Whooping cough outbreak in North Idaho: With low vaccination rates, what can we do? | Opinion
Kootenai County in North Idaho is experiencing an outbreak of whooping cough, with 19 cases in just the first four months of the year (compared with nine cases in all of 2021-23).
We shouldn’t be surprised.
Idaho has the lowest vaccination rates across the board in the country, according to the most recent numbers from the Centers for Disease Control and Prevention.
Idaho’s vaccination rate for five doses of DTaP, which is for the prevention of diphtheria, tetanus and whooping cough (or pertussis) was just 81%, the lowest rate in the nation.
The national median rate is 92.2%, according to the CDC, based on numbers from the 2022-23 school year, the latest year available.
Idaho also has the lowest vaccination rate for:
mumps, measles and rubella: 81.3%
polio: 81.8%
chickenpox: 80.7%
Idaho has some of the most lenient exemption allowances in the country, leading to the highest exemption rate in the nation, at 12.1%. Idaho is one of only 10 states in the country with an exemption rate of higher than 5%.
Idaho law allows parents to exempt their children from getting a vaccine for just about any reason, not only medical or religious beliefs, but also simply for personal beliefs.
That lax exemption policy has led some people to move to Idaho, as documented in an Idaho Statesman story in 2020 about vaccine “refugees” from California.
Come to Idaho for the vaccine laws; stay for the diseases.
The CDC reported that Idaho’s exemption rate increased 2.3 percentage points from the 2021-22 school year.
We’re going in the wrong direction.
The majority of the cases in Kootenai County are among those 18 years and younger, according to the Panhandle Health District, which covers five counties in North Idaho.
Pertussis can cause serious illness in people of all ages but is most dangerous for babies, according to a press release from the district.
About one in eight infants with pertussis get pneumonia. About one in 100 infected infants will have convulsions, and in rare cases, pertussis can be deadly, especially in infants younger than 1.
Many infants are infected by older siblings, parents or other caregivers who might not know they have pertussis because early symptoms are similar to a cold, according to the health district.
Vaccine disinformation
Dr. David Pate, retired CEO of St. Luke’s, said he’s concerned about Idaho’s declining immunization rates, particularly in light of recent outbreaks of vaccine-preventable diseases like whooping cough and measles.
“I’m concerned about low vaccination rates, both here in Idaho, in our country and even many places around the world,” he said in a phone interview. “The anti-vaccine movement has made really a lot of progress, regrettably.”
He places the blame on doctors and others who have spread misinformation about vaccines, casting doubt on the safety and efficacy of vaccines, especially in the wake of unwarranted attacks on the COVID-19 vaccines.
Those professionals have created a class of “vaccine-hesitant,” who may not be so virulently anti-vaccine but stay away from vaccines because of the doubts sown about them.
“For God’s sake, if there’s things that we can do to prevent our children from dying or getting severely ill, why wouldn’t we do that?” Pate said. “And the reason is that we have people out there who would financially benefit from spreading nonsense about vaccines and scaring people.”
Part of the battle is that many people today have never seen a case of mumps, measles, rubella, diphtheria, whooping cough or polio and don’t know how serious and dangerous these conditions can be.
Return of diseases
Pate warns against the dangers of the growing anti-science sentiment, emphasizing the historical importance of vaccines in preventing deadly childhood illnesses.
He cited the recent case of an unvaccinated young man in New York who was left paralyzed after contracting polio from an unvaccinated international traveler, the first known U.S. case of polio in nearly a decade and the first in New York since 1990.
Pate underscores the necessity of vaccines in maintaining herd immunity to protect vulnerable populations, such as infants, the elderly and people who are immunocompromised.
Pate said no medical intervention is without risk, but those risks need to be weighed against the risks of the diseases they prevent.
He used an example of experiencing a medical emergency in your home and needing to be rushed to the hospital. Yes, there’s a risk that you could get in a car crash on the way to the hospital, but that doesn’t mean you shouldn’t use a car to get to the hospital for help.
Chemotherapy and surgery have risks and side effects, but you should still often take those measures to prevent dying from cancer.
All that said, Pate said he advocates for a more compassionate approach to vaccine hesitancy, recognizing that many individuals have been misled by misinformation.
He told me a story, which he relayed on a recent episode of Idaho Matters on Boise State Public Radio, about being approached by a woman who was anti-vaccine, raised by anti-vaccine parents and was raising her kids without vaccines. She told him she had been listening to Pate on the radio for the past four years and, because he was providing factual information without judgment, decided to get her and her family vaccinated.
Now, we just have to do that a few thousand more times.
Pate suggests strategies such as community outreach campaigns and personal testimonies from parents who regret not vaccinating their children as effective ways to combat vaccine hesitancy and protect public health.
Sound the alarm
I’ve been thinking about the Sound the Alarm campaign, in which the American Red Cross works with local fire departments to distribute free smoke alarms, targeting neighborhoods that have a higher rate of home fires or are more vulnerable.
I’ve worked in other places where the fire department and Red Cross blanket a neighborhood shortly after a house fire in that neighborhood, recognizing that if there was a faulty smoke detector or none at all, the situation likely would be similar at neighboring houses. Where there’s smoke, there’s fire, so to speak.
The Sound the Alarm program has installed 2.5 million free smoke alarms in 1 million homes since October 2014, saving an estimated 2,000 lives.
Why not do the same thing for outbreaks, targeting affected counties, even school districts or Census tracts with education campaigns and vaccine clinics where people live.
Katherine Hoyer, communications manager for the Panhandle Health District, said that as soon as the district received reports of the first several cases in this most recent whooping cough outbreak, district officials alerted health care partners to be aware of the potential for more cases with a reminder that vaccination is the best defense against severe disease. They also contacted local schools and child care centers to provide guidance and resources.
It’s a good start, but we should do more to ensure these small outbreaks don’t become epidemics.
“The more ways that we can get these messages out the better,” Pate said. “It’s the people that are spreading the disinformation that we need to get mad at and hold them accountable, not the people that have been tricked.”
