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Michael Hiltzik

Rich, educated and stupid parents are driving the vaccination crisis

How ignorance and wealth combine to produce the anti-vaccination crisis

The most shocking and disheartening story you'll read in the Los Angeles Times today may be our piece on the stunning decline in vaccination rates among California's kindergarten-age children.

Kids are coming to school with immunization exemptions at twice the rate of seven years ago. As my colleagues Paloma Esquivel and Sandra Poindexter document, high rates of "personal belief" exemptions from child immunizations are correlated with high median incomes. They write:

"In Los Angeles County, the rise in personal belief exemptions is most prominent in wealthy coastal and mountain communities, The Times analysis shows. The more than 150 schools with exemption rates of 8% or higher for at least one vaccine were located in census tracts where the incomes averaged $94,500 — nearly 60% higher than the county median."

That 8% exemption level is the point at which lack of immunization threatens herd immunity, an important factor in preventing and constraining disease outbreaks. 

We can see signs of damaged herd immunity in stark statistics: California, which has experienced 61 cases of measles so far this year, four times the level at this point a year ago, has been identified by the Centers for Disease Control as a national trouble spot. California is also currently dealing with a whooping cough epidemic, at least partially because of declining vaccination rates.

State law requires entering kindergartners to be vaccinated against measles, whooping cough, polio, mumps, rubella, hepatitis B, chicken pox, diphtheria and tetanus. Parents can get personal belief exemptions, but the standards for allowing these have clearly become unacceptably loose in recent years. Nor does the state appear to have a policy governing the circumstances under which an unvaccinated child be permitted to attend school.

Let's be plain about a personal belief exemption: It's based on nothing. Parents may claim it because of something they've heard, or something they've read, or something they've been told by an indulgent pediatrician whose license should be scrutinized with great care by medical regulators. But it's not based on science, which tells us that, except under certain very specific conditions, vaccines are safe. (Those with medical reasons to forgo vaccinations can also obtain exemptions, but these are rare and often temporary.)

The childhood diseases that immunizations guard against are what are dangerous, and allowing inchoate personal beliefs to introduce unimmunized children into schools is a distinct threat to public health.

Esquivel and Poindexter quote Tammy Murphy, superintendent of the Montecito Union School District in Santa Barbara, a district that has an astonishing 27.5% exemption rate, stating that she tries to respect parents' decisions.

"I don't think they make this decision out of a place of ignorance," Murphy told them. "It's one they've thought about deeply. They're reading all about this and making what they feel is the best-informed decision they can for their child."

Murphy sounds like she may be part of the problem; the district itself has been irresponsibly tolerant in handing out exemptions. The parents are indeed making this decision out of ignorance. They haven't thought about it deeply -- certainly they haven't given a dime's worth of thought to the effect their anti-immunization decision has on their neighbors, on other children, and on their own children.

The median income in the Montecito district is nearly $103,000, and the median home price is more than $1 million: proof that you can be rich and successful, yet not have a clue.

If we were talking about parents without access to healthcare or adequate medical information, the decline in vaccinations might be understandable; anti-vaccination claptrap has been hawked by television personalities such as Katie Couric and Jenny McCarthy as though it's just another entertainment segment. They should be ashamed. (We discussed Couric's peculiar brand of irresponsibility here and here.) But for it to take root among parents with access to established scientific facts is inexcusable. 

But there's no reason for state and local school officials to buy into this trend. The rules for personal belief exemptions should be tightened up and made crystal clear. Citing something you've heard on Katie Couric's show won't cut it. 

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