Vax Romana? Peace with Measles (and Vaccination Exemptions) Could Soon Be at an End
The latest battle in the vaccination wars is being played out on the measles front, with so-called anti-vaxxers defending the right to not vaccinate and their opponents pointing to a recent Disneyland outbreak as evidence of a serious reduction in herd immunity. The fight has brought new attention to an old issue—should parents be allowed to opt kids out of childhood vaccinations?
Although concerns about vaccine side effects and personal and religious beliefs are behind the choice not to vaccinate, many feel that the impact on the greater good outweighs the right to make that choice.
“I understand that there are families that in some cases are concerned about the effect of vaccinations,” President Barack Obama said during an interview on Today. “The science is… pretty indisputable. We've looked at this again and again. There is every reason to get vaccinated, but there aren't reasons to not.”
Successful vaccination programs require a critical portion of a community to be inoculated against contagious diseases, creating what is known as herd immunity. Mathematical models from the World Health Organization show that at least 93-95 percent of a population must be immune to achieve herd immunity for measles. If this threshold is met, even those not eligible for vaccination—such as toddlers or immunocompromised individuals—will receive some protection from containment of the disease.
Although the United States had a 94.7 percent vaccination rate for measles, mumps, rubella (MMR) among kindergarteners last year, a recent CDC report warned that those numbers weren’t spread evenly across the country. For example only 81.7 percent of children in Colorado had the two-dose MMR vaccination compared to 99.7 percent in Mississippi.
When vaccination levels drop below the threshold—whether locally or as a nation—the whole population is at risk. That makes a live-and-let-live attitude on the topic difficult to maintain.
“It's tragic to see measles making a resurgence," Orange County Health Care Agency spokeswoman Deanne Thompson told the Associated Press. "When our immunity falls, it creates a problem for the whole community.”
Tragedy or not, exemptions that can lead to a weakening of group immunity exist in all 50 states and in some cases they’re extremely easy to get.
All states require children to be vaccinated before starting school and, as of 2014, all allowed exemptions for medical reasons such as allergic reactions to vaccine or a compromised immune system. When it came to non-medical exemptions, 48 states allowed a religious vaccine exemption and 20 states allowed a personal belief exemption. Mississippi and West Virginia were the only states that didn’t allow claims of religious or personal belief as a reason waive vaccinations before enrolling in school.
Perhaps because of a belief of a link between MMR vaccine and autism (which as been thoroughly debunked) or perhaps just because of a sense of personal liberty, the numbers of people choosing not to vaccinate have grown significantly in the past decade. For instance, in the state of California—the epicenter of the current measles outbreak—parents decided against vaccinating kindergarten-age children at twice the rate they did seven years ago.
It could be that the trend not to vaccinate is just as contagious as the disease. A recent study published in the journal Pediatrics found that parents who refuse to vaccinate their children are geographically clustered.
Analyzing records of children in Northern California, the study’s authors found five statistically significant regions of under-immunization, including south of Sacramento (13.5 percent refusal rate), East Bay (10.2 percent), and northeastern San Francisco (7.4 percent). Refusal rates outside of those areas were 2.6 percent.
An outbreak of measles in those communities or others like them could be potentially devastating and the likelihood of outbreaks is becoming more prevalent. After being declared eliminated by the CDC in 2000, the number of measles outbreaks has grown steadily over the past few years. Last year alone, there were 644 cases nationwide.
The public health issue at hand has quickly become political, with lawmakers across the country introducing legislation to address vaccination rates. While many of these proposed policies take aim at exemptions, not every bill is aimed at tightening the laws. Where lawmakers in California, Oregon, Minnesota, Maine, Vermont, and Washington are trying to eliminate or make it difficult to obtain nonmedical exemptions, legislation in Mississippi, Montana, and New York would widen existing exemptions.
Perhaps a middle ground lies in the efforts of states such as Oregon and Minnesota, where proposed legislation mandates counseling to ensure the decision to refuse vaccination is fully informed.
