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As autism rates rise, the vaccination debate rages on

The Plummer Building in downtown Rochester was lit up blue April 2 by Mayo Clinic as a show of support on Autism Awareness Day.

It was joined by other iconic sites across the globe, such as the White House, the Empire State Building, Niagra Falls, the Panama Canal, Christ the Redeemer statue in Brazil, the archaeological site of Petra and dozens more.

Why such a public push for awareness this year? Autism rates have exploded, and those who blame vaccines for that increase have become more prominent under the administration of President Donald Trump . Andrew Wakefield, the controversial figure who largely created the anti-vax movement in 1998 and lost his medical license 12 years later, attended Trump's inauguration.

A 2016 report from the Centers for Disease Control and Prevention (CDC) says autism rates increased from 1-in-150 in 2000 to 1-in-68 by 2012. The CDC's next biennial report on autism isn't due until 2018, but many now characterize autism as an epidemic.

Autism Spectrum Disorder is a developmental disorder typically marked by difficulty communicating and repetitive behaviors. Diagnosis typically occurs within the first 2 years of an infant's life and can result in mild impairment, severe disability or anywhere in between.

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Rochester has played a prominent role in the autism debate for years, thanks largely to research done by Mayo Clinic and the Rochester Epidemiology Project , which includes Olmsted Medical Center and Olmsted County Public Health.

Kris Ehresmann, the Minnesota Department of Health's infectious disease director, lauds those regional health assets while insisting there is no link between vaccines and autism — a popular belief among anti-vaxxers. Though she admits feeling personal anxiety before vaccinating her own children, she still urges parents to "see the value of vaccines."

"The most important message is vaccines have been well vetted," Ehresmann said. "They're safe, they're effective and they save lives. That's the message we want parents to be aware of. Their goal is for a safe, happy, healthy child, and that's our goal, too."

The Rochester connection

After 14 years of insistent advocacy for their son, Brad and Joan Trahan succeeded in getting Mayo Clinic insurance to cover intensive autism therapy last fall. Reece Trahan, a Century student with a severe form of ASD, was briefly enrolled in one-on-one therapy called Applied Behavior Analysis before it was deemed too expensive and too late for him to make progress.

"We'll always wonder where he would have been if he had been prescribed ABA therapy sooner," Brad Trahan said. "Had we not had to go through the battles … we're confident he'd be further along than he was if we didn't have to play the political game."

In February, Rochester Public Schools took a stand on vaccinations, echoing elements of an international debate that's been simmering for decades . Since Wakefield's controversial — and since retracted — 1998 study that linked autism to vaccinations, opposition has increased.

The Rochester School Board voted unanimously on Feb. 21 to remove 204 students from class if the proper vaccination paperwork wasn't submitted by March 1. RPS communication director Heather Nessler said 62 students failed to hit that deadline, but everyone was in compliance by the end of the month.

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Of the district's nearly 18,000 students, Nessler said 370 students have filed for a conscientious exemption to avoid vaccinations. Another 125 have a medical exemption. According to a Pew Research Study released in February, 17 percent of U.S. adults believe the MMR vaccine (measles, mumps and rubella) should not be required to attend school, even if it puts other students at risk.

Additionally, RPS has experienced a 64 percent increase in students with ASD over the past decade — from 175 in 2007 to 275 in the current school year.

Nessler says RPS has added five intensive ASD classrooms since 2007, with each room staffed by one special education teacher and two paraprofessionals to serve 30 of those students. Those staffing additions are mandated by Minnesota Department of Education case-load requirements.

The other 70 ASD students, who are on the mild end of the spectrum, spend the majority of their days in a general education setting, Nessler said. Those increased numbers still required the district to add another "5-6 special education teachers and 5-6 special education paraprofessionals" to administer Individualized Education Plans.

Nessler says those staffing additions mean RPS is now paying nearly $1.4 million more each year to serve its autistic students than it did a decade ago.

Debate intensifies

Multiple vaccine skeptics in Southeast Minnesota declined Post Bulletin's interview requests, but there's a vocal minority across the country who are anything but bashful about their beliefs.

In fact, dozens gathered March 31 in Washington, D.C., to deliver a letter signed by nearly 300 physicians and researchers urging Trump to create a vaccine safety commission — weeks after a letter signed by 350 prominent health organizations was delivered to the White House encouraging him to accept the established science.

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The event was organized by the "Revolution for Truth" and Robert Kennedy Jr., an outspoken vaccine opponent, was among the featured speakers.

Maren Caldwell, a member of the nonprofit People Advocating for Vaccine Education, attended the event to decry the "fake news, the lies, the corruption going on with the CDC."

