by Kevin Crowe and Roxana Popescu inewsource

More San Diego County parents than ever before decided to skip some or all immunizations for their kindergartners in 2010 by signing personal belief waivers. It’s a trend that has left public health officials on edge and anti-vaccine advocates feeling vindicated.

The number of personal belief exemptions for kindergartners grew more in San Diego than in any other county from 2009 to 2010 to a total of 1,306, or about 3 percent of enrolled students.

While the overall percentage of children locally and across California missing vaccines for any reason – including medical waivers or obstacles to health care – has remained small but steady, the number of personal belief waivers has almost doubled during the past decade.

What worries public health and disease specialists most is the clustering of unvaccinated children, who could become sick and rapidly spread disease.

Both the trend against immunization and clustering are pronounced in San Diego County, where about half of the kindergartners with exemptions are enrolled in just 10 percent of the schools.

inewsource, an investigative reporting nonprofit based at San Diego State University, analyzed the numbers of vaccinated and unvaccinated local kindergarten students from 1990 to 2010 and found:

  • Statewide, about 2.3 percent of kindergartners had the exemptions in 2010.
Click to search for immunization exemption rates in San Diego schools.
  • The increase in the number of personal belief exemptions among kindergartners from 2009 to 2010 grew more in San Diego than in any other county in California. The number jumped 21 percent here to 1,306, compared to 15 percent statewide to 11,858.
  • Statewide, almost half of the kindergartners with exemptions are enrolled in just 7 percent of schools.
  • Private schools and public charter schools had the highest exemption rates, as did schools in North County. Oasis Organic School, a private elementary school in Encinitas, had the highest rate of all San Diego County schools, at 83 percent, and Dehesa Charter School in Escondido had the largest number of students with personal belief exemptions: 40 students in a cohort of 90.

State and county health officials point to the 2008 measles outbreak in San Diego and the recent whooping cough epidemic, which claimed 10 lives in California, as examples of what could come if growing segments of the population aren’t vaccinated against these diseases.

But Dana Tankell, a chiropractor in San Diego who has never vaccinated either of her school aged daughters, was relieved to learn that more parents are opting out.

“I feel like people are getting smarter. They’re standing up for themselves and they’re making decisions based on knowledge instead of following everybody else,” she said.

Dana Tankell, a chiropractor in San Diego, shows a pamphlet she hands out in her office on the dangers of vaccines. She said she has not had either of her two school-aged daughters immunized. ROXANA POPESCU, The Watchdog Institute

Both sides of the vaccine debate seem to settle on one point: despite the highly publicized refutation of Andrew Wakefield’s studies linking autism and vaccines and the uptick in cases of vaccine-preventable disease like measles and whooping cough, many parents remain deeply suspicious of vaccines – and will likely stay that way.

“If the news about Wakefield’s deception has any impact, it is likely that it will take several years to see,” said Dr. Gil Chavez, an epidemiologist with the California Department of Public Health.

Parents opting out tend to be white and affluent, said Dr. Wilma Wooten, the San Diego County public health officer.

Dr. Wooten said she is not surprised the number of personal exemptions is growing and noted that autism isn’t the driving factor anymore. Instead, parents are weighing fears of allergies and other side effects associated with vaccines, placing more trust in holistic medicine, spacing out shots.

Others sign the waivers because it’s easier than digging up health record or making a doctor’s appointment.

“It’s just more convenient when they’re offered the option to opt out,” Dr. Wooten said. “Actually, we know that for some parents, their kid has been vaccinated, but it’s easier to sign that waiver when they’re at school.”

The specter of autism continues to sway the debate.

“I think it’s still in the back of the minds of parents that vaccines might be that trigger, even though we’ve shown undeniably, through many studies, that vaccines are not linked to autism,” she said. “Even though you have the facts, sometimes it’s difficult to separate the facts from emotion.”

The county has held public forums so parents can meet with medical experts and address concerns, Dr. Wooten said. It also hosts vaccine clinics and informs uninsured parents about free vaccine opportunities.

Officials are trying to increase vaccination rates. One way is adding more requirements. In January, amid the ongoing whooping cough epidemic, the state ordered middle school and high school students to get booster shots against the disease before enrolling this fall. Parents can still request exemptions.

In San Diego County last year, 1,144 cases of whooping cough, known as pertussis, were reported, including two infant deaths. As of Wednesday, the county’s Health and Human Services Department reported 326 cases so far this year. More than 2,000 cases have been reported statewide.

Dr. Wooten said the state is also considering requiring schools to give parents educational materials when they sign the exemption waiver.

Lara Condon, mother to a boy, 5, and a girl, 3, said that despite reading about Wakefield’s research fraud, she trusts a different authority: experience. Condon watched her cousin’s son develop “autistic symptoms” after getting his 18-month shots. The timing of the symptoms reaffirmed her decision not to vaccinate her children.

