Some contend that there are two Idahos. Divided by rivers, mountains and even a time zone, North Idaho has a new and possibly more potent distinction from its southern half--fear.
An increasing number of Idahoans living north of the 45th Parallel are afraid of vaccinations. For whatever reason--and there are quite a few--more Panhandle parents are opting not to vaccinate their children against diphtheria, hepatitis, measles, mumps, pertussis, polio, rubella and/or tetanus. Analysts are hard pressed to stereotype exemption seekers. They include the college educated and high-school dropouts, six-figure-salaried professionals and families requiring government assistance, uber-conservatives and left-wing progressives--all with a common fear of the needle.
But the fear of vaccinations in the north is matched only by the fear of the lack of vaccinations in the south--in particular, at the Boise office of the Department of Health and Welfare. That's where the state's top health officials have been pouring over the latest statistics on Idaho's vaccination exemptions, and they don't like what they see.
In fact, the contrasting fears may be best represented by two very different women. One, in the north, is a heart-on-her-sleeve rabblerouser who takes on everyone "from the governor on down" in her fight against vaccines. The other, in the south, may be Idaho's most authoritative voice on disease, yet she has no desire to engage in a heated debate over vaccinations.
When Ingri Cassel walked into the Common Knowledge Tea House, a cozy used-book store doubling as a tea room tucked into a Sandpoint neighborhood, both arms were filled with anti-vaccination literature. She is usually poised to convince anyone who will listen that vaccinations are an ultimate evil. But between her promotions of alternative medicine and diatribes against the government, it quickly becomes clear that Cassel's motivations are quite personal. Within seconds of beginning our conversation, Cassel said she needed to "make one thing clear."
"First of all," Cassel said, her finger punctuating the air with each word. "I need to correct you. You need to stop using the word immunization. We don't say immunization. Vaccines don't immunize anything."
The tone had been set.
"I started doing this work because I'm not vaccine free," said Cassel. "There was a car accident when I was 3 or 4, and I ended up in an emergency room. They gave me a tetanus shot. That was the first assault."
Cassel is a second-generation crusader. Her mother, Walene James, is the author of several books, including 1988's Immunization: The Reality Behind the Myth, based, Cassel said, on her sister's court battle in Virginia, where she was accused of child neglect for not having her son vaccinated.
Cassel is the president of a group called Vaccination Liberation, which trumpets on its website such topics as: "Why Doctors are Idiots," "Vaccines Exposed: A Hidden Crime Against Children," and "Doctors Are the Third Leading Cause of Death." Cassel insisted that her group was not registered as a business or nonprofit in spite of the fact that it collects membership dues ($30) and sells products (books, DVDs and CDs).
"We don't register and we won't," said Cassel. "But I have over 500 members that have paid dues over the years."
Without divulging membership, Cassel said she has a few political allies, too, including State Sen. Shawn Keough.
"That's not exactly accurate," Keough told BW. "I support vaccines."
But the eight-term District 1 senator said she agreed with Cassel in objecting to the exemption form used by parents to opt their children out of vaccinations.
"I would never sign that form the way it's written now," said Keough, who expects to bring up the controversial issue in the 2012 legislative session.
"We have quite a bit of political support up here," Cassel said. "But we don't have support from down south. They just wallow in ignorance."
"Down south" would include the Governor's Office. In an email to BW, Cassel referred to Gov. C.L. "Butch" Otter as "Butcher."
"When I called the Governor's Office regarding the vaccination exemption form, they basically told me that I'm going to get in trouble if I keep telling people how to fill it out," she said.
Cassel's organization publishes a how-to guide to alter the document. By crossing out or inserting key words, the form is dramatically altered.
For example, the document includes the following:
"I know that failure to follow the recommendations about vaccination may endanger the health or life of my child and others ..."
Cassel recommends parents alter the document to:
"I know that failure to following the recommendations about vaccination may endanger the health or life of my child and others ..."
Christine Hahn knows that--due in large part to Cassel's coaching--some of Idaho's vaccination exemption forms have been altered by parents, but she's not too worried about it.
"If a parent tweaks this form, they're going to exempt anyway," said Hahn. "They see the language on the form. They have already decided that they disagree with it. I just don't think that's a fight we're going to get into. Push hasn't come to shove on any of this."Dr. Hahn is the state's Chief Epidemiologist in the Division of Health of Idaho's Dept. of Health and Welfare. She is also a member of the infection control committees of Saint Alphonsus and St. Lukes Regional Medical Centers in Boise
Hahn said she's less concerned about words that may have been crossed out or altered on the front of the exemption form and more concerned about what parents are writing on the back.
"For the first time, beginning this fall, we asked parents to explain their personal, religious or medical reasons why they're not having their child immunized. We're going to ask the school districts to de-identify the forms--in other words, take away any names from the form--and then forward them to us. We have no desire to track anyone down, but we really need to better understand their reasoning."
Hahn spread a number of graphs and charts across a huge conference table at Health and Welfare's State Street headquarters. The one chart that stood out from the rest contained what Health and Welfare would consider some good news (Eastern Idaho's 2.4 percent immunization exemption rate, for example), some so-so news (District 4, including Ada County's rate, which is 3.3 percent), and some rather troubling news.
