Endless Thread - Infectious, Pt. 4: Anatomy Of An Outbreak

Episode Date: May 23, 2019

Even considering the winding road of scientific advancement and the new expressway that is the internet, what the heck happened in Clark County? With reporting from the ground in Washington and Oregon, we take the fourth episode of our vaccine series to trace the societal pathogens, identify the symptoms, and try to prescribe a solution to what some are calling a “canary in the coal mine” for a near future of eroding herd immunity and increasing threats of outbreak for all kinds of diseases in the U.S.

Support for endless thread comes from MathWorks, creator of MATLAB and Simulink Software, to design and develop engineered systems, accelerating the pace of discovery in engineering and science. Learn more at Mathworks.com. Support for WBUR comes from Is Business Broken, a podcast from the Marotra Institute at Boston University that explores questions like,

why is innovation in healthcare so hard? Is ESG just greenwashing? and, of course, is business broken? Listen, wherever you get your podcasts. Produced by the I-Lab at WBUR, Boston. This is part four of Infectious, our special series on vaccines. If you haven't already heard parts one through three, you should go listen to those first.

Okay, enjoy. And I have been covering the measles outbreak in Oregon and Washington. But where are we right now? And how many beers deeper are we? We are currently at Real M Inn in Southeast Portland. Okay. And at least three beers and one whiskey deep for me. Okay.

I think you're doing a little bit less. Yeah, I'm three beers. I didn't have a whiskey. It is mid-March 2019. I am in what I am told is a bar that is part of old Portland in Oregon. Real M. And as you can hear, that is not Amory Sieberton. That is a locally based reporter named Molly Harbourton.

Barger, and as you can also hear, we are technically off the clock, but we're still recording. Molly is welcoming me to the city by regaling me with some of her favorite Oregonian lore. And she knows a fair bit. Just read her bylines in the Oregonian newspaper. Molly is prolific. But there's this one story that Molly heard when she first moved here in 2011. She says, this story tells you something essential about the spirit of the region. And it explains a lot about why we ended up traveling here to do our reporting.

Apparently, some years back, the county started building a county road in Milwaukee, Oregon. I say started because this is a part of the country where the seasonal weather makes for a lot of work stoppages. And so they had built half of this road, and then they stopped for the winter. And in the time between that and when they could start building again, someone had built their house at the end of the road? Wait, Ben. Yes, Amory? Obviously, I wasn't there for the story,

and you're my guide on this trip you took out west, but somebody just built a house in the winter when nobody was looking, just plopped it right down? Yep, that's how the story goes. And then the county just let them have that house. They didn't bulldoze it, they didn't sue them, they didn't pull it down, they did nothing. So this person just has,

county built driveway. The longest driveway. Super long driveway. To their house. It's paved. It's not gravel. You know? Uh-huh.

And that was the first time that I was like, oh, this is in a very different place than I've ever lived. But what does it tell you? Like, why, like, what does that mean? You know, the Wild West is kind of like an idea that you see a lot of in movies if you've never lived out here. But it still kind of lives here. little bit where you can kind of get to do what you want and there's a respect for that idea

that like if you have taken the initiative and you have done this thing, we'll kind of let you be. It's not necessarily the government. This is just one story, but I heard different versions of it over and over while I was traveling this area. It's in the water. This kind of unspoken arrangement between everyone and everyone else. You don't mess with me. I don't mess with you. which really does make the Pacific Northwest sound like the Wild West. But what happens when this kind of regional U-do-you-streak contributes to one of the biggest measles outbreaks in the U.S. in almost two decades?

Today, we explore a new kind of American frontier and give a view from the epicenter of a measles outbreak to figure out why it happened. And what that means for parts of the country beyond the thick towering pine forests of Oregon and Washington State. I'm Ben Brock Johnson. I'm Amory Severson. And you're listening to Endless Thread.

