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Declining vaccine rates: Mostly a white problem

In this photo illustration, vials of measles, mumps and rubella vaccine are displayed on a counter at a Walgreens Pharmacy on January 26, 2015 in Mill Valley, Calif. (Photo by Illustration Justin Sullivan/Getty Images)

Americans have grown accustomed to reading about the various social and scientific phenomena that give white Americans -- on average -- longer life spans, better health and better access to quality health care than any other group.

The truth is a bit more complicated. And new data from a Pew Research Center poll examining American attitudes about a range of scientific issues suggests that the way that white, black and Latino adults think about vaccines is helping to drive another pretty complex but important health trend.

Vaccine refusal, combined with decisions by some parents to spread out vaccines over longer periods of time than recommended, have pushed vaccine coverage rates among school-aged children so low in some areas of some states that they are now comparable to those in some developing and conflict-ridden countries. That situation helped to fuel an outbreak of communicable disease earlier this year. And on Wednesday, it prompted California Gov. Jerry Brown (D) to sign a bill into law barring personal and religious exemptions to the schedule of recommended vaccines for children.

But what few people outside of public health circles say -- but the data also makes clear -- is that parents who delay or avoid vaccines are largely, but certainly not exclusively, white, well-educated and well-to-do or outright rich.

The Pew data released Wednesday reveals some differences in the way that white parents think about vaccine safety compared to black and Latino ones -- but not the type you would expect. White parents were far more likely to describe vaccines as safe but ranked behind Latino parents and just above the share of black moms and dads when it comes to whether the government should mandate vaccines.

The differences in perceived vaccine safety were statistically significant, while the tiny differences in the share of white, black and Latino parents who said that vaccines should be required were not, according to Cary Funk, Pew's associate director of research.

"Why we see what we do here in the data and what that means: Those are always the critical and hard questions," Funk told me. "We do see some differences along racial and ethnic lines in a number of the biomedical questions we asked. But I'd have to say, this is one of those areas where we may need to dig deeper."

One note about timing before we turn to some of the bigger questions about the politics of vaccines.

The Pew survey polled 2,002 individuals in August 2014. Then Pew conducted a separate but related survey raising the questions about vaccines in February 2015. The timing of both is significant because by February, news of a measles outbreak that began at Disneyland had reached wide circulation.

[Why Hispanic Americans live longer: the mystery that has puzzled researchers for decades]

By April, federal health officials had detected 159 cases of measles in the United States. Of these just more than 82 percent had not been vaccinated or had an unverifiable vaccination status. And of those who were not vaccinated at all and lived in the United States where such vaccinations are recommended, 43 percent had not been treated due to philosophical or religious objections. Another 40 percent were too young for treatment when they were exposed.

This suggests, if nothing else, that the way that Americans think about vaccines is critical to reducing the spread of highly communicable diseases like the measles.

So, the Pew data tells us that white Americans, as a group, are more confident about vaccine safety than others. The headlines, detailed local reporting based on data and several researchers have told us that a subgroup of mostly well-to do white Americans living in free-thinking enclaves have managed to push vaccination rates down close to dangerous levels in some communities. But neither the questions that adults -- particularly black and Latino ones -- have about vaccine safety nor what's happening in those select communities have pushed actual MMR immunization rates for any racial or ethnic group below 90 percent nationwide.

What's going on? Well, public health officials explain it this way.

First a healthy reminder about panic. The vast majority of children in the United States are still being vaccinated no matter how many scientific or philosophical questions parents may have. Helping to drive this pattern along are public policies that limit the number of parents who can opt out. (See coverage rates in Mississippi, one of two states that already have the kind of policy that California just put in place.) Also, a federal program that since the mid-1990s has covered the cost of vaccines for almost every child also functions like fuel in the nation's vaccination machine.

In fact, Congress funded the Vaccines for Children program after a measles outbreak produced 55,622 cases across the country between 1989 and 1991, killing 123 people. A disproportionate share of those infected were Native American, Latino, black or low-income individuals of any race. So dealing with the cost of vaccines seemed prudent. Once the program was in place, things started changing.

Between 1995 and 2011, the country eliminated racial and ethnic disparities in MMR vaccination rates.

That's the simple version. What's really happened is that the share of white children vaccinated grew slightly and has since declined just a bit. Meanwhile, vaccination rates in most other racial and ethnic groups grew and, in several cases, have been sustained.

Vaccination rates among blacks also dropped slightly between 2005 and 2011, but the long-term trend clearly shows black and Hispanic vaccination rates rising, while whites have stagnated and recently regressed a bit. And given the advantages many white Americans have in access to care, it's more striking that their vaccination rates are basically about the same now.

That combination suggests that public policies can make a difference -- and that a small but vocal group of people concerned about vaccine safety really can too.

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