Catalyst Spring 2015


Measles Vaccinations: Progress in Baltimore

Person getting vaccination shot

By Deborah Bailin

Measles was declared eradicated in the United States in 2000 but, since then, the number of U.S. cases has increased. Imported from abroad and fueled by misinformation from a fraudulent study linking vaccines to autism, measles outbreaks have grown among unvaccinated and under-vaccinated populations. In 2014 there were 644 documented cases in 27 states, and there will likely be more in 2015.

Fortunately, science-based policies have helped some cities like Baltimore, MD, buck the trend. After an outbreak in the 1990s sickened hundreds (nationwide, thousands became ill and 41 died), Maryland policy makers knew something needed to change. Since then, the city of Baltimore and the state of Maryland have made important policy changes and engaged with the public to help residents protect themselves and their communities. Access to immunizations has improved: clinics have added extra hours, walk-in appointments have been encouraged, the city lifted its requirement of a pre-vaccination physical exam, and vaccines are offered free of charge. Today, the vaccination rate for Baltimore schoolchildren is 99 percent.

Vulnerable Gains

As Baltimore Health Commissioner Dr. Leana S. Wen notes, however, “Baltimore is not an island.” All 50 states and the District of Columbia allow medical exemptions, which are necessary for children under one year of age, those with compromised immune systems, and those with certain allergies. These individuals must rely on the vast majority of those around them being immunized. Yet 48 states including Maryland have religious exemptions, and 19 also permit “personal belief” exemptions, which makes it easy for vaccine skeptics to put not only their own children at risk but also others who cannot be vaccinated.

Vaccine skeptics have existed as long as vaccines, but their gripes were more legitimate a century ago. Prior to the Biologics Control Act of 1902, safeguards we now take for granted like inspection and labeling did not exist, and contamination was common. Since then, however, a strong set of protections has evolved to make vaccines remarkably safe and effective thanks to rigorous risk-benefit analyses; strict testing to assess safety, purity, potency, and effectiveness; multi-stage clinical trials; and adverse event reporting.

It’s important to remember that smallpox, before it was eradicated, killed more people in the twentieth century than both world wars combined. Today, no one dies from smallpox. The extraordinary success of vaccines against many devastating diseases has opened the door to distorted risk perceptions, outdated misconceptions, and misinformation. This complacency threatens the progress being made in cities like Baltimore. As Dr. Wen rightly notes, “We’ve come too far to let that happen.”

Deborah Bailin is a democracy analyst in the Center for Science and Democracy at the Union of Concerned Scientists. Read more from Deborah on our blog, The Equation.