The show featuring stories found in the vast ecosystem of online communities called Reddit. We're coming to you from WBUR, Boston's NPR station. And we're bringing you a special series, infectious. The strange past and surprising present of vaccines and anti-vaxxers. Part four, anatomy of an outbreak. So you and Josh Swartz, intrepid co-producers, went to Oregon and Washington State without me. We did, and I'm sorry, but some of us had to go because the Clark County measles outbreak has been a hot topic on Reddit. Back in January, someone posted a very basic news article

about it, yet it sparked almost 4,000 comments in response. The most popular one from Redditor Zander Cruz said, if only there was a way to stop such a tragedy. Classic Reddit response, a different post. This one on the legal advice subreddit had the headline, Ex-wife refuses to vaccinate our three-year-old son. I live near the measles outbreak, and I'm very concerned. Yeah. So clearly, Redditors are talking about this independent thinking and how it's having a real impact on how the region has been dealing with vaccines

and vaccine resistance. The first example of this battle that we found after getting off the plane, a high-temperature fight happening in Olympia, Washington, the state capital. The state legislature is one of a set of imposing stones. state capital buildings set off of Puget Sound. It's full of people. Today is apparently Massage Awareness Day. Massage Awareness Day, as in lawmakers and visitors,

were literally getting massages in the middle of the main lobby. A brass band was setting up in the atrium. There were lots of school tours moving through. It was also the last day of the state legislature session. We were trying to track down one of Clark County's elected officials, Paul Harris. but we couldn't find the right elevator. Down the hall past the water's up to your left. Not even counting the vaccine debate,

Representative Paul Harris is busy on the last day of lawmaking, which is why we were a little bit surprised when his staff brought us into the inner sanctum and left us unsupervised. It looks like, here's a question, is this his office? It's got to be, right? Yeah, these pictures are of him. I thought he's got a Rubik's cube.

While we were playing with his Rubik's cube, Representative Harris was on the House floor trying to lead his party through a final set of bills that have been introduced over the last few months. Harris is the leader of the Republican caucus. So on the last day of legislating, he had a lot of legislating to do. But eventually, the man of the hour arrived.

We've got a few minutes, but only a few of us. We're going to start voting. Hi, Ben. Thank you very much for giving this one minute. You bet. Hi, Josh. Boston. Thanks for sneaking away.

Absolutely. On one particular bill, Harris's party had not been falling in line. House Bill 1638, introduced by Harris, right as the region's measles outbreak had been reaching a fever pitch. And Harris was frustrated about this. He seemed to feel like the whole thing was getting blown out of proportion. The bill does one simple thing. It takes away the personal exemption for the measles mumps in ribella. That's all it does.

Some of my caucus thought that it went farther than that. There's two religious exemptions, and there's a medical exemption. It does nothing to those. It just touches the philosophical and personal exemption for mumps, measles, and rebella. So these exemptions are basically an official way to say, hey, I decided not to vaccinate my kid, but I still want to participate in basic society, like putting my kid in public school,

even though there's a rule about not letting unvaccinated kids into public school? Right. And there are three kinds of exemptions that are used across the U.S. The first is medical. All 50 states have that one. The second is religious. Most states have that. And the third is called the personal or philosophical exemption. It is the easiest to get, and only a handful of states have it. And Harris is trying to get rid of the personal or philosophical exemption in Washington state. But the medical exemption and the religious exemption, they'd still be there. Is there a burden of proof for the religious exemption that doesn't exist for the personal exemption? There's not.

So the religious exemption in our state is wide open. That's interesting, right? Because if, so I wanted to use a personal or philosophical exemption and couldn't be very easy for me to jump over to the religious exemption, right? Yeah, it would be. To be quite frank, yes. So even with Bill 1638 in effect, you wouldn't even have to prove the religious exemption in Washington State. You just say it's against my religion and they give you the exemption? Pretty much.

So there's really no teeth in this bill around this issue. It's incremental at most. Harris says he introduced the bill because he was worried about low vaccination rates in his district. And this bill might help tip the scales just enough so that people in Clark County reach that magical vaccination rate. that number that makes for what's called herd immunity or community immunity. So it's harder for a super contagious disease like the measles to spread. My goal is not to cause these people problems, but I am concerned when I have the measles appear in my community.

Then I hear from the other side, well, yeah, but nobody died. And I go, oh my gosh, is that our criteria for, I hope not. It's a pretty low bar. That's a pretty low bar. I did have, I believe, two kids, hot. hospitalized. They're okay. What I want to do, I have 8,000 people that already got vaccinated. I just want to get my community immunity up. But this is the Wild West, where there's supposedly this fierce independent spirit. Right. And on this bill, Harris has had some intense pushback from representatives in his own party, votes he can usually rely on.

