By Jeffrey Kluger
September 25, 2014

I’ve felt ridiculous plenty of times in my life, but rarely so much as the day I took my first daughter to the doctor to get her first round of vaccines. It was a routine visit during which her weight, length, alertness and other basic metrics would be checked. But at the end of the appointment would come the shots.

When that time arrived, I held my daughter in my lap, knowing two things she could not: that in a few seconds, she’d be howling in pain and outrage and that the needle that would be plunged into her wonderfully chubby thigh would introduce a stream of viral traces into her otherwise clean and pristine immune system. I was seized by a sudden fear that I was doing a very bad thing.

That’s what the people behind the antivaccine movement would have me believe, but I knew better–and for a long time, so did most American parents. In 1952 there were 57,879 cases of paralytic polio in the U.S. By 1961, just six years after the vaccine was introduced, the number was 1,312–a 98% reduction. Today the figure is zero. In the 1950s, before the introduction of the measles vaccine, 3 million to 4 million Americans contracted the disease each year and 48,000 were hospitalized. In 2012 there were just 55 cases.

But recent outbreaks of measles in New York City and Orange County, California; whooping cough throughout the entire state of California; and mumps in the communities around Ohio State University in Columbus suggest that the hard-learned lesson that vaccines are not only safe but also critical to the health and safety of all children is being unlearned.

The geography of the outbreaks is telling. Doctors who treat cardiovascular disease worry most about the U.S.’s so-called stroke belt in the Deep South, where obesity rates are highest and eating habits are, broadly speaking, poorest. The antivaccination movement is more a scourge of blue states. Its adherents are primarily well-educated and comparatively affluent people who consider themselves well informed. But they’re doing a lot of damage–and the numbers explain why.

For most diseases, vaccination rates must remain very high–up to 95% in some cases–to establish what’s known as herd immunity, the protection provided by an entire community to the handful of people who can’t be vaccinated because of a demonstrable medical condition. In the U.S. at large, the numbers are pretty good, with close to 95% of incoming kindergartners in compliance with vaccine guidelines, according to a 2012–13 survey from the U.S. Centers for Disease Control and Prevention (CDC).

But that figure conceals a lot of holes. Louisiana has an impressive 96.6% rate for the measles, mumps and rubella (MMR) vaccine and a 98.3% rate for diphtheria, tetanus and pertussis. Mississippi leads the nation with a near perfect 99.9% for both. California, meanwhile, clocks in at just 92.7% and 92.5%, and Colorado rolls in last at a woeful 85.7% and 82.9%.

In New York City, vaccination rates in public schools top 98%. But a recent survey of 245 of the city’s private schools revealed that half of them are below 90%, and 37 of them are below 70%. Nine schools fall in a range from 41% down to 18.4%.

In Ohio, it’s not all of Columbus that’s turned against vaccines; it’s mostly places like the Clintonville community, an upscale neighborhood where the antivax movement has gained traction. “There are a lot of university employees living there,” says Misti Crane, a reporter for the Columbus Dispatch who, along with co-investigator Jennifer Smith Richards, analyzed statewide vaccination rates and led the charge in establishing the high-income, low-vax link. “They are dual-income and college educated. It’s a community of ‘Hey, I know better.'”

But what these folks think they know just ain’t so. And not only are their own children being put in danger, but so, potentially, are everyone else’s.

Gaps in the Herd

Julie Snoeberger doesn’t care what you want to call her–and there are few names you could come up with that she hasn’t heard before. “I’ve been called a crackpot and a baby killer,” she says.

Snoeberger began steeling herself against this kind of criticism more than 15 years ago, when her baby son began getting his first rounds of vaccines. After his 12-month shots, he developed chronic ear infections. At 18 months, she says, the MMR vaccine transformed him within 48 hours from a happy, verbal child to one who was violent, antisocial and had “lost all his words.”

