In San Francisco’s upscale Pacific Heights neighborhood, some 200 students from kindergarten to the eighth grade attend classes at the private San Francisco Waldorf School. On any given afternoon outside of the cheerful, modern white building, parents congregate to wait for their kids. Chit-chat includes the typical fodder like play dates and birthdays, or who was cast in the school play. But occasionally the topic of illness arises — which is where things can take a turn towards the atypical. You might, for instance, hear about “chicken pox parties,” where healthy kids come over to sick kids’ houses to catch the disease.
Of course, there’s a vaccine for chicken pox. It’s been available since 1995, and is part of every state’s recommended vaccine schedule, which the majority of US children receive. But SF Waldorf represents an unusual population: only 35 percent of incoming kindergarteners are up to date on all their vaccinations, one of the lowest rates in San Francisco for a school of its size and vastly lower than the national average of 95 percent. Which puts SF Waldorf firmly in the crosshairs of a national debate.
A vast minority of parents across the country, around 1.8 percent, opt out of vaccines by citing either religious or philosophical reasons. And these non-vaccinators have, in recent years, been the subject of intense media scrutiny. In part, you can blame a former Playboy bunny: Jenny McCarthy, who ABC recently hired as a new host on The View, has waged an ardent, vocal campaign against “toxins” in vaccines that she believes were responsible for causing her son’s autism.
Recent outbreaks of preventable illnesses have only added more fuel to the fire. This year, 16 states have reported cases of measles, making 2013 the second worst year for the disease since 2000. In August, the illness struck 21 people linked to a single Texas megachurch that eschewed vaccinations. And just last week, a new study concluded that vaccine refusals were largely to blame for a 2010 outbreak of whooping cough in California.
Anti-vaccinators are typically branded as naïve simpletons, while pro-vaccinators are slammed as being reactionary reductionists
The issue of vaccination invariably provokes polarized debates, often manifesting in online comment sections and on Twitter and Facebook. Often, the levels of savagery and vitriol are on par with those surrounding debates about abortion and gun control. Anti-vaccinators are typically branded as naïve simpletons, while pro-vaccinators are slammed as being reactionary reductionists.
The reality, like most things, is more nuanced. At the SF Waldorf School parents are educated, liberal-leaning, wealthy enough to afford the $20,200 a year for kindergarten, and often working in technology, law, and other white-collar professions that demand critical thinking skills. But some of them are also treating flawed, precarious medical advice as gospel — and disregarding the health of an entire community in so doing. Looking at the decisions of these parents to stray from standard medical advice, and also at the community of doctors and educators who support them, provides a unique window into one of our country’s most taboo topics.
‘Not fully proven on some level’
When Rebecca* and Mike became pregnant with their daughter, Laura, the issue of whether to give her the standard childhood vaccinations seemed like a choice between life and death. But not in the way you might assume.
Rebecca, who asked that her name and the names of her family members be changed, has a family history of autoimmune dysfunction. Her father died of scleroderma, and her sister suffered from PXE — both rare but serious diseases that manifest in the skin. Rebecca was afraid that vaccines, which by design stimulate the body’s immune response, might unintentionally trigger a disease that Laura may have been predisposed to inherit.
“I was afraid that her immune system was at risk of reacting against her,” Rebecca says. “And my questions about that were not answered in a convincing way by the medical establishment.”
"It’s my responsibility to be very vigilant."
Rebecca and Mike didn’t vaccinate Laura for anything. When she enrolled at SF Waldorf, they signed what is known as a “personal belief exemption” or a PBE — a piece of paperwork that allows parents to opt out of some or all of the vaccines required by the state for entrance into kindergarten. In the US, 18 states offer PBEs and 22 offer exemptions based on religion.
Laura’s parents say they did not take the decision lightly.
“As someone who has chosen a different path, it’s my responsibility to be very vigilant,” Rebecca says. At the slightest sign of illness, her daughter goes right to bed, is fed bone broth, and stays there. Rebecca doesn’t take Laura on trips to countries with high incidence of serious disease, like polio or measles. (This year, the United States has had 173 cases of measles. By contrast, the Republic of Georgia had 7,000.)
Health concerns weren’t the only factor behind Rebecca’s decision: she’s also suspicious about the true motives of pharmaceutical companies that profit from the sale of vaccines. “It makes it hard to feel there are neutral, trustworthy sources of information,” she says.
Rebecca’s fears about government and Big Pharma collusion, along with her theory that vaccines trigger autoimmune disorders, are not uncommon among her fellow parents at SF Waldorf. Although the more infamous fear that vaccines cause autism isn’t as much of a concern (more about that in a minute), parents do worry that the shots might trigger allergies, asthma, and even type 2 diabetes.