His staff told us it's unlike anything they've ever seen. One staffer told us that Harris got an earful from fellow Republicans for even talking to us. But also, while we were waiting in his office unsupervised... Check out the book on his desk. Whoa. So on his desk, there's a book that says, How to End the Autism Epidemic by J.B. Handley. You guys are just pulling books off his desk now?

I mean, there was really only this one book, and it was relevant. So we asked him about it. Who'd you get it from? Where did it come from? I got it from a guy that wasn't happy with me, apparently, because the letter inside wasn't super nice. But I think it's something that I think somebody that wanted to inform me on autism. J.B. Hanley, by the way, not an often published author or scientist, a former private equity firm manager who has a son with autism.

He's also the co-founder of a group called Generation Rescue. Is that the Jenny McCarthy group? Yep. Like Jenny McCarthy, former MTV Personality, Playboy model. Without a doubt in my mind, I believe vaccinations triggered Evans' autism. Harris doesn't buy the autism vaccine's connection at all, by the way. But he knows the people who make the argument and the other arguments against getting vaccinated pretty well. He says the group is small, but loud. I'm getting emails from the same people over and over and over and over and

over again. So when I start looking at the addresses and I look at the names and... Sure. This is a very vigilant group that don't believe the same way I do. Is that group informed choice Washington? Do you recognize that name? I think informed choice is part of the group. Yeah, absolutely. Informed Choice Washington was familiar to us

because we had just gone to that group's conference north of Seattle, or rather, our buddy Alison Bruzek did. What's up? How's it going? I'm good. Who are you? I'm a producer with KUOW. I don't know. Do you need a title?

Do you need like a real title? That's good enough. Yeah, that was good. I'll take it. Allison helped us out because this conference was a long ways away and the timing was tricky. Also, it was kind of the perfect place to meet the movement. It was billed as a healthy immunity conference

about maintaining a healthy immune system more generally. You know, if you've ever been to a conference, there's like a ballroom situation. So you like walk into the ballroom. It's like packed. Like packed with people. and like six vendors all along the sides, and then, you know, just a projector and a screen.

And not only do we now advocate for scientific integrity and vaccine policy and advocate to protect parental rights and informed consent, but we also educate on true, healthy immunity and a whole different paradigm of living. This is Bernadette Pager with informed Choice Washington speaking to the 150-year-so conference goers.

Ladies and gentlemen, please welcome Dr. Dr. Zach Bush, MD. And then there's like a, you know, a person up there talking. All right. Thank you all for having me. What a full room. Wonderful to see so many spirits here. A beautiful, soulful community here.

And what a gorgeous setting. What are the vendors vending? All kinds of things. So, CBD, there was a clinic for people that don't want to vaccinate. You could talk to them about getting a medical exemption or you could talk to them about other issues with your health. There were candle kind of vendors with like lip balms and stuff like that. Someone is selling $7.00 glyphosate free eggs and all of the milks on the coffee table are nut milks. $7 for a dozen glyphosate free eggs, glyphosate as in the herbicide, one of the active ingredients in Roundup.

Alternative eggs and alternative ideas. A woman named Lacey told Alice. and her reason for choosing not to vaccinate her children. My personal view is that it violates the commandment, thou shalt not commit adultery. Adultery, Lacey says, because of what is in vaccines, like fragments of fetal DNA cells. This is actually a familiar refrain from people

who are suspicious of vaccine ingredients. The idea is there's dead baby fetus cells in vaccines. And this comes from the fact that 60 years ago stem cells from two aborted fetuses were used to help grow the cells used in vaccines today. The original stem cells were filtered out long ago, but the idea survives. But still, adultery? I think adultery is much more expansive than just going out, you know, cheating on your spouse or going outside your marriage. I think that when you adult, you can adulterate your body.

God gave us this body. And my daughter, it really is a beautiful thing to behold. an unadulterated, God-given immune system, given the nutrients it needs. It really is a beautiful thing. It's truly remarkable. Let's set aside religion, though, because Allison told us the conference as a whole wasn't like that at all. There was a really interesting presentation by this guy, Dr. Thomas Cowen. Everyone who presented was either a doctor, a PhD, or a nurse.

