The headlines might lead you to think that Texas is a hotbed of infection, threatened with measles and pocketed with pertussis. And you’d be right to some extent and left asking, What makes Texas so welcoming to infectious disease?
Deep in the heart of Texas and in its extremities, there’s certainly an attitude of resistance to government intervention, as any quick bumper sticker survey will tell you, and that resistance extends to vaccine requirements. Even tracking immunizations itself is politicized, the Texas Tribune reports, noting that decade-long calls from the Texas Medical Association for automatic inclusion in an immunization registry have met with resistance from conservative Republicans.
Texas is one of the states that allows parents to opt out of vaccines on the basis of personal beliefs or “reasons of conscience” and still have their children attend public school. The exemption rate in the state isn’t nearly as high as rates in areas of Colorado and California, where exemptions are considered to be particularly lax. Yet since Texas began allowing non-medical exemptions in 2003, rates of opt-out because of “conscience” have climbed every year. Regardless of where they’re offered, these exemptions are billed on many anti-vaccination sites as a way of expressing one’s independence from authority, a sort of “You can’t tell me what to do with my child” thumbing at The Man.
That thumbing has consequences. The Lone Star state has just weathered a measles outbreak courtesy of a virus that traveled from Indonesia to a church full of unvaccinated, homeschooled children in North Texas. In that episode, at least 20 people were infected. The state is also now in the midst of what is predicted to be of its biggest pertussis outbreaks since the 1950s, which has slammed at least 2000 people and killed two infants. Authorities calculate that for every known case of pertussis, 10 more people are walking around with it, coughing on babies too young to be vaccinated or infecting others whose immunity–natural or acquired–has waned.
In response, public health experts are strongly recommending that everyone be up-to-date on their pertussis vaccines and boosters and that pregnant women–caregivers are the ones most likely to transmit infection to infants–also be sure to get their Tdap vaccine updated. Texas has a reported below-average uptake of pertussis vaccination at 94%.
This is also the state whose legislature voted down a 2007 executive order adding the anti-cancer HPV vaccine to the schedule, citing infringement on personal liberty and a fear that the vaccine would somehow make girls promiscuous, clearly a greater concern than the risk of their developing cervical cancer. Texas Governor Rick Perry’s effort to mandate the vaccine then led to related surreality during the 2012 Republican presidential debates in which Michele Bachmann, who is not from Texas, wildly asserted that the vaccine would cause mental retardation.
In regular old reality, although some mavericky attitudes might drive vaccine refusal in Texas, the state is really no worse than many others and certainly better than some areas of California, for example. There just happen to be a whole lot of people in Texas, which also happens to boast three of the nation’s top 10 most populous cities.
Like parents across the country, Texas parents are in some instances falling victim to non-evidence-based claims about vaccines, such as the persistent rumor that vaccines cause autism (they don’t) or that the vaccine schedule is “too much, too soon.” That is not the case; indeed, the current schedule is more like “orders of magnitude less” than previous schedules and–as experts point out repeatedly–much less than an infant encounters out there in the microbe-riddled world–or from the caregiver with pertussis.
These ideas to space out the schedule to avoid overwhelming an immune system might make sense if the immune system were, say, a tiny, finite measuring cup that can only handle so much. But that’s not how it works. In reality, the immune system handles an immeasurable number of antigens because its job is to do exactly that. We can either present those antigens in a way that activates immunity without killing children, or we can let nature present them and deal with the accompanying negative outcomes that include permanent disability and death, in addition to colossal economic and social costs.
The evidence-based reason babies and children get ‘so many so soon’ is that in early life, humans are at their most vulnerable to the diseases these vaccines prevent. These outbreaks–particularly the pertussis outbreak in Texas that’s already killed two babies–are the strongest argument that can be made for administering vaccines as soon as feasible to protect infants and children. It’s also a good reminder to make sure you’re up to date on your own boosters, whether you live in Texas or not.