Door County, as well as most of the country, can no longer count on high vaccination rates to protect them from measles, thanks to those rates declining coupled with an increase in voluntary exemptions.
A 95 percent vaccination rate is necessary to prevent measles from taking hold in a community, because measles is so contagious, more contagious than the flu or Covid.
The U.S. has a 92.7 percent vaccination rate overall for measles/mumps/rubella or MMR and Wisconsin is second to last at 84.8 percent, compared to other states. Door County’s vaccination rate for measles is 85 percent.
Is Door County vulnerable to an outbreak of measles like the one occurring in Texas and New Mexico right now? Simply put, yes, according to Door County Public Health Nurse Holly Neri. Measles is preventable by vaccines, she said, and when a community falls below rates necessary to provide “herd immunity,” it has an entry point for the highly contagious virus.
Herd immunity is when enough of the population is vaccinated against or has contracted a disease, is immune, and then is less likely to transmit that disease to others, Neri explained. Herd immunity is necessary to protect the few people who are unable to get a vaccination for health or other reasons. In the case of measles, herd immunity protects infants, who are not able to get the MMR vaccination until they are 12 months old.
In Wisconsin, children enrolling in public or private school need to show proof they have the required immunizations or provide a waiver signed by a parent or guardian for exemption. Children should get two doses of MMR vaccine, starting with the first dose at 12 to 15 months of age, and the second dose at 4 through 6 years of age.
If someone was born after 1957 and has not received two doses of the MMR vaccine, they may want to consider getting one, according to the CDC, especially if they are healthcare workers, international travelers, or people with weakened immune systems. Additionally, adults born between 1963 and 1968 may want to get a booster. During that time, some children received an inactive version of the vaccine that was less effective than the live vaccine.
If you are unsure of your immunization status for measles, Neri said you can get a titer test to measure the level of antibodies against the disease in your blood.
As of March 4, at least 250 people in Texas and New Mexico have contracted measles, in an outbreak that began in January. The outbreak – defined as more than three cases in one area – began in a few schools with large populations of unvaccinated students. Two people have died as a result of the highly contagious virus. Most of the afflicted are unvaccinated children and teenagers. One of the fatalities was a child, the other an adult.
Door County rates by school
The Wisconsin Department of Health Services compiles vaccination rate data by county, district and school for the 2023-2024 school year. That data also shows vaccine exemption rates by category. In Wisconsin, parents and guardians can cite three vaccination exemptions: health, religious and personal.
Door County schools range from higher vaccination rates of 93 percent at Gibraltar High School to as low as 75 percent at St. John’s Evangelical Lutheran School in Valmy. No Door County school definitively meets the 95 percent threshold needed for herd immunity to measles.
School vaccination data does not give a perfect picture of community immunization rates, as it is missing information from homeschooled students. The data is still valuable, because if an outbreak occurs, it usually happens within populations that are in close and regular contact, like schools, according to Ajay Sethi, professor of population health sciences and the director of the Master of Public Health program at UW-Madison.
“The first case is always one person,” Sethi said, and there is a very high likelihood that person is unvaccinated. It does not have to spread from there, he said, but if the vaccination rate in a community is below that 95 percent threshold, chances are higher it will, especially with a disease like measles.
Measles is contagious four days before and after the telltale rash of red patches and bumps appears. Without that obvious measles symptom, someone might not know to isolate themselves for those first four infectious days, and if they are in close contact with other unvaccinated people, the disease will spread easily, Sethi said.
The Texas outbreak began in Gaines County. One of the school districts, Loop Independent School District, has one of the highest conscientious exemption rates for vaccination in the country at 47.95 percent.
The part exemptions play
Conscientious exemptions in Wisconsin can be checked as personal or religious exemptions on the waiver families are required to fill out to enroll their children in school if they are not vaccinated.
There was a rise in conscientious exemption rates even before Covid, according to Sethi. It is important to understand health exemptions versus religious or personal exemptions because as the latter two begin to rise, a community can reach a point where herd immunity becomes unattainable unless people start changing their minds about vaccine hesitancy, he said.
Vaccine hesitancy is not new, Sethi said, but it is increasing in the last decade or so. There has been an overall movement towards autonomy as being more important than the greater good when it comes to vaccination, he said.
“Sitting at a university as a public health person, yeah, I wish more people would opt to get vaccinated,” he said. “Sometimes, I think it’s not so much the vaccine, it may be the mandate that is unsettling for people. I’m not sure if everybody has complete knowledge of how vaccines work, or what is it about the vaccine that makes them worry? But it’s more of a general feeling, and then it can sometimes be interwoven with just the idea of not wanting to be told to do something. It can be very hard to tease apart.”
Another part of vaccine hesitancy, particularly in regards to MMR, Sethi said, is the false link between vaccines and autism. A paper published by Dr. Andrew Wakefield in the medical journal The Lancet in 1998 linked the vaccine with autism and colitis, a digestive system disorder. Several investigations into his study showed that it was poorly conducted and parts of the research were outright falsified, leading to the paper being retracted and Wakefield losing his medical license.
