This is a sad tale of an up-scale little community which illustrates, in my opinion, a poor decision taken by a number of presumably very bright, well-educated parents who should have known better.
Ashland is a small avant-guarde town in scenic Southern Oregon. It is perhaps best know for its Shakespeare Festival, which is itself the centerpiece of a community that prides itself on its rich artistic offerings and its history. Ashland oozes up-scale affluence, egalitarianism, intellectual-ness and confidence, and it reminds me in no small way of Berkeley California.
There is a strong progressive voice in Ashland, which reveals itself in the nature of the programming and tone of our Ashland-based public radio station Jefferson Public Radio (JPR), and by many of the people who express their opinions on JPR's talk shows. The folks I'm referring to are public spirited souls with the best of intentions, who crave a more perfect world, one in which violence is obsolete and in which disputes are settled through negotiation and compromise. They are people who are convinced that the proper application of debate, laws, love, education, intelligence and good intentions can overcome almost any obstacle.
As a group, these people generally take great interest in their own health and are reasonably fit — they eat "natural" foods, watch their weight, take trendy supplements, appreciate alternative medicine and (I'd like to think) exercise regularly. With respect to the issues of health, many within this not insignificant subpopulation have learned that the chances of getting certain diseases — like whooping cough — are extremely small. Moreover, they understand that vaccinations to ward off diseases carry with them a small but real risk of adverse reactions. So they're faced with a dilemma: should they place their kids at risk for contracting the disease, or at risk of an adverse reaction to vaccination?
A fair number have opted to risk disease rather than vaccination.
Two cases of pertussis have been confirmed in Jackson County over the past three weeks, and physicians have identified 35 more people with symptoms that strongly suggest they have the disease commonly known as whooping cough.
One confirmed case is a person over age 70 who lives in Jacksonville; the other is a teenager from Ashland, said Viki Brown, a Jackson County public health nurse.
All of the "presumptive" cases live in Ashland. Brown said they have symptoms of pertussis, but laboratory tests have not yet confirmed that they have been infected by the Bordetella pertussis bacterium.
Public health officials are concerned about an outbreak in Ashland because many children there have not been vaccinated against childhood diseases such as pertussis. In 2001, for example, about 10 percent of Ashland children were not vaccinated against childhood diseases, compared to about 3 percent for Jackson County overall and 2.7 percent statewide. [Emphasis added — ed.]
Pertussis is often more severe in people who have not been vaccinated.
[ . . . ]
Pertussis usually begins with symptoms that mimic the common cold, but the cough persists and becomes more severe, with episodes of rapid coughing followed by a high-pitched "whoop" while gasping for breath.
Whooping cough can strike anyone, but it hits infants hardest, and it can be fatal if pneumonia develops. Seventy percent of all fatalities are in infants under the age of six months. In adults who do not seek treatment, it can persist for months.
Pertussis is generally a rare disease because most parents immunize their children against it. Outbreaks tend to be sporadic and localized, but a reservoir of the bacteria often persists to seed new cases.
Jackson County had a significant outbreak of pertussis in 2003, when 140 cases were recorded. There were just three recorded cases during the three years before the outbreak, and just four in 2004.
[ . . . ]
Brown noted that at least one pertussis case has been identified within recent weeks in both Josephine and Douglas counties.
So what's happened here?
It's simple. When virtually everyone in a population is vaccinated, the incidence of disease is drastically reduced. Then, those very few people who opt not to be vaccinated are protected because the disease never gains a foothold in the "sea" of their own population.
But when relatively large numbers of the population decide — for whatever reason — not to risk vaccination, then the likelihood that disease will enter the population is greatly increased, as is the risk of contracting the disease for those who have not been vaccinated.
And that's what we see here. The risk of contracting whooping cough is only minimal for the unvaccinated if virtually everyone else in the population is vaccinated. Ironically, those who decided against vaccinating their own kids did more than place their children at risk: they also made their kids potential vectors for the spread of the disease to other unvaccinated souls. And in this case, that potential is apparently being realized, giving whole new meaning to the term "community activism" . . ..
I became aware of this story while half thawed-out this morning as I was awakening to a news report on JPR. What really grabbed my attention was a comment by a public health official. Ever so delicately, she informed JPR's listeners that the outbreak of pertussis was due to "Ashland's culture" . . .
"Ashland's culture" — indeed. I can well imagine a fair number affluent, intelligent, educated and cultured parents asking the question: if the risk of pertussis is minimal, why should I gamble my kid's health by having him vaccinated? Why not just avoid the risk of adverse reaction and keep his body — well — "unpolluted"?
Sadly, I guess that question is now answered . . .
UPDATE: In a very smart post, Respectful Insolence expands on the notion of "herd immunity" here. Orac makes the telling point that "much of the anti-vaccination hysteria is fed by "alties", even though many of their fears (for instance, of autism) are unfounded."
In my opinion, these Ashand parents in some ways resemble "Intellectual Morons": they're smart and educated enough to make sound decisions, but their commitment to an appealing fantasy trumps their commitment to what actually is.