'For Shawn Broomfield and his wife, there was never a question whether or not to have their four children vaccinated.
Broomfield, a software engineer, and his wife, a veterinarian, trusted in the extensive body of research showing vaccines are safe.
“We never seriously considered [not having them vaccinated],” says the 39-year-old, waiting for his bus in a coffee shop in the southern Washington city of Vancouver. “We don’t think the science supports that.”
Not everybody agrees. As Clark County, of which Vancouver is the capital, reels from an outbreak of measles that has infected at least 54 individuals, almost all of them young children, the community is having to confront some harsh truths - namely that only around 75 per cent of its children are vaccinated, compared to a national average of 92 per cent. Across the state, the figure is 85 per cent.
A combination of anti-vaccine propaganda, a state law that allows parents to opt their children out of being immunised, and a reported cultural suspicion of state medicine among elements of its immigrant population, has made Clark County an anti-vaccination “hotspot”.
Governor Jay Inslee last month declared the outbreak to be a public health emergency. “Measles is a highly contagious infectious disease that can be fatal in small children,” he said.
Dr Alan Melnick, the county health director, is heading efforts to tackle the outbreak.
“There is lot of diversity in our unvaccinated population,” he says. “There is a lot of anti-vaccine propaganda on social media, and some of this stuff is pretty sophisticated. It’s dangerous nonsense.”
He says the fact Washington is one of 17 states that permits parents to object “philosophically” to their children being vaccinated - not just on medical or religious grounds - further compounds the problem.
The quiet city of Vancouver, which sites across the Columbia River from Portland, Oregon, is just the latest community to find itself combatting an outbreak of measles, which is fatal in one to two cases per thousand. The last death from measles in the US was in 2015, but the disease can also cause hearing loss, diarrhoea and swelling of the brain. An outbreak among an Orthodox Jewish population in New York made 2018 the second-worst year for measles since 2000. It is always more perilous for children.'
Read more: Inside the US community battling a major measles outbreak - and a wave of anti-vaccination propaganda
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