The damage was done however, according to Sethi, and the belief that vaccines cause autism has persisted, despite dozens of peer-reviewed and rigorous research to the contrary.
Take all of this and add in Covid vaccine mandates, and you get areas where conscientious vaccine exemptions are rising. According to the Centers for Disease Control, nonmedical exemptions account for more than 93 percent of exemptions, and almost 100 percent of the increase in national exemptions recently.
An October 2024 CDC report echoes Sethi’s statements about vaccine hesitancy making it impossible for communities to reach herd immunity. In previous years, nearly all states had the potential to achieve higher than 95 percent coverage if all nonexempt children were vaccinated. Increases in the percentage of children with voluntary exemptions have left 36 states with the potential to reach herd immunity for measles in 2023-2024. Wisconsin was not one of them.
Door County exemption rates by school vary, but there are a handful with voluntary exemption rates higher than five percent, and some with exemption rates as high as 25 percent.
Healthy skepticism and changing the conversation
“I’m a very logical person,” Gabrielle Daniels said. “My choices about healthcare and my family are logical versus a knee jerk reaction.”
Daniels is a mother of two adult sons and works in administration management at an organic certification agency. She currently resides in Wisconsin and spent many years living and working in Door County as a journalist for the Washington Island Observer newspaper. Her sons did not receive any childhood vaccinations.
Daniels said she understands why people might be vaccine hesitant, because she herself went down that road around the time she and her husband were starting a family. Her husband has severe asthma and allergy-related health issues and the couple started exploring ways to reduce his reliance on medication.
Diet changes helped, she said and that led them toward learning more about natural and herbal medicine. Daniels started taking classes with the School of Natural Healing, founded by Dr. John Christopher, an herbalist and naturopathic doctor who died in 1983. It was around this time she was exposed to vaccine skepticism.
Pregnant with her oldest son, she said she encountered viewpoints that vaccines were harmful, overused and have side effects the medical industry is not honest about. The viewpoints were relatable, she said.
“The pharmaceutical industry is a multibillion corporate capitalist endeavor,” Daniels said. “When medication and healthcare is tied to making it rich, that leaves room for suspicion.”
When Daniels and her husband moved from Door County to another part of the state, they enrolled their sons in a private Waldorf school. Waldorf education is a holistic alternative education program founded by Rudolf Steiner in the early 20th century. Within the school community there were lots of alternative approaches to education and healthcare that “flipped into anti-vaxxing,” she said.
She began seeing red flags in what she was reading online around that time, Daniels said, indicating that maybe anti-vaccination ideology was problematic.
“The algorithm was pushing things my way… stuff from Anonymous (a decentralized group known for cyberattacks against government, government agencies and corporations) or similar groups,” she said. “A lot of highly emotional headlines and conspiracy theories.”
Daniels’ husband’s health was also an indicator that an entirely anti-vaccination stance was not the best choice, she said. While he had reduced his intake of daily medication, he was never able to get off of them completely with natural remedies, and in fact had been admitted to the hospital a number of times when trying to wean off conventional medicine.
Daniels and her family received Covid vaccinations and her sons are now up to date on their immunizations, she said. The risk of serious disease versus vaccine side effects was the motivator for them eventually. Daniels’ brother was diagnosed with long Covid early on in the pandemic.
“My kids were not vaxxed in childhood,” Daniels said. “I signed personal exemption forms.”
While she said she may have done things differently if she could go back, she also said the conversation about vaccines has got to include the legitimate concerns with conventional medicine and the pharmaceutical industry.
That includes how medical professionals respond to people who are vaccine hesitant. She said she encountered doctors who were “complete jerks” and laughed at, ridiculed and dismissed her concerns and did not want to engage with her questions.
Daniels said she wishes we could find a way to acknowledge the real concerns, embrace the fact no medication is perfect, and engage in conversations that can be productive.
“Try not to dismiss people out of hand for even very extreme views. That’s not easy to do,” she acknowledged. “We need to keep talking.”
The tourism factor
The influx of visitors to Door County every year is a consideration when it comes to the likelihood of a measles outbreak here, according to Neri. Measles is not a seasonally cyclical illness, the way the cold or flu is, she said. Anyone can contract measles at any time if they do not have immunity, and anytime there is a mix in populations or the population increases, the risk of diseases being spread or introduced increases.
There is no way to know visitors’ vaccination status, or the rate of immunization in the areas they are coming from, Neri said.
On the flip side, a measles outbreak in Door County could drastically affect the tourism-based economy, according to Sethi. The CDC has issued travel warnings for the current outbreak in Texas. There is a collective incentive for areas where tourism is a major part of the economy for people to talk to each other and say “you know, we really would want to avoid a measles outbreak here,” he added.
“Does Door County really want to be on a list of counties where tourists are discouraged from going?” Sethi said. “That has a lot of economic implications.”