And so it was very scientific conference. I used to be a science journalist, and I used to go to conferences where I would just look at scientific papers all day. And this was like basically that. It looks legit. It looks legit. It checks out. And so I took maps. This one is from a New England Journal of Medicine article in 2013,

showing the rates of antibiotic prescription per state. And the darker the state, the more frequent the antibiotic exposure. And like a lot of the stuff they say. So like Thomas Cowan got up and he was talking about, he was going to talk about vaccines. But one of the ways that he got into it was he was like, what medicine has a problem with is the difference between, a therapy and a disease.

So, for instance, if you get a splinter in your finger and your finger starts to pus up, is that a therapy or a disease? He was like, in medicine right now, we treat it like it's a disease. Like we say, oh, no, pus. Like, you got to wipe away that pus. You got to, like, put something on it. Like, that's a disease. And he's like, but really, for your body, isn't the pus the therapy?

Because what happened was you got a splinter and your body's trying to fix it. And so where it goes a little far for people is he was saying maybe measles is a therapy, not a disease. If you get measles once, you won't get it again. If you get the measles vaccine once, though, can you get measles? You could. This is like super fundamental. Like the way that you're describing his talk is like it's not just like, let me talk about how vaccines are bad. It's like we think about everything the wrong way.

Which I feel like is very intoxicating for people who are looking for answers, right? Yeah, and for people who don't trust the medical system because, and sometimes they don't have reason to trust the medical system. Like I heard so many stories from people who said, I went to my doctor, I told them what happened to me that I had a vaccine injury and they didn't believe me. Yep. And like if they don't believe me, why should I believe them? They've given me no reason to trust them. Stories like mine are so real. We're told that it's a rare person that reacts.

But I've spoken to so many people like me, and we try to say what's happened to us, and we're told it can't be because of a vaccine. And therefore, what you experience isn't real. This is a woman named Mary, who told Allison that she experienced brain swelling after getting a vaccine. But she says doctors didn't believe her. And she gave me this example. Like, you know, if I was in a car crash and I got injured, people might say, oh, you could have gotten that injury at the same. time on that same day, even if you weren't in the car. But because you were in the car crash,

people say very obviously that injury came from the car crash. And she said, but it doesn't happen that way with vaccines. And I feel like it's the brave people who are standing up, sharing their stories out of love for others. And yet, we're not supported by the community that should be consoling us and protecting us. And so that's why I'm coming to places like this, because I feel like I have to speak up. I can't be silent anymore. It was just really heartbreaking, like, all of these individuals.

Like, when you think of the, you know, the anti-Vax community, you think of a certain type of person. And then when you get on the individual level and you hear these stories, I just felt awful that, like, they hadn't been believed by people. And I was like, you don't have to. I don't know, you don't have to think that whatever happened to them came from a vaccine when their research doesn't indicate that, but you can believe that something bad happened to them.

Like, they were injured. These people who represent a spectrum of belief but are passionate enough to attend a full-day conference on the topic of immunity and vaccination, they're influencing a whole other set of people throughout Washington State and Oregon who are maybe not committed enough to go to a conference but are passionate enough to talk about it.

and make decisions for their own families that have an impact in the larger community. And this sphere of influence stretches from north of Seattle all the way to Portland. And to New Seasons, which is like Portland's local version of a Whole Foods. This store in the Woodstock neighborhood of Portland was surrounded by cute shops and bars, local hardware store. Inside New Seasons, you can find yoga flyers galore and pamphlets about doctors who practice natural healing remedies. Outside, you can find the totally happy, normal-looking Ndow-Marquell family, preparing for what was sure to be a big old family grocery shop.

What's your name? Howard Markwell. Nicole Nadeau? Can I? May I? Acadia Markwell. Taylor Markwell. I'm Logan.

Nice to meet all of you. Thank you. So how do you feel about vaccinating your family? Do you want to go first? It's up to you. Go ahead. You know, I'm passionate about this topic. We've considered it a lot, and we chose to mostly vaccinate our children.

