There's an important paper in the New England Journal of Medicine this week about vaccine refusal, providing some alarming statistics on this growing phenomenon. Let's begin with the basics: In the U.S., "vaccine refusal" is more or less tantamount to obtaining a state level exemption from childhood vaccinations for non-medical reasons. Such exemptions are on the rise: According to the paper, "Between 1991 and 2004, the mean state-level rate of nonmedical exemptions increased from 0.98 to 1.48%." That may not sound like much, but vaccine refusal is concentrated in certain areas, or clusters, where the incidence is much higher, and accordingly much more dangerous. States like Colorado, Washington, Oregon, and Michigan in particular are known for having such clusters. The NEJM also provides some other revealing data about who doesn't vaccinate. As the paper puts it:
As compared with the undervaccinated children, the unvaccinated children were more likely to be male, to be white, to belong to households with higher income, to have a married mother with a college education, and to live with four or more other children. Other studies have shown that children who are unvaccinated are likely to belong to families that intentionally refuse vaccines, whereas children who are undervaccinated are likely to have missed some vaccinations because of factors related to the health care system or sociodemographic characteristics.
This socio-economic disparity seems to resonate with a quotation from one of the experts in my Discover piece:
“If vaccine rates start to drop, who’s going to get affected?” Peter Hotez asks. “It’s going to be people who live in poor, crowded conditions. So it’s going to affect the poorest people in our country.”
One last intriguing bit of data on vaccine refusers: They self-educate, and use the Internet to do it. To wit:
...parents of exempt children were more likely than parents of vaccinated children both to have providers who offered complementary or alternative health care and to obtain information from the Internet and groups opposed to aspects of immunization. The most frequent reason for nonvaccination, stated by 69% of the parents, was concern that the vaccine might cause harm.
We typically think of self education, via the Internet especially, as a form of empowerment. But is that really what it is, if people are going online to get misinformation, and on that basis taking actions that can endanger others?
