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field notes

Letter from California: Life in the Measles Outbreak

6 MINS READFeb 12, 2015 | 17:14 GMT

We often publish field notes from my colleagues from geopolitically significant and sometimes exotic places around the world. This note, though, is coming to you from a far less exotic and certainly less interesting place — my living room.

As a resident of Northern California, I get to enjoy the wonderful weather and being a short drive from both the coast and the mountains. I live in a geopolitically significant place in that the Central Valley provides high-value agricultural products for export. It was here, near Fort Ross, that in the 19th century Russia sought to secure the food supply on the Pacific coast as part of its colonial efforts. Today, California's drought is on everyone's minds. However, it is not the first topic that percolates through conversation. Most of my friends are young, scientifically minded and at the start of their careers. Many are considering having children soon. What are they discussing? A topic that has blown up on social media and is now being discussed by presidential hopefuls — vaccines. Except, in our social circle, many spend their time worried that a debate is happening at all.

In my work, I often address disease through a geopolitical lens and the viewpoint is, by necessity, impersonal. I set aside the impact of disease on humans so that I can examine the potential for trade or economic disruption during outbreaks or constraints put on economic growth due to endemic disease. When looking at the U.S. measles outbreak from the 10,000-foot view, there is going to be little lasting impact. While the measles virus was eradicated from the United States in 2000, it is still endemic in many locations around the world. The disease spreads rapidly, but is rarely deadly. The number of cases per year in the United States is still comparatively low. While there will likely be additional local costs for the communities hardest hit, the outbreak will not have a negative impact on the nation's economy.

But living in California — the state that has been the epicenter of the latest outbreak — and having become a new parent last November, I have found it difficult to approach this particular outbreak from that same high-level view. As any parent would, I want to keep my daughter as safe as I possibly can. And as any new parent, I worry more than I should. But I should not be nervous taking her to the grocery store or to the park. And yet, despite what my rational mind is telling me, I am just a little. And that is not because of the disease itself, but because of what caused it.

As someone who follows global disease outbreaks as part of my job, my first question when looking for daycare facilities of my daughter, even before questions of accreditation or curriculum, was their vaccination policy. If they allowed exemptions in the infant room or had older children with exemptions, it was a no-go. My child would be starting daycare before she was fully vaccinated and would have to, for the first year of her life, rely on herd immunity — the measure of protection that unvaccinated individuals enjoy when the vast majority of others are vaccinated. In 21st-century California it seems odd to have to mistrust herd immunity, but that is the situation.

As a developed nation, the United States does not face the same constraints in terms of disease as developing nations. The United States has both the funds and technology —vaccines and medication — to keep diseases in check, as well as robust infrastructure to distribute this technology. This means that it does not have the economic constraint that endemic diseases such as malaria in Africa or parts of Asia present. When examining new treatments as an analyst I look at potential limitations and costs of development to evaluate the global impact. Robust and cheap treatments have more potential to have an impact because they can be used more easily by developing nations where these disease constraints are more prevalent. The measles outbreak, though, is different and is part of a growing trend that despite having the tools to limit disease, there are populations that choose not to use them.

The current measles outbreak started with an imported case at Disneyland that has spread to more than 120 individuals in 17 different U.S. states. Its continued spread has been facilitated in large part because of lack of vaccinations.

The scariest part, as a parent, is that many children in the United States are not vaccinated because their parents made a choice, a misinformed one. The science is simple, the data overwhelming. Vaccines work and are safe. Yes, there are side effects, but they are extremely rare. Vaccines are not poison. There is no substantiated link to autism, despite what a single, falsified, retracted study showed almost two decades ago. And yet vaccination rates continue to decline. And, in the United States, it is not a matter of access. Rather it is affluent, educated areas where the vaccination rates have dipped the furthest. While California law requires that kindergarteners be vaccinated, parents are allowed to opt out and the opt-out rate doubled between the 2007/2008 and 2013/2014 school years. Although it did fall for the 2014/2015 school year, it is still high across the state at 2.5 percent. Locally the rate can be even higher and private schools have a higher rate than public schools. Marin County (San Francisco Bay Area with a median household income over more than $90,000) has a personal belief exemption level of over 7.5 percent. In order to maintain herd immunity for measles, approximately 95 percent of the population needs to be vaccinated.

The outbreak began at Disneyland, a place where many families vacation, but now daycares are closing and high school students without vaccinations are being asked to stay home as new cases continue to be reported. Measles may not be an extremely deadly disease, but it spreads very rapidly and is difficult to contain without vaccinations. The frustrating part of the whole thing, as both a scientist and a parent, is that the magnitude of such an outbreak was preventable.

Before I became a parent, I used to scoff at parents who refused to vaccinate – how could they possibly risk their child's health like that? Having watched my daughter's first round of vaccines, I empathize with the desire to prevent a child's discomfort and protect their health. But failing to vaccinate when there are no underlying medical concerns does not protect a child. It puts not only the one child at risk to contract preventable diseases, but my baby as well.  But there is the personal creeping in. From a geopolitical standpoint, it is important to maintain herd immunity against diseases to prevent their re-emergence. Endemic diseases have the potential to reduce economic output. With the measles outbreak, this is not likely to happen. However, with globalization aiding the spread of some diseases, if the United States fails to use its tools, it could end up constraining itself with endemic disease.

This Field Note was written by Stratfor Science and Technology Analyst Rebecca Keller

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