Anti-vaccine activists just sparked a U.S. state’s worst measles outbreak in decades
After repeated visits from discredited activists, vaccination rates among Minnesota’s Somali-American community plummeted to just 42 per cent in 2014 — far below the threshold to prevent an outbreak.
MINNEAPOLIS—The young mother started getting advice early on from friends in the close-knit Somali immigrant community here. Don’t let your children get the vaccine for measles, mumps and rubella — it causes autism, they said.
Suaado Salah listened. And this spring, her 3-year-old boy and 18-month-old girl contracted measles in Minnesota’s largest outbreak of the highly infectious and potentially deadly disease in nearly three decades. Her daughter, who had a rash, high fever and a cough, was hospitalized for four nights and needed intravenous fluids and oxygen.
Nurse Lydia Fulton administers the vaccine for measles, mumps and rubella to a young patient at the Children’s Primary Care Clinic in Minneapolis. (COURTNEY PERRY / THE WASHINGTON POST)
“I thought: ‘I’m in America. I thought I’m in a safe place and my kids will never get sick in that disease,’ ” said Salah, 26, who has lived in Minnesota for more than a decade. Growing up in Somalia, she’d had measles as a child. A sister died of the disease at age 3.
Salah no longer believes that the MMR vaccine triggers autism, a discredited theory that spread rapidly through the local Somali community, fanned by meetings organized by anti-vaccine groups. The advocates repeatedly invited Andrew Wakefield, the founder of the modern anti-vaccine movement, to talk to worried parents.
Immunization rates plummeted and, last month, the first cases of measles appeared. Soon, there was a full-blown outbreak, one of the starkest consequences of an intensifying anti-vaccine movement in the United States and around the world that has gained traction in part by targeting specific communities.
“It’s remarkable to come in and talk to a population that’s vulnerable and marginalized and who doesn’t necessarily have the capacity for advocacy for themselves, and to take advantage of that,” said Siman Nuurali, a Somali-American clinician who co-ordinates the care of medically complex patients at Children’s Hospitals and Clinics of Minnesota. “It’s abhorrent.”
Although extensive research has disproved any relationship between vaccines and autism, the fear has become entrenched in the community. “I don’t know if we will be able to dig out on our own,” Nuurali said.
Anti-vaccine advocates defend their position and their role, saying they merely provided information to parents.
“The Somalis had decided themselves that they were particularly concerned,” Wakefield said last week. “I was responding to that.”
He maintained that he bears no fault for what is now happening within the community: “I don’t feel responsible at all.”
MMR vaccination rates among U.S.-born children of Somali descent used to be higher than among other children in Minnesota. But the rates plummeted from 92 per cent in 2004 to 42 per cent in 2014, state health department data shows, well below the 92-94 per cent threshold needed to protect a community against measles.
Wakefield, a British activist who now lives in Texas, visited Minneapolis at least three times, in 2010 and 2011, to meet privately with Somali parents of autistic children, according to local anti-vaccine advocates. Wakefield’s prominence stems from a 1998 study he authored, which claimed to show a link between the vaccine and autism. The study was later identified as fraudulent and was retracted by the medical journal that published it, and his medical license was revoked.
The current outbreak was identified in early April. As of Thursday, there were 41 cases, all but two occurring in people who were not vaccinated, and all but one in children 10 and younger. Nearly all have been from the Somali-American community in Hennepin County. A fourth of the patients have been hospitalized. Because of the dangerously low vaccination rates and the disease’s extreme infectiousness, more cases are expected in the weeks ahead.
Measles, which remains endemic in many parts of the world, was eliminated in the United States at the start of this century. It reappeared several years ago as more people — many wealthier, more educated and white — began refusing to vaccinate their children or delaying those shots.
The ramifications already have been significant. A 2014-2015 measles outbreak infected 147 people in seven states and spread to Mexico and Canada. In California, high school students were sent home because of infected classmates. One patient, who was unknowingly infectious, visited a hospital and exposed dozens of pregnant women and babies, including those in the neonatal intensive care unit. Another adult patient was hospitalized and on a breathing machine for three weeks.
Federal guidelines typically recommend that children get the first vaccine dose at 12 to 15 months of age and the second when they are 4 to 6 years old. The combination is 97 per cent effective in preventing the viral disease, which can cause pneumonia, brain swelling, deafness and, in rare instances, death.
Minnesota’s Somali community is the largest in the country. The roots of the outbreak there date to 2008, when parents raised concerns that their children were disproportionately affected by autism spectrum disorder. A limited survey by the state health department the following year found an unexpectedly high number of Somali children in a preschool autism program. But a University of Minnesota study found that Somali children were about as likely as white children to be identified with autism, although they were more likely to have intellectual disabilities.
Around that time, health-care providers began receiving reports of parents refusing the MMR vaccine.
As parents sought to learn more about the disorder, they came across websites of anti-vaccine groups. And activists from those groups started showing up at community health meetings and distributing pamphlets, recalled Lynn Bahta, a longtime state health department nurse who has worked with Somali nurses to counter MMR vaccine resistance within the community.
At one 2011 gathering featuring Wakefield, Bahta recalled, an armed guard barred her, other public health officials and reporters from attending.
