Photo by Amanda Brown/The Star-Ledger - Pediatrician M. Calhoun Thomas immunizes Julian Booker, age 2, in her Orange office. Julian's dad Aree Booker holds the toddler, but Julian's sister Aaliyah, age 8, cannot bear to watch.
Call it one of New Jersey’s medical mysteries.
One of the most affluent states in the country, home to more than a few giants of the pharmaceutical industry, New Jersey also has one of the lowest immunization rates in the nation for babies and toddlers.
The state ranked 42nd last year — and 45th in 2008 — in a telephone survey of parents and pediatricians by the U.S. Centers for Disease Control and Prevention.
New Jersey’s 64 percent rate for giving infants and toddlers recommended shots for polio, hepatitis B, mumps, measles and rubella and other diseases last year was well below the national average of nearly 71 percent, and the lowest in the Northeast. In Pennsylvania, 72 percent of infants and toddlers got their shots. Nearly 71 percent got them in New York City.
Nobody knows for sure why New Jersey’s vaccination rate has slipped so low, but public health professionals and pediatricians say they’ve seen it building for several years.
In low-income and immigrant communities, many lack health insurance, transportation to the doctor’s office, or struggle to understand the complex schedule of up to 28 shots recommended by the time a child is two-and-a-half years old.
And there’s also a growing resistance to vaccines among middle-class and wealthy people for whom money and insurance aren’t an issue. Some reject the schedule of shots urged by the American Academy of Pediatricians and the CDC.
"There is a lot of angst over vaccines," said David Bendich, a pediatrician and president of the Essex Metro Immunization Coalition, which promotes vaccination among city children. "There is so much anti-vaccine feeling in the population. Nurses don’t want to see kids cry. Even some doctors don’t want to give four vaccines in one visit."
To improve vaccine rates, physicians and public health officials formed the New Jersey Immunization Network late last year. They fear what the anti-immunization trend might bring: a comeback for serious diseases like whooping cough and measles, all but wiped out generations ago. They note 1,500 cases of whooping cough erupted this year in California, where doctors say children were unprotected.
"So far we are pretty lucky," said Ruth Gubernick, a public health consultant who specializes in child immunizations. "But we could be a plane ride away" from an outbreak.
Some of the more vocal parents who question vaccines said they were surprised, but not alarmed, by the state’s ranking.
"It’s encouraging to me that parents are saying: wait," said Sue Collins, co-founder of the New Jersey Alliance for Informed Choice in Vaccination.
The law allows parents to delay vaccinating babies and toddlers, unless they go to day care. Mandates don’t kick in until they reach school age. Some parents request pediatricians administer one shot at a given time instead multiple vaccinations because they don’t trust vaccine manufacturers and the government to investigate and reveal side effects.
"Parents are realizing the onus is on them to do their own research," Collins said. "They are not getting the answers they want from health officials and doctors."
Deputy Health Commissioner Susan Walsh said parents shouldn’t alter the schedule of shots. "People who are vaccinated help form a circle of protection around babies and individuals with health conditions who can’t be fully immunized," she said.
Vaccine opponents are meeting regularly with lawmakers to build momentum for a bill that would allow parents of school-aged children to claim a "philosophical exemption" to shots, said Collins, a Long Hill resident.
A small but growing number of parents already use the state’s religious exemption to allow their children to skip the shots required for school. It does not require parents to reveal their religion or present a letter from a member of the clergy.
In the 2005-06 school year, schools gave 452 students a pass because their parents cited religious reasons, state health spokeswoman Donna Leusner said. In the school year that just ended, 3,865 were allowed to skip shots on religious grounds.
Photo by Amanda Brown/The Star-Ledger - Pediatrician M. Calhoun Thomas (left) gives Christopher Burnett, age 12, of Newark, a hug after he got immunized in her Orange office.
Stacy Allan of Summit said she got religious exemptions for her boys, now 5 and 8, after having them vaccinated through their fourth birthdays and watching them suffer with life-threatening food allergies and severe asthma. She hasn’t allowed her 2-year-old daughter to get any shots.
Allan resents doctors who look askance at parents who reject the schedule of shots for their kids. "They make them sound fearful or stupid. They are not," Allan said. "People who are not vaccinating are the most educated. You stop vaccines because you researched it, after weighing the pros and cons."
Many say the early catalyst to the questioning of vaccines was a study by a British doctor 12 years ago linking the measles, mumps and rubella shots to autism. That study was debunked this year by the medical journal that published it.
New Jersey’s immunization rate plummeted from 76 to 62 percent in 2007, the same year the CDC announced the state has the nation’s highest autism rate. That was also the year New Jersey became the first to mandate a flu shot for children from 6 months to 59 months who attend a child care center or preschool.
"When that mandate passed, a whole lot of parents who had no interest in vaccines felt like this was too many and too much," said Barbara Flynn of Summit, an Alliance for Informed Choice member.
Robert Tolan, chief of allergy immunization and infectious diseases at Children’s Hospital of St. Peter’s Medical Center in New Brunswick, admits frustration.
"There are a small percentage of people who are very vocal and very invested in making their viewpoint known," he said. "When I have tried to share scientific information, they don’t seem to respond to that approach. What will happen is that when preventable illness starts striking down our children, the pendulum will swing back."
Families willing to vaccinate who have trouble remembering the complicated schedule or getting to a doctor can get help from the Immunization Network, said Jane Sarwin, a founding member.
The network will help spread the word about free vaccines many clinics and doctors’ offices have because of federal stimulus grants. "By raising awareness about who is providing the vaccines, it will help increase immunization rates," she said.
Within 16 months, pediatricians will have to enter immunization information into a statewide confidential registry, so doctors can contact families when the next shot is due. "This will be a powerful tool for bringing kids up to date," Sarwin said.
Resistance to vaccines, lack of health insurance contribute to N.J.'s low immunization rate