Waldorf is an educational system developed by Rudolf Steiner, an early 20th-century Austrian philosopher, which espouses to create well-rounded children through experiential learning and “age appropriate” content. Children are taught the arts and handicrafts, like woodworking and weaving, along with their academic subjects. The use of computer and TV screens at SF Waldorf is, if not forbidden, strongly disfavored — so no Angry Birds or Mickey Mouse, even at home. Team sports are discouraged until the sixth grade.
There is nothing intrinsically Waldorfian about opting out of vaccines, and the school takes no official stance on the issue. (In fact, several parents and school administrators complained that connecting the issue with the school was unfair and misleading, and objected to the premise of this story.) And yet, it is true that SF Waldorf tends to attract parents who trend towards organic food and alternative health care — acupuncture, herbal medicine, and homeopathy — and who prescribe to the adage of the body-as-temple. For some of them, vaccines are — at best — a necessary evil. And at worst, they’re just evil.
“I was very influenced by naturopathic medicine,” says John, an SF Waldorf parent who also asked that his name be changed. “They talk about: vaccines are going to be very strong in supplanting the body’s natural ability to develop immunity.” John and his wife did vaccinate against polio, measles, mumps, and rubella, but they opted out of chicken pox and flu vaccines for their two kids. “They should still be exposed to some things,” John says. Both of his children partook in chicken pox parties: they were sent to the home of a child with the illness, shared a lollipop, and soon after came down with chicken pox themselves.
Parents like John vaccinate selectively, while other parents space shots out rather than follow the vaccination schedule prescribed by the Centers for Disease Control and Prevention (CDC). Others delay vaccinations by several years, believing the more mature their kids’ immune systems are, the better they’ll be able to withstand the onslaught of foreign agents.
“I delayed vaccinations until my kids were crawling,” says Jane*, an SF Waldorf parent with three children. “I believed that while my children were cocooned in the nice little lair of my sling that they didn’t need vaccinations, and if there was any potential for some kind of injury that it was just better to wait.” Jane’s kids are now fully vaccinated.
By skipping or delaying vaccinations, parents put their own kids — as well as fellow SF Waldorf students and community members — at risk of serious illness. But the school “supports the parents’ right to choose,” says Cory Powers, the grade-school administrative coordinator at SF Waldorf. Administrators also take great pains, Powers adds, to communicate that parents who opt out of vaccinations should prepare for heavy responsibilities: someone infected with measles will face a minimum 18-day quarantine, as recommended by the San Francisco Department of Public Health. That’s a lot of days to take off work to care for a sick kid.
“When the parent comes and signs a personal belief exemption, we tell them that if you make that choice, it’s not a frivolous or casual one,” Powers says. But for the most part, she notes, parents who choose to skip or delay vaccinations are the opposite of frivolous. Rather, she describes them as “choosing extremely consciously and holistically.”
“These are people who are also questioning GMOs,” Powers says. “Things that are not fully proven on some level.”
What science says
But there’s a big difference between not eating GMOs and not getting a vaccine. If I don’t eat a corn chip at my local taqueria because I have doubts about the lack of research on GMOs and believe it’s because science and the government are in Monsanto’s pocket, I’m not going to put my dining companions at risk of disease. But if I decide not to vaccinate my kid, I make him a potential carrier. He may be able to fight off measles, mumps, rubella, and other illnesses — but what if he spreads a disease to somebody who, for whatever reason, isn’t so lucky?
If I decide not to vaccinate my kid, I make that kid a potential carrier
Much like any medication, vaccines aren’t 100 percent effective or 100 percent safe. Even the CDC spells this out right on its website. But they exist (and are widely used) because the potential harms of not using them are far greater than any associated hazard. Take, for instance, the MMR (measles, mumps, rubella) vaccine. The CDC estimates that for every 1,000 children in a developed nation who get measles, 1–2 will die. By comparison, for every 3,000–4,000 cases of MMR vaccination, the CDC estimates there will be a “small increased risk” of febrile seizures among children under seven.
The medical establishment, to date, has found no evidence of neurological or autoimmune disorders having been caused by vaccines. The most famous claim, that the MMR vaccine causes autism, was intensively studied and debunked. Andrew Wakefield, the British surgeon behind the original hypothesis, was long ago discredited and stripped of his medical license. Other parents have worried that thiomersal, a preservative containing mercury that was used in vaccines until 2001, causes autism. The preservative was removed from most vaccines as a purely precautionary measure, and subsequent studies have failed to find a shred of evidence for the thiomersal–autism link.
Chicken pox parties also lack medical backing. The idea that it’s healthier to become immune by catching an illness, rather than getting a vaccine, isn’t supported by scientific research. “There is absolutely no evidence for — good science or any theoretical evidence for — the idea that a natural infection makes your body stronger,” says John Swartzberg, a clinical professor at the UC Berkeley School of Public Health. “Natural infection challenges the body with a lot more foreign protein than a vaccine, so it’ll put a lot more stress on the body. Becoming very ill is not good for the body.”
