When Nadine Gartner was pregnant with her daughter six years ago, she was surprised by the number of Portlanders who refused to give their kids early childhood vaccines.

“So many smart, educated parents in my social circles weren’t vaccinating their kids,” said Gartner, who at the time worked as a class-action lawyer. “I thought, these are my peers, these are really smart people. There must be something to this.”

Gartner was alarmed by the amount of seemingly authoritative information available online about vaccines: that they caused autism and neurological disorders; that children were given more vaccines than their immune systems could handle; that vaccines contained toxins.

So she met with her pediatrician.

“He very quickly was able to debunk our fears, and assure us that vaccines were safe and effective,” Gartner said.

But not all parents in Oregon are convinced that vaccines are safe. And despite recent attempts by the state legislature to educate those parents, the number of unvaccinated kids in Oregon continues to rise.

Over the last decade, a growing faction of people have become convinced that vaccinating children is dangerous, despite scientific evidence that overwhelmingly proves vaccines are both safe and one of the best measures for protecting public health.

Vaccines don’t only protect the people who receive them from getting sick; they also help build “herd immunity,” a community’s overall resistance to disease. When more people in a community are vaccinated, an outbreak is far less likely. A fully vaccinated community also helps protect individuals who genuinely shouldn’t receive vaccines—like infants, the elderly, and those with weakened immune systems.

“This is part of a wave of anti-science attitudes in the country, and even the state.”

In Oregon, where both libertarians and natural lifestyle devotees abound, the anti-vaccination mindset is particularly strong. At 7.5 percent, Oregon currently has the highest percent of kindergartners in the country whose guardians claim exemptions for vaccinations on philosophical or religious grounds. That’s a full percentage point higher than what Oregon recorded in 2017—and the figure has risen steadily since the early 2000s.

“There’s an extraordinary amount of information, much of it wrong, some of it right, on the internet,” says State Representative Mitch Greenlick, who chairs the health committee in the Oregon House of Representatives. “This is part of a wave of anti-science attitudes in the country, and even the state.”

Oregon parents are generally required to have their kindergartners vaccinated against diphtheria, measles, mumps, rubella, polio, chickenpox, Hepatitis A and B, and tetanus. But there are exemptions for kids who have medical conditions that would make vaccines dangerous—and for kids whose parents cite religious or philosophical objections to vaccines.

In 2013, Oregon passed a law requiring that parents who claim non-medical vaccine exemptions must either watch an hour-long online video about vaccines produced by the Oregon Health Authority (OHA) or discuss vaccines with a medical professional. But the law has failed to make a meaningful impact on vaccination rates: While Oregon’s rate dropped in 2015 from 7 percent to 5.8 percent, it climbed steadily to 7.5 percent between 2015 and 2018, making the exemption rate higher than before the law went into effect.

The OHA aims to have 95 percent of all Oregon students in kindergarten through 12th grade vaccinated to prevent disease outbreaks. In Multnomah County, only 92 percent of K-12 students are vaccinated.

And some individual Multnomah County schools fall well below that rate. At Sunnyside Environmental K-12, for example, only 78 percent of students are fully vaccinated, making it one of the “most vulnerable” schools in OHA’s registry.

It’s unclear if further legislation mandating vaccines would be effective—or politically feasible. In 2015, Oregon Senator Elizabeth Steiner Hayward attempted to pass a bill that would have gotten rid of nonmedical vaccine exemptions, but dropped it after receiving pushback from fellow lawmakers and constituents. (Steiner Hayward declined an interview with the Mercury for this story; according to her staff, she is not speaking on the record about vaccines at this time.)

Nadine Gartner, who now runs a vaccine education nonprofit called Boost Oregon, said she’s heard lawmakers in Salem refer to vaccines as “more contentious than abortion or guns.”

Representative Greenlick told the Mercury that to his knowledge, there is no vaccine exemption related legislation on the docket for 2019. And even if Oregon did manage to do away with nonmedical exemptions, the relatively small number of doctors sympathetic to the anti-vaccine cause could start signing off on medical exemptions. That’s what happened in California after the state abolished philosophical objections in 2015.

“As a lawyer, I know that laws can change behavior,” said Gartner. “But I’m not convinced that changing the law is going to have the impact that folks may want.”

“I’m not convinced that changing the law is going to have the impact that folks may want.”­

Washington State has requirements for nonmedical exemptions that are similar to Oregon’s. But in Washington, parents don’t have the option to watch a video; they must speak with a medical professional. According to the OHA, a whopping 94 percent of Oregon parents claiming medical exemption in 2018 chose to watch the video rather than speak directly with a doctor.

Washington’s vaccine exemption rate has dropped in recent years, even as Oregon’s has grown.

“If someone feels uncomfortable about vaccines, I don’t know how a one-hour online tutorial is going to change that,” said Gartner.

Boost Oregon organizes two-hour pro-vaccine parent workshops that are facilitated by medical professionals—both traditional physicians and naturopaths, whom Gartner said can help bridge the gap for parents who are skeptical of mainstream medicine.

In a political climate where additional vaccination legislation seems unlikely, education efforts like Gartner’s might be the best bet for reducing the vaccine exemption rate.

But without a mandate to attend such workshops or speak with a physician, it’s almost certain Oregon will still have pockets of strong anti-vaccine sentiment. As Greenlick notes, Oregon’s overall vaccine exemption rate could drop—but if individual counties and schools continue to lag behind state averages, those communities will face the danger of a disease outbreak.

“Even if a relatively small proportion of kids aren’t covered,” said Greenlick, “it’s going to leave some pretty specific danger sites.”