When it comes to preventing infectious diseases, all public health policy is local.
Certainly, global institutions like the World Health Organization and federal agencies like the Centers for Disease Control and Prevention serve vital roles in ensuring that people have the best available protections against contagious illnesses like COVID-19, influenza, measles, and Ebola. But those bodies can only be effective if they are robustly funded and led by people who believe in that mission. Since President Trump pulled the United States out of the WHO, put an averred vaccine skeptic in control of the Department of Health and Human Services, and slashed critical funding for the National Institutes of Health, Americans can’t trust that those organizations can help keep their communities as safe as they could be.
That’s where state and local officials can and must step in. The measles outbreak in Texas, which has claimed at least one child’s life, is a perfect example of what can happen when local public health infrastructure breaks down.
But such outcomes could also happen in other communities, including those in Massachusetts, despite the Commonwealth’s status as a national leader in medical research and innovation.
While the state Department of Public Health does respond to crises — including the COVID pandemic of 2020 and the Mpox outbreak of 2022 — by declaring public health emergencies and ramping up resources and information about vaccinations and treatment, there are still cracks in the Bay State’s public health infrastructure. And those gaps are widening, fueled by a small but vocal anti-vaccination movement that has made it harder for the Legislature to pass even the most common-sense legislation to protect schoolchildren and their families.
“The anti-vax movement may be small in number, but they are very loud in volume,” state Senator Becca Rausch, a Democrat from Needham, told me.
Rausch was speaking of the public hearings held in recent years over legislation aimed at giving school, local, and state officials better tools for keeping communities safe from outbreaks like measles — the once-rare, highly contagious, and sometimes deadly illness that is making an unwanted comeback.
Those included measures like one Rausch introduced that would, among other things, standardize the process of seeking religious or medical vaccine exemptions, boost data collection about immunization rates, and collect statewide data to give parents and community members better information about dangers such as localized drops in herd immunity. But that measure stalled in the face of backlash from a tiny but motivated segment of vaccine skeptics.
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Rausch has refiled the bill and hopes that she and other lawmakers hear from a broader, more representative group of Bay Staters who want to keep schools, day-care centers, and communities safe.
Otherwise, “a minority of voices within that anti-vax movement become the majority in those hearings,” Rausch said.
If you think that dips in vaccination rates can’t happen in places like Massachusetts, think again. Though data collection is incomplete — due to a lack of mandatory reporting requirements in the state — the data that state officials have collected are alarming. For example, according to a hot spot map by the Metropolitan Area Planning Council from the 2022-23 school year, there were day-care and K-12 schools across the Commonwealth that reported vaccine exemption rates of higher than 5 percent. In some communities, kindergarten vaccine exemption rates were as high as 22.7 percent. Given that a 95 percent herd immunity rate is necessary to stop a measles outbreak, these figures are shocking — the data only represent schools and districts that voluntarily reported their rates.
That is despite the fact that the measles vaccine is highly safe and effective, and no major religion prohibits it.
The fault does not lie with individual schools or districts, particularly given the burdensome process of vetting vaccine exemption claims. It is with the state for its lack of immunization rules that results in the piecemeal process that overburdens educators, who should be focused on curricula.
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There is a tiny minority of Americans who have closely held religious beliefs or medical conditions that keep them from being vaccinated. But those are the people who need herd immunity the most and are put at greatest risk when their neighbors and families of classmates opt to skip out on recommended immunizations.
Federal officials are making it hard for the public to weigh in and demand that vaccines remain safe, available, and affordable. After citing the need for additional public comment, the CDC postponed the annual meeting to select next year’s flu vaccine formula. But the website is still closed to comments — just one example of the federal government’s chaotic abdication of its duty.
Don’t let state and local officials do the same. Let your Beacon Hill representative know the majority of Bay Staters want to keep their communities safe, and let your local health officials know that accurate and timely reporting of immunization rates is crucial.
Don’t let to fringe speak for you. There is too much at stake.
Kimberly Atkins Stohr is a columnist for the Globe. She may be reached at kimberly.atkinsstohr@globe.com. Follow her @KimberlyEAtkins.