But decades of research, statistics, and ongoing assurances from scientists and government agencies still can’t convince some parents. Politicians can be bought, the thinking goes. The peer review system in scientific journals is corrupted by Big Pharma influence. Scientists aren’t studying vaccines hard enough, because the money lies in convincing the public that they’re safe when they’re actually not.
“It becomes a question of faith,” says Colin Phipps, a chiropractor in San Francisco who doesn’t believe in vaccines and speaks on panels about the topic. “Do you have faith in the CDC? The FDA? Big pharma? Science not driven by profit or motive? Do politicians have our best intentions at heart? Or do you have faith that the body is built to deal with pathogens in the universe?”
For at least some physicians in San Francisco, addressing the vaccination fears of parents has become a difficult balancing act. “I think vaccines have become a scapegoat for our fears about medicine, the government, and mistrust of authority,” says Dr. Julia Getzelman, whose pediatric practice attracts some vaccine skeptics. Getzelman perceives vaccines as “one of the 20th century’s greatest health successes,” and considers the concerns of parents to be “nebulous” in nature.
But that doesn’t mean she forces vaccines on her patients: some of the children Getzelman sees follow an amended vaccine schedule, one that’s contrary to CDC recommendations. “Nobody in the mainstream supports the alternative vaccine schedule — there’s no science behind it,” Getzelman admits. “But when you’re on the front line of trying to individualize care, it doesn’t necessarily always fit with the mainstream.”
The guy in the iron lung
In America, we live in a pax romana with regards to disease. It might not seem that way sometimes, what with our rising rates of autism, cancer, kids dying from peanut allergies, and so on. But as recently as 50 years ago, there were no preventative measures for mumps, which can make men sterile. Or rubella, which can cause serious birth defects if contracted by a pregnant woman in her first trimester. Measles killed hundreds of people a year, and hospitalized 20 percent of those who caught it — most of them children. Those who grew up in the 1950s remember going to the county fair and gawking at “the guy in the iron lung” paralyzed from polio. The specter of disease was real and present.
Today, we have what’s known as “herd immunity.” That is, enough people have been vaccinated that they protect the unvaccinated, or those whose vaccinations fail. The chances of an American getting these formerly common childhood illnesses are very slim. The chances of dying from them are even slimmer. Not because the diseases aren’t serious, but because they aren’t nearly as prevalent.
In fact, herd immunity is actually why some parents don’t vaccinate. “When you think of it that way, it’s hard to want to get vaccinated when you hear anecdotally about things going wrong from vaccines,” says Dr. Justin Davis, a San Francisco physician.
Time and time again, you get the message: rewards come to those who think out of the box
Davis also points out an irony he perceives among his patients. Many of them consider themselves “global participants” — they bike, recycle, and generally take proactive measures to protect the environment. But when it comes to vaccines and immunity, these parents utilize resources more selfishly. He is somewhat sanguine about this. “I take longer showers than I should, and I drive a car and take airplanes. Who am I to say how people of privilege should choose to use the resources available to them?” Davis says. Of course, there’s an inherent problem with that position: “If everybody were to [opt out of vaccinations],” he admits, “there would be huge ramifications.”
One of the tenets of a Waldorf education is to teach self-reliance, independence, and critical thinking skills. “They’re saying, be educated before you just go along with the herd,” says one parent. Clearly, this same type of impulse also leads some parents to question the status quo with regards to vaccines.
“People on the pro-vaccinations side think that people who don’t vaccinate, or vaccinate selectively, are crazy and uninformed,” says John, the parent whose kids got chicken pox from the lollipop. “I think that the people who make these decisions are actually the most well-informed parents, and they’re generally working with their healthcare providers to make these decisions.”
Questioning authority is an impulse that can often serve you well. And that truth is held in particularly high regard in the Bay Area. After all, this is the land where Apple computer was born and “Think Different” became a mantra. Where the expression “disruption” became the tech-term-du-jour to describe companies that were either breaking or skirting the law. Where Bradley Manning was elected Grand Marshal of the San Francisco Gay Pride Parade. Time and time again, you get the message: rewards come to those who think out of the box.
But when well-educated, high-performing people choose to engage in risky, self-serving medical behavior, it also begs the question: what made them feel so alienated from mainstream Western medicine to begin with?
The answer, according to vaccine advocate Dr. Paul Offit, largely comes down to how medical practitioners are perceived. In his takedown of alternative medicine, Do You Believe In Magic, he writes:
“Practitioners of modern medicine can appear callous and insensitive. Patients feel more like a number than a person. That’s where alternative healers come in: they provide individual care, because they care … Where modern medicine is spiritless and technological … alternative medicine is spiritual and meaningful.”
It is not surprising that a class of person deeply involved in searching for and expressing their own individual uniqueness — and that of their children — would be turned off by a cookie-cutter approach to health. And it’s not surprising that in their disaffection, they’d turn away and seek, as one parent put it, “other modalities.”
And that’s when the doubts begin to creep in.