Mandatory MMR Vaccine Possible in Washington State

The measles outbreak slows as four new cases are confirmed in Oregon.

Infant with measles. Photo courtesy of Washington State Department of Health/Centers for Disease Control

Infant with measles. Photo courtesy of Washington State Department of Health/Centers for Disease Control

A new house bill could increase pressure on Washington parents to vaccinate their children, and is generating discussion from people on all sides of the vaccination argument.

HB 1638—a more urgently pressed piece of legislation because of the ongoing state measles outbreak—would remove the personal and religious exemptions currently allowed for the measles, mumps, and rubella (MMR) vaccines.

Feb. 6 marked the second day in a row that no new measles cases were confirmed in the state, according to the Washington State Department of Health. Fifty of the state’s 51 confirmed cases originated in Clark County, where officials believe the state measles epidemic began among a cohort of unvaccinated Vancouver school children. And from there it spread to a man in King County and four others (so far) in Oregon. On Jan. 25, Gov. Jay Inslee declared the measles outbreak a state of emergency, allocating state resources to help mitigate the spread of the virus that lives in the mucus of the nose and throat.

Rep. Monica Stonier of Clark County said she supports a bill requiring vaccination, with or without an outbreak. “The impacts it’s had on schools and public-health workers, makes it a more urgent issue now,” she said. “It does warrant our narrow focus on the measles outbreak.”

In 2015, a vaccine bill sponsored by Rep. June Robinson, D-Everett, and supported by Gov. Inslee failed to leave the House. It called for the removal of personal or philosophical exemptions from vaccines in the state, and came after a measles outbreak at Disneyland in California that affected more than 90 people across eight states. This new bill would focus on exemptions related to the MMR vaccine.

Stonier, also a teacher and instruction coach, said she has heard from teachers about their struggles to get their classrooms covered as they search for their own proof of vaccination records. Traffic to school offices, along with students proving they’ve received vaccinations, has added to the “already busy schedule” of school. And public-health workers who would typically be responding to the opioid crisis and other large issues have been redirected to address the outbreak. “They had to be pulled off all of that work to respond to the spread of measles,” Stonier said. “So, the normal operations of things in Vancouver in many ways has come to a halt so we could respond to this.”

Stonier said she has heard pushback from some parents who are concerned about the state’s decision-making in the lives of their children. “I respect that position and it’s important for parents to make decisions for their kids,” she said. “The difference here is that the privilege those parents are taking is having a huge impact on the rest of the children.”

Doubting vaccines

Lobat Kimiai of Kirkland isn’t so convinced that vaccines are a good thing, she said, especially when given to young babies as recommended by the Centers of Disease Control (CDC). Being a nutritionist for over 20 years, she is “questioning the safety, the validity and effectiveness of them.” She has done her research, she says—delving into the depths of literature to find a study that supports the CDC vaccine schedule. She has made phone calls to the CDC. She’s sent emails.

She worries that the rate of autism, which a Johns Hopkins Bloomberg and CDC report found was one in 59 in 2018, could be linked to vaccination. However, the 1998 study in The Lancet that drew a link between autism and vaccines—used most frequently in anti-vaccination arguments—was retracted in October 2018.

Other neurological conditions could be linked too, Kimiai said: “I’ve been trying to get answers, trying to find if there’s any safety to this protocol.” Kimiai believes in “strong science,” and admits that vaccines may have helped. “Looking at evidence when you go back, yes maybe it did help for polio,” she said. But she said she believes that measles are “the most benign disease out there. You catch the measles and it’s gone in a week.”

Her son was vaccinated in the 1990s, given one vaccine at six months and the other required vaccines at 12 months. “But back then vaccines weren’t so toxic as they are now with heavy metals,” she said. “That’s what’s causing these neurological conditions.” (The CDC reports that a 2004 study conducted by the Institute of Medicine proved vaccine ingredients, including mercury-based thimerosal, do not cause autism.)

Her son’s food allergies, she speculates, could have come from vaccines. Or, it could be a hereditary condition, given that her husband too has food allergies. One thing she is decided on is her opposition to mandating vaccines. “Our kids are sick these days. There’s so much food allergies and a lot of diabetes,” Kimiai said. “It makes one wonder, especially those of us in health care, we’re questioning these protocols.”

We’ve been here before

Douglas Diekema, a professor of pediatrics at the University of Washington School of Medicine and physician at Seattle Children’s Hospital, said he understands the importance of vaccinations—he was young in his career when doctors began distributing the Haemophilus influenza vaccine. “There’s nothing more important than watching a horrible disease that damages children … nearly disappear,” Diekema said about the illness that can cause meningitis, epiglottitis, or sepsis. Children who developed H-flu typically came down with a fever, and nearly every child with a fever was treated by doctors as a potential H-flu case.

Diekema recalled an instance early in his time at Seattle Children’s—a story he calls the “most memorable” and to some degree the “most terrifying” of his career of more than 30 years: He was called to Oak Harbor to transport a child who had H-flu-caused epiglottitis—it resulted in a blocked airway and the 4-year-old couldn’t breathe. To save the child’s life, the emergency room doctor cut a hole in the neck to bypass the blockage. “Then I had a terrifying 30-minute flight on a helicopter having difficulty getting air into his lungs the entire way,” Diekema said.

This story ends well: The child safely made it to Seattle Children’s from Whidbey Island, but many others don’t, he said. “The measles causes different sorts of problems, but this is an example of how powerful vaccinations can be at eliminating or getting close to getting rid of these horrible diseases of childhood,” Diekema said. He adds that we vaccinate young children for a reason—they’re most at risk for measles and other diseases that can be prevented by vaccines. “It’s not that we’re doing it because it’s convenient. Usually it’s given at the age we can have a vaccine be most effective and as young as possible to protect the baby at its most vulnerable time,” Diekema explained.

The vaccination schedule exists for a reason, he added. “Doctors are not blindly following someone’s recommendation,” he said. “This is very carefully thought out … The conclusion we’ve reached is that it’s safer to vaccinate than to not vaccinate.”

Complications are serious

Of course, immunity can be achieved without a vaccine, Diekema said. But that requires the person to catch the virus. “It’s a little bit like rolling the dice or playing Russian roulette—you may recover from the illness or not,” he said. “A small percentage will suffer very serious outcomes or even death.”

For every 1,000 children who contract the measles, one will develop encephalitis, the swelling of the brain that can cause a mental impairment or leave a child deaf, CDC data shows. And about one or two will die from the measles. “The consequences can be fairly significant and the whole point of vaccination is to give someone that immunity without exposing them to risk of the disease,” he said.

Diekema warns those who question vaccines to be judicious of where they’re getting their information. “There’s a lot of noise out there and a lot of it’s not based on science, but based on belief,” he noted. As a general rule, he said, the most trusted adviser someone has is their physician. “They’re not going to make a recommendation that they think is not in the child’s best interest,” Diekema said. “We will also be able to answer their questions and address their concerns.” And not all vaccines are required—only those, he said, that pose a real risk to U.S. children.

With the country having access to these vaccines, Rep. Stonier says people should not be dealing with the measles in modern-day Washington state. “It seems to be an outdated challenge that we should not be facing,” she said. “Look at places in the world with no vaccinations. They have widespread measles outbreaks that result in death … In places in the world where they’re struggling with measles outbreaks, they’re clamoring for the measles vaccine.”


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