We put a delayed schedule and split up some of the vaccines. I don't believe in mandating families to mandatory vaccines. Nicole might be passionate, but she also sounds kind of reasonable so far. I'd rather my kids get chicken pox. They're not going to die from chicken pox. Right. You know, why am I vaccinating them? Because somebody's making money on me vaccinating against chickenpox.

I mean, the number of people that die from chickenpox, we all had chickenpox when we were kids. We're fine. I did. Yeah, and we're fine. It's the discomfort of missing a week of work to have chickenpox, you know? And I get that. That's a real concern. But, you know, yeah.

So I do think the money pieces it, and it's a larger vehicle of compliance around medication. A larger vehicle of compliance around medication. is a weirdly specific and clinical phrase to use, but okay. Nicole's husband Howard says the debate isn't clinical enough, like it's too emotional, too polarized. It doesn't leave room for their family, where their kids, Acadia, Taylor, and Logan, were vaccinated selectively. You're either a pro-vaccinator or you're an anti-vaccinator.

And I think there is an in-between. I mean, there's, I don't think we're you. Are you the in between? Maybe. I mean, I think we are, we are in between in the sense. We are in between because we did vaccinate our children. We vaccinated our children. And I think we don't dispute that there are illnesses for which vaccines are a good thing.

If one of your kids decided that they wanted to get more vaccinated than they are currently, how would you feel about that? You know, it's like any other medical decision that they are going to make. Sure. You know? Yeah. And we're including our kids in their conversations with their doctors. They hear us talk about it.

Sure. I mean, it's the same thing. We don't eat fast food, right? When my kid's 18 and they get a job and they make have a little money in their pocket, if he wants to go try McDonald's, that's their decision. And it's the same thing with this. If they come through and say, Mom, these are all the reasons and this is why it's important to me. And it's not fear-based, peer pressure-based.

It's, I've done the research. This is all the research that I'm making an argument that this is important to me. then... You know their kids have snuck off to McDonald's, though, right? Oh, definitely. Admittedly, comparing getting vaccines to eating McDonald's is a little needles to chicken nuggets, right? Vaccines being a safe and effective method,

according to mainstream medicine, to protect large groups of people, and McDonald's being, well, food product. But it's revealing. Nicole and Mark lead this clean, organic lifestyle, and to them, avoiding certain vacuble, and being critical of vaccines in general, is at the very least related in some way to avoiding fast food.

Thank you very much. We really appreciate your time. Take care. Yeah, you too. Is this family the rule or the exception, though? Well, it's tricky, right? So strictly speaking, vaccine avoidance isn't mainstream, even in the Pacific Northwest. The vast majority of people do still vaccinate there. But depending on where you are in this area, and it can change from school to school in the same neighborhood even, vaccine rates can be way lower than the national average. And remember Molly Harbarger, health reporter for the Oregonian newspaper? Molly, with the story about the house at the end of the county road.

She says that she encounters people in Portland like Nicole and her family all the time. This is a mainstream belief. This is you could go to your church or your PTA or any kind of group setting and start talking about vaccines one way or another and expect someone in that room to be offended or push back or have a very different opinion. And this daily reality is obviously what helped to create this. The measles virus is spreading like wildfire in Clark County. At last check, there were 22 confirmed cases of measles. At least 36 cases have been confirmed in court. The state now has 50 confirmed cases. The Clark County measles outbreak has now climbed to 63 cases.

When we come back, the measles in Clark County is on the move. At Radio Lab, we love nothing more than nerding out about science, neuroscience, chemistry. But we do also like to get into other kinds of stories, stories about policing, or politics, country music, hockey, sex, of bugs. Regardless of whether we're looking at science or not science, we bring a rigorous curiosity to get you the answers. and hopefully make you see the world anew. Radio Lab, Adventures on the Edge of what we think we know. Wherever you get your podcasts. There is something powerful about the sound of the human voice.

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in mid-March, but the outbreak started January 1st of this year. Yep. And by the time we got to Oregon, Oregonian reporter Molly Harbarger had written 40 articles on the measles outbreak in two months. She was calling the health department like every day. I was actually just looking through all the Clips trying to find our day one story, like first case of measles identified and seeing my own byline and just like not remembering it at all. Oh, I wrote that. Yeah. That's weird.

