to it.

“People often don’t have a complete understanding of those diseases because a lot of them we haven’t seen in so long,” Brooks said. “Certainly the generations coming up now with children, they didn’t see some of the diseases because vaccines subdued those.”

The Centers for Disease Control reports the measles-mumps-rubella (MMR) vaccine is 93 percent effective; a second dose is 97 percent effective.

Even though the medical community has boosted education efforts on the effectiveness of vaccines and the risks of going without, they don’t expect skepticism will ever go away.

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