Post #3: Low Vaccination Rates in the United States and the Outbreaks they Cause

I have finally finished my draft of my paper for this project and I hope to have it completely done tomorrow. I decided that the best way to convey my findings from this project would be in a paper. I divided my paper into three main sections: an introduction/brief history of measles and the MMR vaccine, vaccine hesitancy, and recent measles outbreaks. I concluded with public health efforts that can be made to increase vaccination rates and prevent future measles outbreaks. There was so much more I researched this summer that I could have included in my paper, but I wanted to make my paper concise and convey the most important information I found. I will briefly summarize the main points of my paper below. 

Measles is an extremely contagious disease that infects thousands of people across the world each year. Even though measles was declared to be eradicated from the United States in 2000 due to the widespread success of the MMR vaccine, measles outbreaks continue to occur today. In order to maintain herd immunity, 96-99% of the population needs to be immune. One dose of the MMR vaccine is 93% effective in producing measles immunity and two doses are 97% effective. However, 8.9% of American children have not received the MMR vaccine, putting themselves and others at risk for measles. Vaccine hesitancy is a huge problem that leads to low vaccination rates and measles outbreaks.

In 2019, the World Health Organization named vaccine hesitancy one of the top 10 threats to global health. Even though the MMR vaccine has saved millions of lives, many parents still choose not to vaccinate their children. Many parents believe that vaccines are not necessary. Since they have not seen the diseases that vaccines prevent, they do not understand why their children should be vaccinated. Other parents object to vaccination due to concerns that vaccines can overwhelm their children’s immune system. However, studies suggest that infants are exposed to more pathogens in the environment each day than are in vaccinations. In addition, many parents do not vaccinate their children due to safety concerns about the MMR vaccine, specifically that the MMR vaccine causes autism. Even though countless studies have found no link between the MMR vaccine and autism, many parents still decide not to vaccinate their kids due to concerns about autism. 

While many parents choose not to vaccinate their children due to concerns about safety or other objections, the main reason why most children are unvaccinated is due to the lack of access to vaccination and missed opportunities. According to data from the 2010-2013 National Immunization Survey, 89.6% of children who had not received the MMR vaccine had missed opportunities to receive the vaccine since they had received at least one other recommended childhood vaccine after 12 months of age. In 19-to 35-month-olds who had not received the MMR vaccine, only 34.6% of parents reported refusing the vaccination. This striking data shows that the vast majority of the time, children are not vaccinated due to both missed opportunities and a lack of resources. One of the easiest ways to improve the MMR vaccination rate is to provide opportunities for children to be vaccinated and for primary care providers to capitalize on opportunities to vaccinate their patients.

Due to low MMR vaccination rates in many areas across the United States, measles outbreaks still occur today. In 2017, a major measles outbreak occurred in a Somali community in Hennepin County, Minnesota. With an MMR vaccination rate of 35.6%, an outbreak was bound to occur. The main reason the MMR vaccination rate in this Somali community in Minnesota is so low is because many Somali people believe that the MMR vaccine causes autism. In 2007, Minneapolis Public Schools released data that showed that more Somali children were in special education classes than children of other races. After the outbreak, public health officials worked with members of the Somali community to encourage vaccination and quell any fears that the MMR vaccine causes autism. Thanks to efforts by the Minnesota Department of Public Health and the leaders of this Somali community, the average number of MMR doses administered per week in the state of Minnesota went from 2700 to 9964 in the weeks following these public health education efforts. The public health response to this outbreak shows the importance of being culturally sensitive and working with communities to distribute accurate public health information. 

In 2019, major measles outbreaks occurred in New York and Washington. Between January 1, 2019, and August 1, 2019, 1172 confirmed cases of measles have been reported in 30 different states. This is the most cases the United States has seen since 1992. Over 75% of the confirmed cases of measles in 2019 have been linked to outbreaks in New York. In New York, the majority of the outbreak occurred in Orthodox Jewish communities in both Brooklyn and Rockland County. Free vaccination clinics, fines for non-compliance, and public health education helped increase the MMR vaccination rate and stop the outbreak. In Washington, the outbreak was largely contained in Clark County, an area with a large Eastern European community. Similarly, free vaccination clinics, education, and other public health efforts helped increase the MMR vaccination rate in this community.

As measles outbreaks continue to occur, it is crucial to find ways to increase the MMR vaccination rate. A review of grey and peer-reviewed literature from January 2007-October 2013 showed that targeting under-vaccinated populations, educating people about vaccines, increasing access to vaccines, and encouraging religious and other community leaders to endorse vaccination were the most successful methods to increase vaccine uptake. Education about the benefits and safety of vaccines is also helpful. Finally, taking advantage of opportunities to encourage vaccination at primary care appointments is crucial. As many children in the United States do not see their primary care provider on a regular basis, discussing vaccination at every appointment is extremely important. With efforts like these, herd immunity will eventually be re-established and measles will no longer pose a major threat to the United States.