Defending against infectious diseases remains a critical goal in a county that leads the state in the percentage of unvaccinated children, say Buncombe County health officials.
“We look at immunizations as the way we build a shield of protection around ourselves and our community against serious and potentially deadly diseases,” says Dr. Jennifer Mullendore, medical director of the Buncombe Department of Health and Human Services. “It’s important for children to be vaccinated, but there are vaccines that adults need as well. By increasing the number of people in the community who have received their recommended immunizations, the hope is that we can keep out some of those illnesses that are popping up across the country, like measles and mumps, and keep our community members safe.”
The U.S. Centers for Disease Control and Prevention estimates that 732,000 American children were saved from death and 322 million cases of childhood illnesses were prevented between 1994 and 2014 due to vaccination. The measles vaccine has decreased childhood deaths from measles by 74 percent.
The American Academy of Pediatrics and the CDC recommend that healthy children get vaccinated against 14 diseases by age 2, with boosters later for some, along with an annual inoculation against the flu.
And yet, Buncombe County leads the state when it comes to unvaccinated children. Last school year, says Mullendore, 4.5 percent of the county’s kindergartners didn’t have all the state-mandated vaccinations. That’s more than four times above the North Carolina average of slightly less than 1 percent.
Dr. Mark McNeill, a family physician in solo practice in Asheville, says receiving immunizations is important both for the health of the individuals receiving them and the community as a whole.
“Immunizations have done more for the health of our community than likely all the doctors in our community combined,” he says. “Historically, diseases like influenza, measles, mumps, diphtheria and tetanus cause death and cause serious disability and harm. When people get their recommended immunizations, it goes a long way in helping to prevent them getting these diseases and protecting their overall health.”
Mason Scott, 28, recently received an influenza vaccination at the county’s Immunization Clinic on South French Broad Avenue. The Asheville resident says he wants to avoid catching the virus as well as spreading it to others.
“My wife and I both work at public institutions where we come into contact with a lot of people every day,” Scott says. “And in our personal lives we have friends with young children or who are also caring for their aging parents. I don’t want to lose time with them for fear of taking home or carrying back a virus that I could have prevented. I don’t think that we should chance our own health or that of those around us. Many terrible things have happened in history because vaccinations and immunizations were not available. I would always want to be safer than sorrier.”
Mullendore says county health officials came up with the “shield of protection” slogan a couple of years ago as part of a campaign to increase immunization rates, especially among children. Parents of children entering kindergarten have to submit proof of required immunizations, and for the past 16 years the number of kindergartners who are not fully vaccinated has steadily increased, she says.
“We have led the state in this for a very long time,” she says.
In looking at reasons why this is the case, Mullendore cites the preponderance of alternative medicine practitioners such as chiropractors, naturopaths and acupuncturists. But she says she doesn’t consider parents who don’t vaccinate their children to be bad parents.
“I think everybody is trying to do right by their children, and I think we might just have a population that is more questioning of the Western medicine recommendations for vaccines and a population that is more into nature and natural stuff,” Mullendore says. “But the unfortunate thing about nature is that before vaccines, it was natural to get very sick and sometimes die. That’s what happens still in parts of the world where there aren’t vaccines. There is still polio or there’s still measles killing children every day in parts of the world.”
In the U.S. and other places where vaccines have become the norm, Mullendore believes people have become complacent about the harm that can be caused by infectious diseases. She points out that even though she’s a medical doctor, she’s never seen a patient with a case of the measles.
“We’ve kind of lost our fear,” Mullendore says. “My great grandmother lost a child to a vaccine-preventable disease, but in our current daily life we just don’t see that.”
Health officials also cite the internet’s role in spreading misinformation about vaccines, but Mullendore points out there are reputable online sources that explain the importance of vaccines and how they work.
“There are good resources out there that we encourage people to look at or to talk to — their medical provider or their child’s medical provider — because it does matter,” she says. “Every time there is a case of measles or mumps in our state or in surrounding states, we do tend to hold our breath waiting for that to come into our community. Every couple years it seems we have a big outbreak of pertussis, or whooping cough, locally.”
