VANCOUVER, Wash. — A measles outbreak near Portland, Oregon, has revived a bitter debate over so-called “philosophical” exemptions to childhood vaccinations as public health officials across the Pacific Northwest scramble to limit the fallout.

At least 43 people in Washington and Oregon have fallen ill in recent weeks with the extraordinarily contagious virus, which was eradicated in the U.S. in 2000 as a result of immunization but arrives periodically with overseas travelers.

More than a dozen more cases are suspected, and people who were exposed to the disease traveled to Hawaii and Bend, Oregon, raising the possibility of more diagnoses in the unvaccinated.

Washington Gov. Jay Inslee last week declared a state of emergency because of the outbreak.

“I would hope that this ends soon, but this could go on for weeks, if not months,” said Dr. Alan Melnick, public health director in Clark County, Washington, just north of Portland. The county has had most of the diagnosed cases so far. “This is an exquisitely contagious disease.”

The outbreak has lawmakers in Washington state revisiting non-medical exemptions that allow children to attend school without vaccinations if their parents or guardians express a personal objection.

Liberal-leaning Oregon and Washington have some of the nation’s highest statewide vaccine exemption rates, driven in part by low vaccination levels in scattered communities and at some private and alternative schools.

Four percent of Washington secondary school students have non-medical vaccine exemptions. In Oregon, which has a similar law, 7.5 percent of kindergarteners in 2018 were missing shots for non-medical reasons.

Washington and Oregon are among 17 states that allow some type of non-medical exemption for vaccines for “personal, moral or other beliefs,” according to the National Conference of State Legislatures.

Numerous studies have shown vaccines do not cause autism – a common reason cited by those who don’t want their kids immunized.

Those opposed to certain vaccines also object to an outside authority mandating what they put in their children’s bodies, and some have concerns about the combination of the measles vaccine with the mumps and rubella immunizations, which is how it’s routinely given.

A measure introduced by Republican Rep. Paul Harris of Vancouver, Washington – the epicenter of the current outbreak – would remove the personal exemption specifically for the combined measles, mumps and rubella vaccine, or MMR. It’s scheduled for a public hearing in Olympia on Feb. 8.

Democratic Rep. Monica Stonier of Vancouver, a co-signer on the bill, said she would prefer an even broader proposal, but “right now we’re looking at what we can get moved.”

Previous attempts have failed.

“We’re trying to respond to a very specific concern here and recognize that there may be broader concerns we can consider down the road,” Stonier said.

Oregon has the nation’s highest statewide vaccine exemption rates, and some communities have rates that are even higher. Washington’s exemption rate, although lower, is also high when compared with other states. Nationwide, the median exemption rate for at least one vaccine for children entering kindergarten in the 2017-2018 year was just over 2 percent.

Maine has some of the highest opt-out rates in the country, but also has some of the worst results when it comes to the spread of infectious disease.

Before mass vaccination, 400 to 500 people in the United States died of the measles every year, 50,000 people were hospitalized and 4,000 people developed brain swelling that can cause deafness. One to three cases out of every 1,000 are fatal.

Meanwhile, some Washington parents live in fear that their children could become infected.

Camas, Washington resident Jocelyn Smith says she has an appointment to get her son vaccinated as soon as he’s eligible – the day after he turns 1 year old.

“I haven’t taken the baby in public for 10 days. I’m just so scared,” she said. “Everybody’s staying inside.”

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