Fatuma Ishtar wishes the persistent people who warn that the measles, mumps, and rubella vaccine causes autism would leave her community alone. They’ve done enough damage, she says.
For years, anti-vaccine activists have worked on the sizable Somali-American community in Minnesota, urging them to refuse to let their children receive the MMR vaccine. They’ve been successful: The vaccination rate has plunged.
And now, the state is struggling to contain a large and growing measles outbreak that is spreading rapidly through the Somali community and threatens to move beyond it.
As of Monday, there were 48 confirmed cases of the highly contagious — and potentially deadly — infection, all but two in children under the age of 10. Of the sick, 45 had not been vaccinated against measles. And 41 of the patients are Somali Minnesotans.
Ishtar, a community outreach worker in Minneapolis, blames the anti-vaccination lobby. “They are everywhere. Like, every event, every forum,” she said. “They continue to push the community. I feel offended by this group.”
Michael Osterholm, former state epidemiologist, goes further. Actually, he uses the verb “exploit.”
“What they say is, ‘Remember, measles is just a five-to-seven-day disease. Autism is forever,'” he said. Osterholm, however, knows the dangers of measles. He was the state epidemiologist in 1990, when Minnesota had a large measles outbreak — 460 cases in Minneapolis and St. Paul.
Three children died.
Fear takes hold — and activists swoop in
Somali children living in Minnesota once had vaccination rates as high as or higher than their peers, said Kris Ehresmann, director of the Minnesota Department of Health’s division of infectious disease epidemiology, prevention, and control.
But in 2008, Somali-American parents started to notice that lots of their children were enrolled in the school system’s special program for children on the autism spectrum. They were alarmed; many did not recall seeing cases of autism before coming to the United States.
The University of Minnesota conducted a study. It found an autism rate of 1 in 32 among Somali children in Minneapolis, compared to 1 in 36 among white children in the city’s schools. Statistically, there is no difference between the two rates. But the study also found more autism among Somali and white kids than among African-American and Hispanic children.
A perception started to take hold in the community that something had changed. Non-Somalis who oppose the MMR vaccine fed the fear with frequent trips to speak to parents. The discredited British doctor Andrew Wakefield — who first proposed a link between vaccines and autism in a study later found to be fraudulent — has come to speak to this community at least twice, Ehresmann said.
The result: Only 41 percent of Somali children in Minnesota in the 24-to-35-month age range have received MMR vaccine, she said.
“What’s very striking is that when you look at before and after that point in time, and you can see the impact that the anti-vaccine groups have had on the community,” Ehresmann said.
Many Somali parents have adopted an alternative vaccination schedule, Ehresmann explained. The combined measles-mumps-rubella vaccine — the one Wakefield’s discredited work challenged and the one the anti-vaccine movement fixates on — is supposed to be given in two doses. Children are meant to get their first dose between the ages of 12 and 15 months and the second between 4 and 6 years old.
But Somali parents often hold off on that first dose, waiting until they feel confident their children are developing normally.
That means the community, which has a high birth rate, has a lot of young children who have no protection against the measles virus right now.
A dangerous infection spreads quickly
Decades ago, before the measles vaccine was developed, measles was a rite of childhood for most kids. But it was not a benign one. Children with measles get really sick, and there is a significant risk of serious complications — pneumonia and encephalitis (inflammation of the brain) among them. Early last week, Ehresmann said about half the children infected in this outbreak had been hospitalized.
Measles can also kill. The estimate is that for every 1,000 cases of measles, there are two fatal cases. Deaths in the US are now rare, because case counts are low; there were only 70 measles cases in the entire country last year. But the World Health Organization estimates that globally more than 134,000 children died from measles in 2015.
The measles component of the MMR vaccine is highly effective — in fact, it’s one of the most potent of the vaccines given in childhood. Two doses are considered 97 percent effective at preventing measles infection; one dose is 93 percent effective.
Children have to be vaccinated to go to school in Minnesota, but the state does allow parents who have philosophical objections to opt out. That option is used by parents beyond the Somali community; Ehresmann estimates that 3 to 4 percent of children enrolled in Minnesota kindergartens aren’t fully vaccinated because their parents claim a philosophical objection.
“We know that we’re going to continue to see more cases because we know we have unvaccinated populations. Not just in the Somali community but across the state,” Ehresmann said.
Doctors face a jeering crowd
At a recent community meeting that Osterholm attended, doctors who tried to argue the merits of vaccination were jeered. No mention was made, he said, of the fact that autism rates in the community haven’t fallen since Somali families started to eschew MMR vaccination. If the measles vaccine were the cause of autism, rates should have declined.
“No one is suggesting for a second that [autism in the community] is not an important problem. It is,” Osterholm said. “But it’s not about the vaccine.”
Ishtar, who came to the US a dozen years ago as a refugee, heard the talk about the MMR vaccine and autism when she was deciding whether to vaccinate her two young children — a daughter, 3 1/2, and a son, 2.
Then she learned that the autism theory had come from a doctor whose research was debunked and who lost his medical license. “[T]hat was enough for me to not believe,” she said. Her children are getting all their shots, and on time.
But others in the 32,000-strong Somali-Minnesotan community are swayed by the anti-vaccine activists.
“When they hear a doctor and a group of people saying bad things about vaccinations, then you believe it. Because you’re trying to protect your child,” Ishtar said.
Now, Ishtar worries that her community will be blamed if measles infections sweep more broadly across the state and beyond. A quick Google search turns up headlines on alt-right news websites blaming unvaccinated immigrants for spreading diseases.
“If you keep hearing in the news for so many days consecutive, ‘Oh, the Somali community are dealing with measles’… that will make people stay away from the Somali people,” Ishtar said.
This article has been updated to include the measles case count released Monday by the Minnesota Department of Health.