One factor feeding the “anti-vaxer” mentality is the myth that vaccines cause autism, says Mullendore. Fears about a link to the disorder go back to 1998, when an article published in a medical journal by British physician Andrew Wakefield claimed to find evidence that the measles, mumps and rubella vaccine had caused autism in 12 children. While the research was later found to be fraudulent and Wakefield was stripped of his medical license, fears have persisted, prompting some parents to decide against getting their children vaccinated.
“Once misinformation is out there, it’s really hard to erase it from the public perception,” Mullendore says. “So in spite of numerous studies showing there is no link, that myth still persists. “We try to counteract it, but it’s really difficult.”
The trend against vaccination became more evident with recent infectious outbreaks, including an outbreak of measles that began in Disneyland in California in 2014. Even though the government had declared measles eliminated in the U.S. in 2000, 159 children in 18 states were diagnosed with the disease.
When children enter school in North Carolina, parents have two options if they don’t want their child to be vaccinated. One is a medical exemption in which a medical provider must complete paperwork saying there is a legitimate medical reason why a child can’t be vaccinated for a particular illness; parents must turn the form into the state.
The other option is what’s called a religious exemption. Mullendore says parents who claim this one should have a bona fide religious reason; Christian Science is the only religion that has such a belief. And the state doesn’t require parents to prove they have a religious reason for avoiding immunizations.
“You can’t make people prove their religion,” she says. “And there is no specific form that has to be filled out. It doesn’t have to be signed by any person except for the parent. If it’s not a real religious exemption, then I don’t think people should be using that.”
Mullendore says there has been a push in recent years in some states to do away with religious exemptions. A bill that would do that was filed in the last long session of the N.C. General Assembly, but it didn’t get far.
When there is an outbreak of a particular illness at a school, students with exemptions who might be at risk of getting sick can be sent home for three weeks or more or until the outbreak is over. Health officials strive to create what’s called “herd immunity” in the population.
“It’s the idea that if enough people in the community are vaccinated against a particular illness, that illness has a hard time breaking through and getting into the community,” Mullendore says. “The higher the number of people in the community who are vaccinated, the harder it is for those illnesses to come in and cause havoc.
“There are some people who can’t get vaccinated, like little babies,” she says. “Until they’re fully vaccinated, they’re at risk. Some people have weakened immune systems and can’t be vaccinated. That herd immunity can help protect those who are most vulnerable.”
McNeill, who serves on the executive committee of the Western Carolina Medical Society, says some of his patients are reluctant to get vaccinated, and he attempts to allay their concerns.
“Since immunizations began well over 100 years ago, there’s always been some level of anxiety surrounding immunizations,” he says. “So this is not necessarily a new issue, but it has definitely become more of [one] recently, particularly in Buncombe County. Unfortunately there are a lot of myths and folklore that are circulating among certain communities in the area, and there also is a lot of just bad information coming from the internet and from nonscience-based providers in the community, and that leaves people confused. And on some level that’s understandable.”
McNeill says that when patients raise concerns about vaccines, he tries to answer their questions and understand where they might have gotten bad information.
“And I just do my best to educate them on what the science tells us and what’s most healthy for them and their family,” he says. “I think our community attracts a lot of people who really value healthy lifestyles and also look for more what’s considered ‘natural’ ways of staying healthy. It’s kind of a cultural value here in Buncombe County, and I think with that comes some good things like healthy diets and exercise.
“But unfortunately what comes with that are some suspicion of things that may be manufactured in a lab or in a factory, whether that be pharmaceuticals or immunizations,” McNeill says. “And I think there’s some cultural fear around these vaccinations being non-natural.”
Mullendore is a mother who made sure her children were vaccinated.
“I trust vaccines,” she says. “I believe in the importance of vaccines, and I want everyone in our community to benefit from them.”