This strategy for quelling the growing number of people choosing not to vaccinate is the most promising, according to epidemiologist Saad B. Omer. He suggests states should make the exemption process difficult while ensuring parents are as informed as possible. His opinion stems from a 2012 study he conducted that found a 2.3 times higher rate of nonmedical exemptions in states that had easy opt-out policies versus those that were difficult, he
“All democratic societies must try to balance the rights and views of a variety of constituencies,” Omer wrote in The New York Times. “Parents of children who are too ill for vaccination should of course be granted an exemption. Everyone else—no matter their belief—should face a high burden before being allowed to remove their children from the immunized herd.”
—Elke Weesjes, Editor, Natural Hazards Observer
Shooting the Messenger: Forecasts and Failed Predictions
Hell hath no fury like weather watchers scorned—and if that wasn’t already apparent to most meteorologists it was certainly made clear recently when snow-expectant New Yorkers prepared to get dumped on but merely got dusted.
The Big City hunkered down on January 26, awaiting a snowstorm the National Weather Service had described as “crippling and potentially historic.” The dire forecast (and possibly painful memories of Buffalo in November) prompted Governor Andrew Cuomo to essentially shut down the city, closing the subway for the first time ever. Bus service, commercial flights, PATH trains, and highways were also shut down and nearby state leaders took similar measures.
Imagine the chagrin, then, when parts of the stranded region awoke to find less than a foot of snow covered their forcibly parked cars and quiet streets. No matter that many areas did indeed get the predicted amount of white stuff, the question perpetually asked by news outlets was how could forecasters get it so wrong?
There are a few answers to that—the inability to anticipate the western edge of the storm, differences in weather models, and the general difficulty in forecasting snowstorms. There’s also the valid point that for much of the forecast area, snow speculations weren’t wrong. In fact, according to National Weather Service Director Louis Uccellini, the real problem with the forecast wasn’t the variables, but that most of us don’t understand them.
“It is incumbent on us to communicate forecast uncertainty,” Uccellini said of NWS forecasters. “We need to make the uncertainties clear.”
How to best do that is a topic that has long occupied meteorologists. The World Meteorological Organization has issued guidelines on communicating uncertainty, stating that improved understanding of the changeability in forecasts would enhance decision making and boost audience confidence. The National Research Council has also issued recommendations, specifically for NWS.
The suggestions range from simple ideas such as using color in weather maps and considering how warnings are worded to more technical concepts such as moving from deterministic to probabilistic modeling. In the NWS case, though, years of incorporating this research haven’t created enough change.
“Despite efforts made to educate NWS forecasters on how to interpret and convey this information, they are severely constrained in doing so when adhering to the currently inflexible state of the official product suite,” writes Steve Tracton for the Washington Post’s Capital Weather Gang blog. “Not to mention, users need to be educated on how to understand this information.”
It’s not really clear if a better understanding of uncertainties would have caused officials to act any differently. Many have stated that they would rather be over-prepared for a nonevent than underprepared for a deadly storm. And while that attitude is heartening, it can be a fine a line between unnecessary readiness and warning fatigue.
“It's not whether the city should have prepared so much, it's how people respond,” Irwin Redlener, Director of the National Center for Disaster Preparedness, told the Associated Press. “We don't want the population to get so cynical that they're not heeding the warnings.”
In that sense, then, apologies from forecasters aren’t helpful, because they deflect attention from their audience’s responsibility to be sure they understand the information that they’re using to make decisions. Still, as University of Georgia atmospheric scientist Marshall Shepherd points out, in today’s information environment, it will fall on forecasters to get the point across.
“There is more risk and nuance in weather forecasts than the public is interested in consuming so it is a challenge to craft a message that gets attention, is not ‘hype,’ yet has actionable information,” he writes for Weather Underground. “We must continue to have the discussion about how to communicate uncertainty and risk effectively.”