Interesting. I should read this. I've been writing about this almost every day since January 1st when it started conveniently at the beginning of the year. And so it kind of feels like a lifetime has passed since then. This is a part of the country that has lower vaccination rates generally, so people do get the measles out here sometimes. Also, there's no fluoride in the water. Wait, what?

Just another example of how Portland in the larger region looks a little differently at the world. Sometimes some public health messaging just doesn't stick here. Portland doesn't have fluoride in its water, despite documented benefit. when I went to the dentist here for the first time, they were like, oh, you're not from here, just by looking at my mouth because my teeth look different. And a lot of that is like this home-grown, organic pushback to the idea of like they're putting chemicals in my water. And, you know, we had breweries that were like, do you want chemicals in your beer?

But, you know, we also do have a huge Montessori and Waldorf movement here who don't necessarily subscribe to a lot of public health messaging or help. public health advice and recommendations. So you see these kind of movements really take hold here in a way that they don't necessarily in other places. Under this larger ethos of fierce independence in the region, a lot of smaller, different communities are passing on full vaccination or opting out completely. And it's hard to find a real common denominator.

For instance, a lot of communities that are low in vaccination rates aren't low because they don't have access or are generally what we might call underserved communities, often it's the opposite, places that are affluent, places where parents have the kind of time to do a lot of internet research. It's also true that on the political spectrum, vaccination hesitancy is one spot where people on extremes of the left and the right are in the same boat, sometimes for different reasons. Oregon and Washington are largely still deeply purple states, and so that largely falls into kind of a libertarian streak. You know, people want recreational marijuana because they don't want you to tell me what I can and can't do. You know, we're fine with gay marriage

because, like, let people do what they want to do, which end up being kind of on the progressive end of things. But it's that same kind of thing. Don't tell me how to parent. You know, I know what's best for my kids. And so you get both that kind of rural, libertarian, more far-right streak mixed with your more like Waldorf progressive far left crowd who... Which is basically saying the exact same thing for different reasons. Exactly. All of which is to say that when it comes to the measles or another vaccine preventable disease, there are a lot of potential places for the disease to pop up.

But to understand how this area went from a few cases or a few scares to a full-on public health emergency, we have to understand how an outbreak works. So cue the music. And welcome to Public Health 101. Think of the first person with measles as a blip on a radar screen. The circle radiating out from that blip represents the entire area in which they could have come in contact with and infected other people. Each new person infected with measles represents a new overlapping blip on the radar. We don't know the first, like what caused this really.

but you can definitely see kind of those like hot spots kind of radiating out. Public health departments can usually stop an outbreak after only a few cases. But something happened in January in the Portland area that made things a whole lot worse. In the first or second week, the Portland Trailblazers, which is the NBA team here, they played the Moda Center. and that was listed as a place that a infected person with measles who was contagious at the time had been in. So potentially exposing like hundreds of thousands of people to measles. That was when everyone was like, oh, okay, this is like a real thing that we are going to see getting much worse before it gets better.

In addition to the Moda Center, the Portland Airport and Children's Museum were also listed as infected places. And that's where like these big public spaces that everyone's like, oh, shoot. And we don't actually know if, like, lots of people were infected in those places, but you can definitely see that the cases become much more disparate in where they are located. It's not just that church and not just that school. This is a really important point. It's what makes this particular outbreak in the Pacific Northwest so unique from measles outbreaks in other parts of the country, like the one in Rockland County, New York. Even though there have been several times more cases of measles in the Rockland outbreak than in the Clark County outbreak, the Rockland outbreak is mostly concentrated in isolated Orthodox Jewish communities.

So going back to our radar analogy, think tons of blips beeping, blipping in unison. Clark County is different. It's much more all over the place. It's not a religious community. It's not like cloistered. It's not, you know, one school or one family or whatever. It's two entire states, basically. The person in charge of tackling one of these states is Alan Melnick.

