Recently a measles outbreak occurred in California, spreading out from the international tourist destination that is Disneyland. More than 150 cases have been reported linked to exposure at the park, extending to eight states as well as Mexico and Canada. The California Department of Public Health determined that the type of measles in the majority of those infected was of a kind commonly found in the Philippines, where 50,000 cases still occur each year and claim the lives of more than 100 people annually. A similar outbreak happened in Ohio in 2014 when an unvaccinated Amish humanitarian aid worker returned with the disease and infected nearly 400 people. A year before that, northern Texas saw an outbreak when a man returned from Indonesia and infected more than 20 people at the Eagle Mountain International Church in Newark, an hour's drive from Dallas, including every single unvaccinated child who was exposed. Church leaders allowed a vaccination drive on site to contain the disease but had a history of preaching that God was the trusted source for healing.
Despite the endorsement of non-vaccination by public figures and celebrities, the national rate of vaccination has not dropped significantly since the Wakefield scandal. According to the CDC, there is a difference of only a couple of percentage points in years over the past decade and rates are still above the 90 percent threshold needed for herd immunity. In 2013, Texas had a 92.2 percent vaccination rate, better than 24 other states and up from 90.1 percent in 2006.
Pockets of vaccination resistance are not affecting us on a national or even a state level, but they are doing so on a community level. "High vaccination coverage levels at the national and state levels might mask clustering of unvaccinated children at local levels where vaccine-preventable diseases might be transmitted," the CDC said in a 2013 report. Just one unvaccinated person becoming exposed is enough to spread the disease among his or her like-minded friends and family and from there perhaps to people who can't be vaccinated for medical reasons -- hence the decision by Weir and other doctors to isolate the two populations from each other by segregating their clinics.
It wasn't just doctors who started this recent policy shift. Weir reported that even before she began trying to make her patient load 100 percent vaccinated, she and several colleagues had parents calling her asking if they would see unvaccinated children. Not because they didn't want to vaccinate their children but because they didn't want to expose their children and themselves to families who were anti-vaccination and would seek another doctor if they couldn't find a fully vaccinated practice.
"There was a groundswell of parents asking if we made all our patients vaccinate," says Weir. "They didn't want to deal with a doctor who didn't."
The risk of catching measles from an infected patient is very real. Measles is one of the most contagious diseases in the world. It is transmitted through respiratory droplets expelled by coughing, sneezing, talking or even just breathing, and it infects more than 90 percent of the unvaccinated people with whom it comes into contact. If you share a waiting room with someone who's infected, the very act of that person sitting anywhere near you can spread the virus. In addition, measles can survive for two hours on surfaces such as the elevator panel you touched to get to the floor the clinic is located on, the door handle that led you into the practice or the pen you used to sign in.
It's true that many practices maintain separate waiting areas for sick and well patients, and in the case of Weir's office, those waiting areas even have their own separate ventilation systems that make sure their airflows do not normally mingle. However, because of the nature of measles and how it can spread, this may not be enough. The hallmark of the disease is a distinctive rash that should be an impossible-to-miss sign a person is sick. Avoiding people with visible rashes is no guarantee, though. A sick person is contagious four days before the rash even appears while he or she is asymptomatic. It is perfectly possible for a child in for an annual checkup to be infected with measles, to be unaware of it and to play with another child in a waiting room for non-contagious patients.
Or consider the R in MMR, rubella. Like measles, it is highly contagious, but unlike measles, it is generally a milder disease. A rash and a low fever are all you have to deal with most of the time, and the vast majority of people who catch it recover just fine.
Except for pregnant women in their first trimester. For them, rubella is a nightmare in virus form that attacks their unborn children. In the rubella epidemic of the 1960s, America saw 2,100 neonatal deaths from the disease and more than 11,000 abortions. Some of the abortions were caused by the rubella itself, but others were sought voluntarily after the women learned of the dangers their babies faced from congenital rubella syndrome. Tens of thousands of the children who survived were born blind, deaf and/or mentally retarded.
And as with measles, simply avoiding people with rashes will not protect you. Half of those infected are completely asymptomatic. An unvaccinated person might be helpfully holding the clinic door open for a newly pregnant woman weathering morning sickness and be killing or maiming her child at the same time, completely oblivious of the fact.
When Weir started her vaccination policy, patiently explaining things of this nature as gently as she could became a major part of her initiative.
"I had my nurse pull all our files and go through them one by one to find out who needed to be caught up on their schedules," says Weir. "Then we had each person come in for a consultation so that we could try to convince them what needed to be done."
Some of the cases in which vaccinations weren't up to schedule were simply due to negligence. In others, parents who were worried about how many shots were to be given all at once had their children put on alternative schedules. Instead of getting four shots in one visit, the children would get a shot a month over the course of four visits.
"It still meets the medical guidelines," says Weir. "It just means more trips to the doctor. I have kids myself. I know it hurts watching them get all those shots at once. Spacing it out makes a lot of parents feel better and still gets vaccination done in the time prescribed."
Others needed more convincing because of misinformation they'd read online concerning autism and the side effects of vaccinations, or accurate information they'd read but did not understand, such as the harmful-sounding ingredients in vaccines, like formaldehyde.
"It was a little weird sometimes," says Weir. "I had patients that could rattle off an entire list of ingredients in a vaccine, and yet when I questioned them about what each one did and how it affected the body, they didn't really know. It was just this kind of fear. Fear of additives or bad reactions. One patient told me she'd read that 10 percent of all children who were vaccinated died from it. Ten percent! That's just an insane number."
In all, Weir herself had about ten patients who held out against vaccination. She invited them to tell her which articles and sources had given them concerns. Weir would then print those articles out and go over them line by line with the patients, explaining and debunking bad or false data.