The medical community has heard stories like this before and patiently refutes them: if her son developed signs of autism, they were linked not to the vaccine but to the simple fact that the disorder often begins to present itself at the same age at which kids start getting vaccinated. And as for ear infections, well, they are practically ubiquitous among babies. Nonetheless, Snoeberger quit vaccinating her boy and partly credits that with the fact that now, at 17, he is “a typical teenager.” Her daughter, 19, who got all her vaccines, had no ill effects from them.

A former sales and marketing professional living in Beavercreek–the second largest suburb of Dayton, Ohio, and which has a median income of $75,000–Snoeberger has made it her mission to bang the antivaccine drum. “Mothers like me are needed to plant the seeds of doubt in others,” she says. “That’s all I can do.”

The arguments that have been central to the antivaccine movement for decades are familiar: The shots are overused and teeming with toxins. They cause autism, bipolar disorder, ADHD, allergies and more. They are profit centers for greedy doctors and Big Pharma, and everybody’s keeping the dangers quiet. “The conspiracy theories come up a lot,” says Joan Bowe, director of personal health for the Delaware County General Health District in Ohio, which was hit by the mumps epidemic earlier this year. “They usually involve the government wanting the vaccines out there.”

None of that is true, but that doesn’t mean the rumormongers are ill-intentioned. Even epidemiologists and school administrators agree that antivax parents are motivated by nothing more than what they think is right–despite the science showing they are wrong. “These are good families trying to make the best call they think they can for their kids,” says Paul Craft, the superintendent of schools in Delaware County. The idea that their best call is in fact the worst one doesn’t always get through, partly because there are doctors willing to back up vaccine opponents.

“As I perceive it, vaccines should be an elective procedure,” says Dr. Janet Levatin, who practices near Cleveland, citing measles as one argument in favor of that belief. “For a well-nourished, healthy, normal child in a developed country, measles should not be a problem,” she says–a position at odds with the 592 cases of the disease that had occurred across 21 states as of late August, according to the CDC, the biggest national outbreak since 1994.

Other doctors–those who support vaccines–have a number of ways to deal with patients who believe the shots are dangerous. Some simply refuse to treat the family, which handles the entire matter neatly but squanders the chance to change the patients’ minds when they come in for visits. Others seek to engage.

“Our strategy has been to give them science-based resources as opposed to the other things they’ve been hearing,” says Dr. Bonnie Pugh, a member of a Columbus-area practice. “We have had some people turn around.”

Why So Blue?

Columbus, like so many of the viral hot spots in the past year, ought to be a very vaccine-friendly place. Ohio State University by itself is the home or workplace to 100,000 people, and health care is a major and growing part of the regional economy–with 24,000 jobs added in the sector in just the past year. That’s not the kind of crowd that you’d expect to be unfamiliar with the basics of disease prevention.

But the mumps outbreak–which has led to 483 infections in 2014, as of the last week in August–was almost surely caused by people letting their vaccine defenses down. Mumps is a particularly tricky disease to control, because although the vaccine is entirely safe, it is only 80% to 90% effective, which means that compliance rates have to remain especially high to control its spread.

No surprise, the antivax activists piled on to that fact, with a claim that 97% of the people who contracted mumps had been vaccinated, so what was the point of getting the shots in the first place? But that number appears to have been invented. “When we asked patients if they’d been vaccinated in childhood,” says Columbus deputy health commissioner Mysheika Williams Roberts, “only 80% said yes. And we were able to confirm only 42% overall.”

There are a lot of theories about why vaccine denialism is such a problem in left-leaning communities, and one of the most persuasive is the master-of-the-universe phenomenon. The wealthier you are and the higher your education level, the more you lose sight of the randomness of misfortune and come to believe you can control variables and eliminate risk.

“When people achieve a certain status, they think they’re invincible,” says Roberts. “They think it will never happen to them, and if it does, they’ll have the resources to deal with it.”