Disaster News Redux: The Trials of Creating Ebola Drugs
Desperate Times: Public attention focused on untested drugs that might be used to treat Ebola after two Americans where given an experimental serum in August. The drug, called ZMapp, was given to Kent Brantly and Nancy Writebol after they stricken with the disease while working in Liberia.
Brantly and Writebol recovered, but health officials warned that the drug was only used because the benefits outweighed the risks. Because it hadn’t had the benefit of the years-long clinical trials required by the U.S. Food and Drug administration, there was no way to tell what the long-term health effects might be.
Health officials and drugmakers were working to fast-track treatment, but didn’t expect Phase I trials to be complete until January 2015. The drug given to Brantly and Writebol was only approved for emergency uses.
Critical Measures: Although several drugmakers where able to launch Ebola drug trials, a decline in the number of cases has brought at least one to a halt and threatens others.
The pharmaceutical company Chimerix announced that it would stop testing of its antiviral drug, brincidofovir, early this month, according to the New York Times. The trial, being held in Liberia, aimed at treating 140 patients but has seen less than 10 Ebola cases since its January 2 start date.
“The past weeks have brought the extremely positive news that Ebola infections are falling across West Africa, including in Liberia where our trial of brincidofovir was based,” University of Oxford professor Peter Horby, who led the trail, told The Guardian. “We’re delighted that infections are falling, but fewer patients makes it more difficult to carry out the robust scientific studies needed to ensure a new treatment will be safe and effective.”
Several other trials are facing similar circumstances, including a drug known as favipiravir, which is testing in Guinea and a trial testing plasma from the blood of Ebola survivors (known as convalescent serum). Both those trials are still ongoing, with the maker of favipiravir, called Avigan, stating that they had tested a “decent” number of patients and would attempt to find more, according to the Times. Last week, Guinea officials approved the drug for wider use, according to Reuters.
The Next Tests: Meanwhile, testing of ZMapp is about to move forward in Liberia, where the number of Ebola cases has once again ticked up, according to Scientific American. Guinea and Sierra Leone have opted not to participate based on the trial methodology, which uses a placebo control.
In addition to the fluctuating Ebola case count, it’s possible that Guinea’s approval of favipiravir could cause trouble for Zmapp and convalescent serum trials by muddying the factors used to interpret results. Widespread use would also make it more difficult to organize new trials, according to Scientific American.
Call Outs: Calls for Papers, Abstracts, Proposals, and More
Call for Applications
Department of Homeland Security Graduate Student Fellowship
Coastal Hazards Center
Deadline: February 27, 2015
The Coastal Hazards Center is accepting applications for the Department of Homeland Security Graduate Fellowship program. Applicants should be highly motivated and interested in pursuing a graduate degree focused on coastal hazards. Fellows complete two 10-week paid summer internships and attend the Department of Homeland Security Science and Technology Summit. For more information on the program and how to apply, visit the Coastal Hazards Center Web site.
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Call for Applications
Gulf Research Program Early-Career Research Fellowships
National Academy of Sciences
Deadline: February 27, 2015
The Gulf Research Program is accepting fellowship applications from tenure-track professionals who contribute to the improvement of human health, the environment, and oil system safety. Up to five fellows will be selected for two-year fellowships. Fellows will receive a two-year grant of $76,000 for research-related expenses and mentorship from a leader in the discipline. For more information on the program and how to submit an application, visit the National Academies Web site.
Some New Web Resources
Ready-to-use Educational Fire Safety Programs and Presentations
This U.S. Fire Administration Web site lists different programs, presentations, and toolkits promoting fire safety. The listed materials can be downloaded for free and are aimed at diverse audiences from smokers and amateur chefs to preschoolers and seniors. Even if you’ve visited the site before, you’ll want to keep an eye out for great new additions—like the recently released Fire Safety Program Toolkit, which has all the material you need to create or update effective fire safety programs.