I have a lot of emotions about it, but happy is not one of them. This is a nightmare. Melnick is the Clark County Public Health Director. He works in the Center for Community Health. building just over the border in Vancouver, Washington. It's a well-worn government building, quiet, lots of carpet. Melnick, who was smartly dressed in magenta and purple, is a very busy man. We could tell because he was just about to wolf down some lunch when we walked in,

and then he stopped to talk to us because he had a thing right after he was literally too busy to eat lunch. Are you tired? Are you asking for tired of the measles outbreak? it's invigorating and tiring and stretching our resources all at the same time for something that is completely and utterly preventable the amount of funding we put in this between us and the state over a million dollars now the county close to i think the last i look we were close to 700,000 was money and time that could be spent on addressing many other public health issues for example

we're in the flu season right now. So yeah, I'm tired, I guess, okay? Were you aware or concerned about a potential outbreak before it happened? Or were you mostly just sort of surprised and reacting to it? This is no surprise at all. This is inevitable. To prevent measles transmission in a community, you need vaccination rates as high as 95% for what we call herd immunity

to keep the bug from bouncing from person to person. Herd immunity or community immunity means that enough people within a certain group are vaccinated against a disease to keep it from spreading within that group. I mean, the average for the county is around 80%, which is well below 95%. But if you look at some schools, you know, we're in the 40, 50% range of vaccination. Dr. Melnick is quick to cite facts about measles because all the bad information out there, frustrates him to no end, including statements like this. We haven't had any deaths from measles in the last several years in the United States.

And you know why? Because we vaccinate people. You know, we've had 72 cases in Clark County, but we've been doing whatever we can and contain it. We've been using various methods of quarantine and active monitoring and surveillance to keep it as low as we have. Another piece of information that Dr. Melnick is trying to combat, the idea is. idea that measles is a benign disease. Before the 60s, when we started vaccinating people, 400 to 500 people died every year in the United States from measles.

We had about 4,000 cases of measles encephalitis every year in the United States. 4,000. That's a swelling of the brain that can result in permanent damage and deafness. And we had about 50,000 hospitalizations every year in the United States before the vaccine became universally used. Dr. Melnick is also worried about the people who can't be vaccinated against the measles, like people with compromised immune systems. Mortality rate for measles is one to three per thousand cases. So we've seen 72, so we haven't

had a death, but I mean, we haven't had that because we've kept the numbers down. The numbers get big. We'll see more deaths. But really, the numbers are already big, because as we've said, measles was supposedly eradicated from the United States in the year 2000. The definition of an outbreak is basically when you see a disease, when you observe an incidence of disease or cases of disease that are greater than expected. You know what the expected number of cases of measles is? It should be zero, okay? The other thing I should say about measles, when we talk about it being exclusively contagious, is the first few days of your symptoms with measles, when you are contagious is runny nose, cough, red eyes, you know, fever. Those are respiratory symptoms that are

really common. These symptoms occur before you develop a rash, yet you're exquisitely contagious with measles. So does this keep me up at night? Yeah, that's why we're working around the clock to contain this thing. And this is the amazing part. Containing an outbreak is hard, especially with the exquisitely contagious measles. As soon as Melnick's team gets a report of a case, they go find that person and interview them and their families. They find out everywhere all of those people have been recently, and then they go to all of those places and interview all of the people in those places about where they have been. They figure out what kind of quarantine situation needs to happen. It is crazy time-consuming. Melnick's team apparently spent 19,000 hours doing this,

doing something that might not even stop the spread of the disease. And the timing is tricky, because someone could have the measles for up to three weeks without showing any symptoms. So what we see is a generation of cases, some multiple generations. So you have that first, you know, the first case or two early on. Then you can expect seven to 21 days later, your next generation. I'll be happy when we go 21 days, one incubation period without a new case. How many days are you at? And I'll be thrilled if we, and we'll declare it over if we go two incubation periods.

