Doctor Collins rushes through a bustling pediatric office looking for her next patient. A child wails its mother's arms as they wait their turn, and every seat is taken in the lobby. Busy would be an understatement, with the waiting room feeling like a Best Buy during a black friday sale rather than your typical doctor's office. The measles outbreak plaguing the New York community has reached the suburb of Westchester, and riotous effects have followed. Measles is one of the most highly infectious diseases in existence, and for parents that haven’t vaccinated their children, one of the greatest threats to their child’s safety. The Measles virus, formerly thought to have been eliminated in 2000, is one of the top 10 global health threats, as stated by the World Health Organization. The disease’s rampant reemergence hasn’t been due to a new mutation of the virus, or a science experiment gone wrong. It's been entirely caused by parents that have elected to forgo basic vaccines for their children. And, in a busy pediatric office in Mount Kisco, New York, the effects have become extremely prevalent.
The measles virus has caused a widespread global panic, and with five confirmed cases in Westchester County, Doctor Margaret Collins has her hands full. Dr. Collins is one of Westchester, New York’s best pediatric physicians. She graduated summa cum laude from the University of Pennsylvania with a major in Biological Basis of Behavior, then went to George Washington University Medical School and graduated first in her class. She completed her pediatric residency at North Shore University Hospital and was chief resident, then came back home to join the Mt. Kisco Medical Group, and has now been there for the last 26 years.
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In these 26 years of practicing, she’s worked through the worst “epidemics”. However, the sheer panic tied into the Measles outbreaks have been enough to even shock her, but not enough to prevent her from saying “I told you so”. Doctor Collins has always been one of the strongest advocates for immunizations, and with the recent uptake in the amount of measles cases seen globally, she only wishes people had taken action sooner. “When I started practicing I got pretty fired up by anti-vaxxers”, says Collins. “I would come at them with all the science, all the studies of how safe it was, how bad those diseases could be, I could get into 20-30 minute conversations about that. They’d listen politely, nod their head, then they’d refuse all the vaccines”. When asked about how many of her patients remain unvaccinated today, she replied “about 25% of my patients. Despite all the studies, parents wholeheartedly believe that vaccines would harm their children more than these diseases could, and no matter how I try some of them just won’t listen”.
Measles now poses one of the greatest health threats in history due to its highly contagious nature. The extreme spread of the virus is largely due to the amount of travelers in and out of the United States acting as carriers of the disease, transmitting it to children unprotected against it. According to the CDC, the percentage of children who are unvaccinated has quadrupled since 2001, even though “the overall utilization of most vaccines remains high”.
As a result of “anti vaxxers” choosing not to vaccinate their children, massive outbreaks of Measles in both the United States and global have started to reemerge, and in 2014, one outbreak lead to more than 600 measles cases. As for 2019, the amount of measles cases has already surpassed the amount of outbreaks in the last 5 years, and by May 1st, 2019 there have already been over 700 cases. “Measles is a bad illness”, says Collins, 'if you are exposed to someone with the measles and you aren’t vaccinated, you have a 90% chance of getting it. Most people don’t die from it but 2 out of 1000 do, which is scary if your child is sick”.
For residents of Westchester, New York, this threat isn’t just a global problem, its a problem close to home. Katy McKee of Chappaqua, New York expressed her sentiments on the disease while waiting for her son Max to be vaccinated. McKee was once a vaccine-hesitant parent, and refused immunizations for her son up until he was three years old. Now at four, Max is in the process of “catching up” on all of his vaccinations. “[My initial fear] wasn’t autism”, says McKee, “that was never my fear in that, I was more concerned about… you know you hear about brain swelling, really scary things”.
The greatest fear most parents have regarding vaccinations is the possible health threats tied to immunizations. One study conducted in 2002 linked the MMR (measles, mumps and rubella) vaccination to Autism, and since then has founded the idea in many parents’ minds that the vaccine can cause Autism. However, a decade-long study by the Annals of Internal Medicine published on March 5th, 2019 has now officially and unequivocally proven there is no link between the vaccination and Autism. Parents that were once opposed to vaccinations have now begun desperately looking for ways to protect their children against a disease that is running rampant across the country.
“I don’t think I changed my mind on the topic willingly', says McKee. “Dr. Collins took a lot of time trying to convince me to change my mind, and I think the thing that really provoked it was seeing on the news just how contagious the Measles virus really is. I’m afraid of Max getting sick, and most importantly, I’m afraid of him getting my mother who isn’t in great health sick. I would hate for either of them to suffer because of me”. This fear has clearly been felt by the other parents in Westchester, based on the large attendance at the free MMR clinic held at Doctor Collins’ office on the day McKee and her son visited for his vaccines.
Pediatric Nurse Marissa Boyd provided further information regarding the Measles virus during the clinic hours, citing “young children under a year who haven’t been vaccinated yet, people who are immunocompromised; those who are on chemotherapy, who have had organ transplants, people with HIV, people who are on medications that may suppress their immune systems like arthritis medications”, as most susceptible to the measles virus. As for the length of time a person is contagious, the incubation period after you’re exposed is 7-21 days. “Measles is actually one of the most contagious infectious diseases that we know of”, says Boyd, “susceptible individuals will get measles if they’re exposed up to 90% of the time”.