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A Guide to Public Health Careers
This recently launched website will give those interested in public health careers a better understanding of the professional landscape, including expert interviews and the educational requirements needed to enter, advance, and succeed in the field. Also useful is a concise overview of the ten most common areas of public health study a list the top employers in the field.
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2004 Indian Ocean: 10 Years On
This report by Aon Benfield’s Impact Forecasting center delves into the science behind tsunamis and explains how this information is being incorporated into new probabilistic models for Japan, Chile, and Southeast Asia. The report also examines how early warning systems have drastically improved and discusses the availability of tsunami insurance coverage in the Asia Pacific region.
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State of the Climate Summary Information
This user friendly Web site by the National Climatic Data Center offers visitors monthly summaries recapping global and national climate-related occurrences. With data going back to February 2012, it provides users with selected climate anomalies and events and offers statewide and worldwide average precipitation and temperatures rankings. In addition, users can find detailed data on a variety of natural hazards, including drought, hurricanes, and tornadoes.
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Community Resilience through PreservationThis blog entry by the Rockefeller Foundation’s 100 Resilient Cities initiative examines how Seattle was able to use community engagement in its historic Chinatown neighborhood to create a safer more resilient city. The initiative is dedicated to helping cities around the world become more resilient to the physical, social, and economic challenges. Visitors to the site will find information about the 100 cities selected to participate and read about their history, demographics, challenges, and goals.
Conferences and Events
[Below are some recent announcements received by the Natural Hazards Center. For a comprehensive list of upcoming hazards-related meetings, visit our Web site at www.colorado.edu/hazards/resources/conferences.html.]
February 26-27, 2015
Ice Rescue Operations and Training Meeting
National Association of State Boating Law Administrators
Bay City, Michigan
Cost and Registration: $695 before March 8, open until filled
This conference will focus on ice rescue practices, techniques, and equipment to reduce risk and will improve first responder understanding of the effects of cold water on victims. Topics include cold water injuries, ice dynamic, on-ice tools, surface rescue, and ice searches.
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March 30 to April 2, 2015
National Hurricane Conference
National Hurricane Conference
Austin, Texas
Cost and Registration: $400 before March 27, open until filled
This conference will focus on improving hurricane preparedness, response, recovery and mitigation in the United States, Caribbean, and the Pacific. Topics include lessons learned, multijurisdictional response, effective communication in crises, evacuation planning, coastal evacuations, debris management planning, and hurricane protection for homes and commercial buildings.
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April 14-17, 2015
Preparedness Summit
National Association of County and City Health Officials
Atlanta, Georgia
Cost and Registration: $775 before March 6, open until filled
This conference will focus on global health security preparedness, including protecting against infectious disease and the effects of climate change on health. Topics include lessons from the frontlines of the Ebola outbreak, strengthening relationships between public health and emergency management, biosecurity and biodefense, and crisis leadership in public health emergencies.
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April 17-18, 2015
International Symposium on Anthropology and Natural Disasters
University of Coimbra
Coimbra, Portugal
Cost and Registration: $65 before March 1, open until filled
This conference will present an anthropological perspective helpful in understanding human behavior in relation to disasters. Topics include, bioarcheological responses in Byzantine Greece, impacts of natural disasters on human life, and the relationship between social and cultural anthropology and disasters.
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April 20-24, 2015International Wildland Fire Safety Summit and Human Dimensions of Wildland Fire
International Association of Wildland Fire
Boise, Idaho
Cost and Registration: $550 before March 2, open until filled
This conference will examine the social aspects of wildfire and use research findings, innovations, and lessons learned to discuss ways to improve practice. Topics included indigenous experience with wildfire, predicting homeowner mitigation behavior, assessing firefighter risk, wildfire loss policies, and international case studies in wildfire response.