This is true even of upscale people who are trained in science. Dr. Jane Rosini, a pediatrician in a practice on Manhattan’s Upper West Side, recalls struggling to convince one father, a biologist, that vaccines truly are safe and effective. “He said he thought he knew better,” she says. “People are trying to be the ultimate parents. Every piece of clothing and food is thought out, and vaccines fall into that category.”

Persuading the Avoiders

One way epidemiologists and psychologists have found to open people’s eyes to the dangers of vaccine avoidance is to frame the risks not in general terms–the numerical odds of contracting a disease–but rather the specific consequences. Mumps can cause deafness, for example, and, says Roberts, “once we see those complications, vaccine rates go way up.”

Another far more personal risk is orchitis and oophoritis–inflammation of the testes or ovaries–which can lead to sterility. That’s a wake-up call for college kids who look forward to starting a family one day. “I was one of the first 20 cases in the OSU outbreak,” says Jonathan Planchett, a junior majoring in economics, who was halfway through a 19-hour car ride home from spring break in Miami when he felt a pain in his jaw and another student in the car confirmed that his face was badly swollen. “I was pretty freaked out. The doctors at the health center asked me if I had experienced orchitis. I didn’t know mumps could lead to any of that.”

Enlisting pediatric practices in the fight also helps. Mary DiOrio, Ohio’s state epidemiologist, is ramping up implementation of a program known as MOBI–maximizing office-based immunizations–that is becoming increasingly popular in other parts of the nation. MOBI is a peer-taught program in which nurses and other health providers practice how to grab the opportunities whenever families are in the office to check on children’s vaccine status and bring them current if they’ve fallen behind. “We think people listen to their providers,” says DiOrio. “We get the information out there and let the doctors do the talking.”

Where persuasion doesn’t do it, legislation might. All 50 states have laws that require kids to be in compliance with vaccine guidelines before attending public schools, and 49 of them extend those rules to day-care centers. Ohio is the lone exception. Nicki Antonio and Ryan Smith, a bipartisan pair of lawmakers in the state assembly, have introduced a bill to include day-care centers in the requirements. “Currently, it’s up to the day-care centers to track down information about who is vaccinated,” says Antonio, from the Cleveland suburb of Lakewood. “This will turn the responsibility back to the parents.”

But there is a gap in most such laws throughout the nation. Being “in compliance” with vaccine guidelines does not mean kids have received all the vaccines the American Academy of Pediatrics recommends. It means either that they have received the vaccines or that their parents have exercised one of the opt-outs available under the laws. Those opt-outs include medical waivers for kids who cannot be vaccinated and waivers for religious reasons. However, 17 states, including Ohio, also have an opt-out for “philosophical” reasons, and that’s the one being exploited.

But there are ways to change vaccine avoiders’ minds. Schools are permitted to require unvaccinated children to stay home during outbreaks–which kids just see as the equivalent of a snow day–but they’re also permitted to bar them from school activities. That one can sting. “We start with shots across the bow,” says Craft. “We say that unvaccinated kids can’t come to school dances or play on sports teams because of the risk. That gets it on the child’s radar screen.” And that, in turn, gets it on the parents’.

The vaccine opponents are not going away anytime soon, though encouragingly, some are going dark. Playboy model and talk-show host Jenny McCarthy, who more than anyone else lit the antivax fires, speaks little of the matter anymore. Parents who don’t vaccinate increasingly complain that they are becoming pariahs in their communities, resented by parents who seek to protect their own children and see the antivax parents as undermining their efforts. Some doctors view this kind of impromptu, parent-on-parent persuasion as the best way to bring vaccine opponents around.

None of that, of course, is of interest to a virus, a mindless clump of deadly nothing that knows how to do exactly one thing: replicate itself inside a living organism. The fight should not be a fair one, because one of those infectible organisms–the human being–has the power to think and reason and choose. Vaccines give us the once unheard-of power to choose health. It’s a choice doctors are fighting to help more and more people make.

Write to Jeffrey Kluger at jeffrey.kluger@time.com.

This appears in the October 06, 2014 issue of TIME.

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