The last case that we had was on March 12th. Okay. So by definition, this outbreak won't be over into May. And it's May, as we're recording this episode. And thankfully for Melnick, the crisis is over. For now, they officially declared the outbreak over on April 29th, almost four months after it began. In tonight's Health Watch, the measles outbreak in Clark County is officially over. Foxwell's Bonnie City. One may be good thing that came out of this outbreak was that vaccination rates in Clark County skyrocketed. According to the Washington State Health Department, more than five times as many people

got the measles vaccine this January compared to last January. All the people were like, Measles, shoot, better get the shot. Or shoot, better get my kids vaccinated. And that came with some of its own problems. Vaccine providers getting slammed by new signups. But Dr. Melnick isn't one for silver linings. Having an outbreak is a really lousy way to get vaccination rates up, because memory will fade. People will forget about this. And without any policy change, this is a temporary benefit. Melnick was right in one sense. People's memories about Clark County have faded. Since we saw them in March, Clark County's outbreak went 42 days without a new case. The outbreak ended. Since then, incidents have popped up that have been worse, or at least bad enough that they

have taken over the headlines. The temporary bump in vaccination rates because of the outbreak may have ended. But there's also been a policy change. I'm thrilled to sign this bill, House Bill 1638. A win for Representative Paul Harris and others in favor of nudging the population into community immunity, getting the vaccine numbers up. But also maybe not a huge change. The independent spirit of the region lives on.

You might still get away with building a house at the end of a half-built county road. But there's one more layer here that some people say is getting lost in all of the don't tread on me talk. When Josh and I were walking around one of these nice neighborhoods in North Portland, asking people how they felt about the outbreak, I ran into three women who were on their lunch break, walking around the block. One, named Felicia, mentioned this feeling that there's a certain type of person who avoids vaccines. What's your view of this whole thing? I grew up here. I'm vaccinated.

In my opinion. the voices who are the loudest often come from those who have the pocketbooks to match that and the time, and they can do that. And that's unfortunate. Another woman in this group who didn't want to be identified said this type of privilege has some pretty uncomfortable origins.

Portland's very like, I like my kombucha and my white entitlement, and I don't like rules. And I like to just like, I like to believe that things don't apply to me in the way that they do to others because I'm such a free thinker. But I don't know if you know this, but Oregon was founded as like a white supremacist state. People who are like, you know, measles isn't a deadly disease. Chickenpox isn't a deadly disease. I'm not going to vaccinate my kids against these things because I can afford to take two weeks off

and isolate my kid if they get sick. And it's like that's just ridiculous, right? Like that's like, that's the part of it that is so frustrating to me. It's so short-sighted. From the story of the guy building his house in the middle of a county road south of Portland, Oregon, to the battle within the Republican caucus in Olympia, Washington, to the Healthy Immunity Conference and a woman who feels so alone in her belief that she was injured by a vaccine,

to families like the Markwells, who are somewhere in the middle, to Alan Melnick, whose solemn charge is protecting the county from a health disaster. All of these ingredients are important parts of the story of what happened in the Clark County outbreak. Here's the thing, though. Whatever Oregon and Washington's story is, it's just a piece of a much bigger puzzle. We're learning a little bit about how this stuff happens, but everywhere is different, and new pockets of resistance are breaking out all over the country. My name is Ginger Taylor, and I live in Brunswick, Maine, and I'm the director of the Maine Coalition for Vaccine Choice.

What is that? It's a group of parents who have gotten together just to try to preserve our rights to make our own medical decisions for us and for our children. The idea that the vaccine industry and public health can hold a competition between them and those that are critical with them and then not allow those who are critical with them into the arena. But they win every argument. Well, you know, you're shadowboxing. We want to have the fight. They're running from the fight.

In the final part of infectious, can we get society on the same page, at least enough to prevent future outbreaks, even as resistance to vaccines is having its own outbreak. Endless Thread is a production of WBUR, Boston's NPR station, in partnership with Reddit. Josh Swartz is our producer, and when we were driving all over the Pacific Northwest, he said we were just a couple of idiots in cars. Iris Adler is our executive producer, and she prefers listening to our vaccine series from one of her... Cozy places. Mix and sound design by Paul Vicus, who would like some community immunity from...

Late stage capitalism. Michael Pope is our advisor at Reddit who thinks it might help lawmakers pass more bills if they presented some... High quality gifts. Our intern is Magdiela Mata. Special thanks to our buddy Alison Bruzek at K-U-O-W. Allison, we miss you in Boston. On Reddit, we are endless underscore thread.

If you want to contribute art for an upcoming episode or give us a juicy story tip so we can tell it like we did today, hit us up there. My co-host and producer is Amory Siebertson. I'm senior producer and host Ben Brock Johnson. I'll let myself out.