Jobs, Jobs, Jobs
Training Instructor
Arkansas Department of Emergency Management
North Little Rock, Arkansas
Salary: $30,713 to $52,167
Deadline: February 18, 2015
This position is responsible for developing, coordinating, and implementing emergency management preparedness training. Duties include researching material for use in course content, conducting training and evaluating results, analyzing post-disaster damage assessments, and revising programs based on recent research. A bachelor’s degree in business administration or a related area and two years of experience is required.
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Director of Planning and Preparedness
Pennsylvania Emergency Management Agency
Harrisburg, Pennsylvania
Salary: $66,973 to $101,829
Deadline: February 27, 2015
This position is responsible for overseeing tactical and operational planning, community preparedness, and training, exercise, and evaluation programs. Duties include implementing emergency management policies, coordinating community planning, conducting public outreach, and developing homeland security programs. A bachelor’s degree and six years of emergency management experience, including supervisory and emergency management program planning, are required.
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Program Director
National Science Foundation Infrastructure Management and Extreme Events Program
Arlington, Virginia
Salary: Not Listed
Deadline: March 1, 2015
This position is responsible for ensuring the program supports fundamental, multidisciplinary research on the impact of hazards and extreme events on civil infrastructure and society. Duties include soliciting, receiving, and reviewing research and education proposals, making funding recommendations, administering awards, interacting with other federal agencies, and forming and guiding interagency collaborations. A PhD in a related field and six years of research experience is required.
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Private Sector Coordinator
Southern California Earthquake Center
Los Angeles, California
Salary: Not Listed
Deadline: Open until filled
This position will raise private sector awareness of the University of Southern California’s Southern California Earthquake Center, increase participation in its projects, and develop funding opportunities. Duties include administrating the academic, research, and clinical program; developing program operating policies; and implementing a promotion strategy for the program. A bachelor’s degree in a related field and three years of experience is required.
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Research Director
National Center for Disaster Medicine and Public Health
Rockville, Maryland
Salary: Not Listed
Deadline: Open until filled
This position will lead research efforts at the National Center for Disaster Medicine and Public Health and be responsible for providing scientific, technical, and program support services. Duties include preparing technical reports, writing literature reviews, conducting investigations of human subjects ethics compliance, data analysis and interpretation, overseeing quality control, supervising research, and submitting abstracts and posters of results. A master’s degree in a social science or health-related field and at least six years of experience is required.
Webinars, Training, and Education
Webinar
Measles Outbreak: Exploring the Role of Public Health Law
February 19, 2015, 1 p.m. to 2:30 p.m.EST
The Network for Public Health Law, U.S. Centers for Disease Control and Prevention, and others
Cost and Registration: Free, register online before the event
This webinar will explore legal issues associated with the recent measles outbreak that has infected more than 100 people in the United States. Topics include an overview of vaccination laws and exemptions, state-level temporary exclusion laws for unvaccinated students, and a case study for implementing legal disease control measures.
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Webinar
Insight into an Academic Career in the Hazard and Disaster Mitigation Field
February 26, 2015, 2:00 p.m. to 4:00 p.m. EST
The William Averette Anderson Fund
Cost and Registration: Free, register online before the event
This webinar, the second in the Fund’s series on hazards and disaster mitigation careers, will offer perspectives from experts on academic careers in the field. The webinar includes presentations from four respected scholars who actively participate in hazards and disasters research and education.
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Webinar
Delivering Operational Resilience Through the Cloud
Emergency Management
March 5, 2015, 2:00 p.m. to 3 p.m. EST
Cost and Registration: Free, register online before the event
This webinar will explore how the cloud can provide a resilient platform for mission-critical public safety solutions. Topics include elements of the cloud essential for emergency response, solutions to support citizens and responders, and common sense approaches for including the cloud in an emergency management strategy.
Contributions of jobs, conferences, and other content to this newsletter can be sent to jolie.breeden@colorado.edu. Please include “for Disaster Research” in the subject line.
To subscribe, visit http://www.colorado.edu/hazards/dr/.