"There's definitely a disturbing trend up in the Panhandle," said Hahn. "We're talking about this quite a bit lately here at Health and Welfare."
Hahn's finger traced a steadily rising line representing the school exemption rate by Public Health District 1, representing Benewah, Bonner, Boundary, Kootenai and Shoshone counties. Since the beginning of the 2006-2007 school year, the northernmost district's exemption rate has grown nearly one-third, registering 7.4 percent at the end of the last school year, nearly double the state rate of 3.8 percent.
"We're worried most about that particular trend," said Hahn. "I think we have an issue, in particular, with young parents who are too young to personally remember some diseases--for example, measles."
Hahn said she was recently at an Advisory Committee on Immunization Practices meeting in Atlanta, where there was quite a bit of talk about measles outbreaks in Canada, Mexico and Europe.
"You've heard of snakes on a plane," she asked. "Well, what scares us is measles on a plane."
Measles and Myths
A closer look at school immunization records in North Idaho reveals the vaccination that parents choose to keep their children away from more than any other is MMR (measles, mumps and rubella).
"Even after the misinformation spread by Andrew Wakefield has been put to rest, those doubts still linger," said Hahn.
Andrew Wakefield, a former surgeon from Britain, is largely credited for creating a global pushback against the MMR vaccine in 1998, even though he was barred from further practicing medicine and ruled to be "dishonest and irresponsible" by a statutory tribunal of the British General Medical Council.
Wakefield's 1998 document presented what turned out to be false evidence that autism spectrum disorders could be caused by the MMR vaccine. Investigations by the Sunday Times of London revealed that Wakefield had manipulated evidence. But by then, Wakefield's article had swept across the world, causing MMR vaccination rates to drop precipitously.
Wakefield is not alone with his MMR infamy. Former Playboy Playmate-turned-actress Jenny McCarthy found notoriety with her book Healing and Preventing Autism: A Complete Guide, documenting her son's autism while blaming vaccinations for many instances of the affliction. McCarthy plugged her story on Oprah, the Today Show and the Tonight Show as a self-professed vaccine expert. In April, Time Magazine reported that as many as 24 percent of parents surveyed by the University of Michigan said they placed "some trust" in information provided by celebrities about the safety of vaccines.
Yet another well-known figure, Bill Gates, pushed back against claims such as McCarthy's in a February interview with CNN.
"It's an absolute lie that has killed thousands of kids," said Gates, who recently pledged $10 billion to distribute vaccines worldwide. "The mothers who heard that lie, many of them didn't have their kids take either pertussis or measles vaccines, and their children are dead today."
If Idaho's Panhandle is a key target for state health officials to improve vaccination rates, the Lake Pend Oreille School District No. 84 is ground zero.
"We probably have a higher immunization exemption rate than the whole United States," said Dana Williams, head nurse for the district. "A lot of it has to do with misinformation regarding the vaccine for measles, mumps and rubella. Some keep saying that MMR is supposedly connected to autism, which is bunk."
Williams is a busy woman lately. She's the lone full-time nurse for the entire district. The recommendation from the Centers for Disease Control and Prevention is one nurse per 750 students.
"But we have 3,700 kids in the district," said Williams. "So far this semester, I've done 360 action plans, and that's not even including our high schools. We have some sick kids here. It's everything from mild asthma to diabetes. I've been traveling quite a few miles between schools this year."
Williams said she's anxious to have conversations with parents who may choose to exempt their children from vaccinations.
"There's a lot of people up here that are, let's say, off the grid," said Williams. "But we sit down and talk with them. And we tell them that if there's an outbreak and their child doesn't have a vaccine, he or she can be kept out of school for up to six weeks. And one more thing--our school board policy doesn't force us to give the child their homework once they have been sent home. Our policy pretty much tells the parent, 'You're on your own,' even though a lot of our teachers feel guilty and send work home anyway."
Williams said her fear is even greater than her frustration.
"This is stupid. There's absolutely no reason for these exemption rates," she said. "We're going to end up with something bad happening here. People don't realize that a child can die from a bad case of chicken pox or the mumps."
Cynthia Taggart, public information officer of the Panhandle Health District, which includes Williams' school district, said the vaccination exemption rates aren't anything new to her part of the state.
"It's a mind set," said Taggart. "We have had vaccination opponents here for many, many years. It goes way back."
Taggart said the region's "streak of independence" runs through each of the many reasons for exemptions.
"Idahoans want freedom of choice in everything," said Taggart. "And, well, this is their choice. We don't argue with them, but we do tell them that their choice has consequences. That's really all we can do."
Taggart said she was quite familiar with Cassel and her Vaccination Liberation movement. In fact, everyone that BW spoke with in North and Southern Idaho knew of Cassel and her initiative.
Cassel is gearing up for a new debate, this time over Gardasil, the human papilloma virus vaccine designed to prevent cervical cancer, genital warts and some other cancers.
"It's not required in Idaho right now but they're pushing for it," said Cassel. "They're chomping at the bit to force that vaccine on little girls and boys. But if I have anything to do with it, that will never happen in Idaho. Over my dead body."