"They're telling us that there's no correlation whatsoever, that vaccines do not cause autism," she said, according to Newsweek . "We're here to tell you it absolutely, 100 percent does."

Vaccine skeptics routinely point to federal protections offered for vaccine manufacturers — effectively preventing lawsuits — while the National Vaccine Injury Compensation Program , created by Ronald Reagan in 1986, has paid out approximately $3.5 billion as prime examples of their concerns.

Additionally, a recent peer-reviewed study from researchers at Duke and Harvard universities links acetaminophen given to babies before or after vaccines to increased rates of autism. Dr. Diane Hennacy Powell , a controversial vaccine skeptic trained at Johns Hopkins, says that's one of many red flags in the raging debate.

"When doctors first started vaccinating children, the benefits clearly outweighed the risks," said Powell, a former faculty member at Harvard Medical School. "We are seeing more complications now … (and) we need to redefine this debate in scientific, and not political terms."

Mainstream science pushes back

The mainstream medical community, by and large, continues to scoff at the concerns raised by so-called anti-vaxxers, who are often derided as conspiracy theorists. Mayo Clinic's Robert Jacobson, an expert in the vaccine field, is among the prominent doctors to dismiss the alleged link between vaccines and autism.

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Dozens of studies have widely debunked the alleged link between vaccines and autism, including a 2015 report from the Journal of American Medical Association that studied 95,000 children and has been called the largest of its kind. A 2005 study conducted by the Rochester Epidemiology Project when Jacobson was the department chair is among prior reports to reach the same conclusion.

Jacobson cautions the public not to embrace Trump's anti-vax rhetoric simply because he holds a position of political power.

"I don't think he represents the majority of the people (on vaccines), nor has there been a major shift in how the population feels," Jacobson said. "If anything, I think the anti-vaccine movement has gotten a big boost because he has taken it on in a public way by meeting with the people who fraudulently claim that vaccines cause autism."

Ehresmann echoed Jacobson's sentiment.

"Any time a prominent figure or anyone in a prominent position makes a statement (about vaccines), they do have potential to sway public perception," Ehresman said. "We think it's very important that people are speaking accurately. Any time someone says something that isn't accurate, that's a challenge for us because we have to go back and reset the dial on public opinion."

'Vaccines are their own worst enemy'

Back in 2000, measles was declared to be eradicated in the U.S. — But in 2014, 667 cases were reported across 27 states.

So what changed? Public perception of vaccines, according to the latest numbers from Pew Research .

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Though widely considered debunked, Wakefield's controversial study continues to influence opinions on vaccines and reduce vaccination rates. That's readily apparent when you compare perceptions across age groups, political ideology, science knowledge, education, income levels and race.

According to Pew, millennials and conservatives have less confidence in vaccines than their elderly and liberal counterparts. Specifically, 90 percent of liberals believe vaccines should be required to attend school compared to 73 percent for conservatives.

Those numbers almost mirror to the split between 18-29-year-olds (77%) and those who are 65-older (90%). Across four age groups, vaccine confidence skews higher as respondents got older.

Jacobson says he isn't surprised by the split by age groups, noting many in the older generation actually saw the impacts of diseases that have been wiped out by vaccines.

"Frankly, vaccines are their own worst enemy," Jacobson said. "By eliminating these diseases, these (younger) people have no idea these are all about."

Though 88 percent of Americans consider the health benefits outweigh the risks for the MMR vaccine, rates fall precipitously among those with low science knowledge (55%), personal income less than $30,000 (60%), and an education of high school or less (61%).

Race was also a critical factor for the same question. Whites had the highest confidence level at 79 percent, while Hispanics came in at 61 percent and African-Americans sat at just 56 percent.

Ehresmann actually attended a Washington D.C. conference in February where the primary point of discussion was the new Pew study. It comes as no surprise that she fully supports one specific question — who should play a major role in policy issues related to childhood vaccines.

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Medical scientists topped that poll with 73 percent of Americans believing they should play a major role in policy decisions. For comparison purposes, pharmaceutical leaders (27%), health insurance company leaders (26%), and elected officials (25%) surpass that only when added together.

That makes Trump's rhetoric especially important, according to Ehresmann.

"It's important to us that people have access to what science is showing," Ehresmann said. "Any time a prominent figure — whether it's an actor, an athlete or anyone in a prominent position — makes a statement … they do have the potential to sway public perception. We think it's very important that people are speaking accurately. Any time someone says something that isn't accurate, that's a challenge for us because we have to go back and reset the dial of public perception."

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Kris Ehresmann, the Minnesota Department of Health

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Kris Ehresmann, the Minnesota Department of Health

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