“I definitely, absolutely think there’s a link” between autism and vaccines, she added.

Lara Condon at her Chiropractic Life Center office in Encinitas on Wednesday. BILL WECHTER, North County Times

Many school administrators were reluctant to discuss the rise in exemptions, hinting at the balance they must strike between providing a safe and healthy environment for all students and respecting parents’ wishes.

Maria Stephens, director of Oasis Organic School, which had the largest number of unvaccinated children, declined to be interviewed. The school’s website stays it offers “an alternative, holistic pre-K and elementary education choice” and teaches children about green living practices while focusing on the “body, mind and spririt.”

It’s an ethos that could appeal to parents who are likely to view vaccines as toxic or unnatural — a key population Dr. Wooten said is contributing to the rise in exemptions.

Susan Freeman, principal of L.R. Green Elementary in Escondido, said the school actively works with parents to ensure children are immunized if cost or convenience are the reason for an exemption. Nineteen of its 115 kindergartners (16.5 percent) had personal belief exemptions last fall. That’s a significant increase over the previous two years. In 2008, only 2 students had these exemptions, and in 2009, 7 students had them.

“My LVN (licensed vocational nurse) continues to work with families throughout the school year, reminding them that it would be a good idea if their children were immunized,” Freeman said. “He’s a very hands on kind of guy.”

Cameron Curry, executive director of Classical Academy and Coastal Academy, charter schools in Escondido and Oceanside, where 20 percent and 28 percent of kindergartners, respectively, had personal belief exemptions, takes a less involved approach.

“It’s not appropriate for me to meddle with the medical choices our families make,” he wrote in an email. Asked if students are at risk, he answered: “This is a question that only public health officials can answer; I am not qualified to do so.”

California is one of 20 states allowing philosophical exemptions to vaccines for schoolchildren, as a distinction from religious or medical exemptions. While overall the number of unvaccinated children in California is low, clusters of exemptions create pockets of vulnerability, said Dr. Saad Omer, an infectious disease epidemiologist at Emory University.

“These kids are not spread evenly, and it increases the risk at the local level,” he said.

As a community’s immunity rates for vaccine-preventable diseases like measles fall below certain thresholds, people who are vaccinated and unvaccinated alike will be more prone to getting sick, though the risk is not equal for each group.

“If the number of children in a school who are immune to measles drops below 90 percent and measles is introduced into that school, an outbreak may occur,” said Dr. Chavez, with CDPH.

Dr. Wooten said another concern is that people without immunity can put babies or adults with compromised immune systems or those who cannot be vaccinated at risk.

Click to search immunization exemption rates by county.

“It definitely does worry me,” she said. “Those are the vulnerable populations, and if we don’t have that ring, if you will, of individuals vaccinated around them, then we put that younger vulnerable group at risk.”

Last year’s whooping cough outbreak, the worst in California in 60 years, killed 10 babies and sickened thousands more. A drop in vaccination rates was one of the causes, public health experts believe.

Tankell, the chiropractor, has not vaccinated either of her daughters and said holistic health care keeps them robust.

“She’s never been to a pediatrician,” she said of her oldest, Corrina, 12, who came to work with her on a recent afternoon. “She never gets sick. If she gets sick once in year, it’s a lot.”

Tankell agrees that parents need to educate themselves about vaccines. She keeps a stack of colorful flyers listing vaccine ingredients on the front counter, ready to be handed to anyone who might be interested. She urges patients to read up on side effects and decide on a case by cases basis which risks are worth immunity.

“What are your options?” she asked. “I just want people to be educated. We keep creating more vaccines, for how many different diseases? What is in the vaccine? Formaldehyde, mercury, all kinds of poison we’re putting into our bodies.”

Asked about the health of other children, Tankell answered that autonomy trumps collective immunity. “It’s my choice not to vaccinate. It’s their choice to vaccinate.”

Dr. Paul Offit, an infectious disease specialist and director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, says that until people flip those priorities, preventable outbreaks will keep happening.

Vaccines are a victim of their own success, he mused. With a few exceptions – chicken pox, the flu — the diseases they keep at bay are distant memories – leading parents to fear vaccine side effects more than the illnesses themselves.

“For young parents today, mothers less than 30, they don’t see these diseases. They didn’t grow up with them,” Dr. Offit said in a phone interview. His generation, in contrast, grew up with measles and polio, and they know the havoc these illnesses can wreak.

“Measles were a killer,” he said.

Dr. Offit wryly suggested that a terrifying outbreak could turn the tide in favor of vaccination again. “If we have one or two cases of polio, or diphtheria, I think people would be scared again.”

Joanne Faryon is a freelance reporter and former inewsource and KPBS reporter.