Boyd also made a striking comparison on just how contagious measles is, by comparing it to the contagion rate of chickenpox. “If you have 10 people who are susceptible to chickenpox and they’re exposed, only 7 will get sick. 9 out of those 10 will get sick if they’re exposed to Measles. Carriers of the disease going around not realizing they’re sick yet are so concerning because they’re going to public places with lots of people and there's bound to be susceptible people that have been exposed”. The risk caused by vaccine-hesitant parents has outweighed the “potential threats” caused by vaccines, and now that Autism has been ruled out, there is very little evidence supporting anti-vaxxers rationale on not vaccinating their children. The greatest challenge now is encouraging parents to change their minds on vaccinations.
When asked about her success on changing parents’ minds, Collins said that it was hard, but not impossible. “Parents get information in both directions from their social groups. I always tell the parents I’m not going to force them to do anything. We’ll talk about it in two months, in four months, and I gradually see patients become more comfortable with vaccines over those first few months. I currently have patients I’m seeing today that are in the process of catching up with their vaccines they didn’t receive beforehand”.
With a contagion rate of 90 percent, it comes at no shock just how incredibly fast Measles has spread across the country. States all across the country are currently experiencing widespread outbreaks, and it is entirely due to the amount of children and adults that have declined vaccinations. Measles is a disease that is 99% preventable through vaccinations, but because of anti-vaxxers, the disease thought to have been completely eliminated in 2000 has made a rampant reemergence in the United States. Currently, New York City is facing one of the worst measles outbreaks in decades, with 423 of the 704 reported cases taking place within the city. Rockland county, a northern suburb in New York has also recorded 200 cases.
According to the New York Times, public health emergencies have now been declared in both these locations, and schools in these locations have been closed to prevent further infection. These areas are heavily populated by Orthodox Jewish communities who have declined vaccinations for their children, and the main culprit for their reluctance has been handbooks and hotlines that have misinformed parents on vaccine dangers. Anti-Vaxxer propaganda has run rampant through the Orthodox communities, and many parents fear that vaccines could be the reason their children are becoming sick in the first place. As a response, the city has issued summonses to those not following vaccination requirements, and has closed some ultra-Orthodox Jewish schools where unvaccinated students were attending class.
These communities are very reluctant to change, and with their Rabbis and other religious officials preaching vaccine danger, it is going to be difficult to change their minds. Governor Mario Cuomo has made steps in trying to take legal action against the ability to opt-out, but New York lawmakers have been reluctant to step in. Cuomo wants to make it illegal to opt out of vaccinations for religious or philosophical reasons during this “public health crisis”. However, according to one New York Times reporter named Jesse McKinley, 'the lawmakers' reluctance seems to stem from concern about angering ultra-Orthodox and other religious constituents who have often wielded political influence”. This could make it even more difficult to stop the continuous spread of Measles in New York City, and for now the best roadblock officials can put up is closing public schools in the orthodox areas of the city and limiting travel.
For Westchester County however, the threat is made much worse by the confirmed cases, because it proves the Measles virus has finally escaped the New York City bubble. Five confirmed cases has put local communities into a “state of emergency”, and with vaccine clinics being run out of local doctors offices, many parents are scared for the safety of their children. McKee was only one of the many parents that attended the free vaccination session, but her emotions reflected the entire group. “I first heard about the outbreaks when my sister called me to tell me that she received an email from the school district that there were some few confirmed cases in the area. My reaction was simply, ‘oh sh*t.’ This whole outbreak terrifies me, but the fact it’s now so close to home makes it feel so much more real. I’m here to get Max vaccinated today because I’m genuinely afraid.” One school district in Chappaqua, New York sent out a Measles PSA email to all members of the school district once the cases were announced, listing frequently asked questions about the MMR vaccination, and the dates and locations for the free vaccination clinics. The email additionally encouraged parents to, “please call your doctor if you have any specific questions about yourself or your family. For more information, call the NYS Measles Hotline at 1-888-364-4837”.
The realization that this disease isn’t simply another news story has presented a great shock to many parents, and for many anti-vaxxers, it could be the push they need to change their stance on vaccinations. Vaccine clinics have been opened all across New York State, and members of the CDC and New York Department of Public Health have begun progress on properly informing Orthodox communities on the benefits of vaccinations. Since the surge in Measles reporting in New York City, there has also been an immense uptake in MMR vaccinations among children in the city, according to data from New York City’s health department, with many of them coming from within the Orthodox community.
Yet, despite this progress, the amount of people that still remain unvaccinated presents enough of a challenge that the Measles outbreak doesn’t seem likely to be resolved in the near future. The only known cure is prevention, and for those concerned, Doctor Collins provided advice on the best way to avoid exposure. “Two doses of the Measles vaccine provides over 90% protection against the measles. It's the best, and only way we have to keep kids and adults safe”. For parents like McKee, the only hope now is that the virus passes their children unharmed, or that they can be vaccinated in time.
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