Sara Griffith saw children die of measles when she served in the Peace Corps in West Africa. “It’s horrendous,” says Griffith, now a school nurse in Spokane.

But in America, it’s safer. We vaccinate.

Except this year, the United States was hit with the largest measles outbreak in over a decade. Since January, there have been 118 cases, leading to 47 hospitalizations. And nearly 90 percent of those infected weren’t vaccinated, reports the Centers for Disease Control.

Some of those cases were in Washington state, which, at 6.2 percent, has the highest percentage of kindergartners in the nation opting out from at least one required vaccination. And Spokane County’s rate is even worse. From 2006 to 2010, the county’s vaccination opt-out rate hovered around 9 percent, more than triple its 1997 rate. So why aren’t parents choosing to vaccinate their kids, and what can be done to raise the number of vaccinated children?

One possible contributor: In Washington state, opting out is a cinch. Many states only allow exemptions for religious reasons, or require written explanations. But in Washington, it only takes a parent’s signature.

Meanwhile, over the past three decades, getting vaccinated has become more complicated. The vaccination schedule has tripled in length. Entirely new vaccinations, like those for chicken pox, are now required. (Fewer children in Spokane County received the chicken pox vaccination than any other required vaccination.) Harried parents, health officials speculate, may just want to duck the hassle.

“It’s hard to tell the difference between a real philosophical exemption, and a convenience exemption,” says Kathe Reed-McKay, health services director for Spokane Public Schools. The Spokane Regional Health Department found that some parents had actually vaccinated their children but showed up to register their kids for school without the proper vaccination paperwork, and so they simply signed an exemption for sake of ease.

That’s why, this year, the state Legislature passed bills requiring a doctor’s signature for exemption from vaccination, providing proof that the doctor ran through the risks and benefits of vaccination.

Some opposed the bill, including virtually all of Spokane’s Republican legislators. And while home-school students won’t be affected, the Home School Legal Defense Association called the bill an “attack on parents’ rights to decide whether they should immunize their children.”

“Sometimes physicians are not willing to sign a release unless their belief system is similar to their parents,” says the association’s staff attorney, T. J. Schmidt.

The highest immunization exemption rates in Spokane come from private schools and home school-public school partnerships.

“Homeschooling parents by their very nature … would seem to be more open to medical alternatives,” Schmidt says.

Over 54 percent of the kindergartners at St. Michaels School weren’t fully vaccinated, according to the Washington State Department of Health. At Valley Christian, it’s 50 percent. At Cheney Home Works, 53 percent. Compare these to the public schools with some of the highest rates: At Jefferson Elementary, only about 11 percent of the kindergartners this year weren’t fully vaccinated. At Roosevelt Elementary, it’s around 25 percent.

“The families that we serve have very particular concerns around the health and welfare and schooling of their children,” says Shannon Lawson, Cheney Home Works program director.
Yet, nationally, with all types of schools, numbers have increased.

“I do believe there has been an increase in true personal exemptions,” Reed-McKay says. “That was based in the inaccurate research for the association between autism and measles vaccine. Parents are concerned.”

Last year, a national poll conducted by C.S. Mott’s Children Hospital found “vaccine safety” was the No. 1 priority for parents when it came to children’s health research.

“I really don’t try to sway people. I just want people to be informed,” says Griffith, the school nurse. “I think it’s very hard for every parent, after they have a newborn, to face injections on their child.”

She says the campaign to vaccinate needs to be an emotional one, focused on protecting the child. And it’s not just a matter of preventing five days of chicken pox misery, she says. Schools serve more students with suppressed immune systems — kids who can’t get vaccines and are very vulnerable to disease — than ever.

“There are children all over this earth who do die of those diseases,” Griffith says.