In this special investigation, the ABC11 I-Team joined the seven other ABC Owned Television Stations to dig into vaccination rates and their impact on the significant return of measles in across the country.
"People who lived through these diseases that killed their children were so desperate for the vaccine they wouldn't have dreamed of refusing them," said Dr. Gabriela Maradiaga-Panayotti, a Duke Hospital pediatrician. "There are many people now who don't think this is an active issue. They don't think it's going to affect them or their child and what worries me is how we are getting the information to these families."
Worst outbreak in a generation
According to the Centers for Disease Control and Prevention (CDC), measles reemerged as early as January 2018. By that summer, health officials reported 107 cases in 21 states, including three in North Carolina (all in Johnston County).
This year, confirmed cases of measles have skyrocketed to 1,241 - the most since 1992. The majority of those cases are linked to outbreaks in New York, but health officials have reported outbreaks in 30 other states.
INTERACTIVE MAP: Check immunization rates where you live
The majority of the people who got the measles were unvaccinated.
"While they are not perfect, they are really great at preventing something that can be really terrible for your child," Dr. Maradiaga-Panayotti said of the measles vaccine. "Some of the diseases, like measles, are so contagious that it just takes a few people who aren't vaccinated to all of a sudden spread the disease."
The measles vaccination is 97 percent effective, according to health officials. High-risk groups include pregnant women, infants and people considered immunocompromised or immunosuppressed.
The vaccine schedule widely accepted among doctors includes two doses of the measles vaccine: the first one is typically administered when a child is one year old and the second before the child goes to school, between the ages of four and six.
Before the vaccine program began in the 1960s, as many as 4 million people contracted the measles every year, leading to tens of thousands of hospitalizations and hundreds of deaths.
Vaccination rates dropping
Many of the measles cases in New York have been concentrated among children of Ultra-Orthodox Jewish families, many of whom attend religious schools where the vaccination rates are below 95 percent, which is the threshold considered necessary to maintain immunity among the community, a condition known as herd immunity.
In North Carolina, vaccinations rates among many public, private and parochial schools, have generally hovered in and around 95 percent, but data obtained by the I-Team shows those numbers falling below that threshold in the last couple of years. Schools in Chatham, Cumberland, Durham and Wake Counties all saw an increase in the number of students who were not immunized between the 2016-2017 and 2017-2018 school years.
Last year vaccination rates among kindergarten students in Cumberland, Durham, and Wake Counties were 93.8 percent, 93.3 percent, and 94.1 percent respectively.
North Carolina laws on vaccines
State statutes are actually quite clear on the necessity of vaccines: no child can attend a school (pre K-12), whether public, private or parochial, unless parents or guardians can provide certified forms with immunization history or a qualified exemption.
If either of those are not presented to the school within 30 days from after the first day of school, the principal is obligated to deny access for the child to the school.
The law does allows for two exemptions: medical and religious. Medical exemptions, by far the less common exemption, can only be request by a state-licensed physician. There are also specific forms for doctors to complete and submit to the North Carolina Department of Health and Human Services.
Religious exemptions, in contrast, require little to no verification. In fact, while the law states parents or guardians must maintain "bona fide" religious beliefs, the exemption requires no proof of membership to a house of worship, no signature from clergy, nor does it require any notarization from an attorney.
Instead, all a parent or guardian has to do is submit a "statement" - one for each child - to the school, day care center or camp only, and not to the state for review or approval.
Incidentally, "personal belief" or "philosophy" not based on religious belief is not permitted for exemptions.
The General Assembly last tried to amend the laws in 2015 and end religious exemptions, but a lengthy and loud protest stifled those efforts.
Sen. Mike Woodard (D-Durham), who sits on the Senate Health Care Committee, says lawmakers have a "very narrow needle" to thread when it comes to public health and religious freedom.
"I won't say we're afraid to touch it, but it is a very tough public policy area," Woodard said of the immunization debate. "I don't have a crystal ball so I don't know where there's a tipping point when we look at measles or smallpox or chicken pox outbreaks in schools and say we need to be stricter about vaccinations."
Perhaps as further sign of the divisiveness of the issue, several other lawmakers - including the chairs of health committees in the House and Senate - declined to speak with the ABC11 I-Team.
"This is a very, very difficult public policy question for all of us," Woodard said. "I try to stay informed but to me the science is overwhelming that we should be vaccinating our children."
"Acknowledge" but don't "invalidate"
Dr. Maradiaga-Panayotti, a mother of young children herself, said to raise immunization rates requires a revised approach from doctors and other health care providers.
Specifically, she said, doctors should not outright dismiss or downplay concerns of parents who may have "read something online" or "heard from a friend of a friend of a friend."
"When a parent expresses these concerns, I connect with them in the sense that I know they're wanting to do the best thing for their child because they love them like nobody else loves them," Dr. Maradiaga-Panayotti said. "I totally acknowledge that it's coming from a great place of loving parenthood. You want to do the best thing for your kid. It's important for doctors to acknowledge that and not invalidate, or make fun of them or dismiss their concerns because then the relationship and trust is broken."
Despite what she calls a "mountain" of scientific research promoting vaccines, the doctor said vaccinations are now an emotional issue for younger parents and not a pragmatic one.
"When you are worried about something, you can show someone all of the encyclopedias, the research, but they can still have the one friend they knew who had this one event and for them that's reality. I'm biased," she said. "I believe in vaccines, I believe that they protect their child and I recommend you get it just like my children did, but I want to hear you out."
ABC11 attempts to speak with anti-vaccine families
The ABC11 I-Team worked on this story for several weeks and made numerous attempts to connect with families in the Triangle and across North Carolina who chose not to vaccinate their children or choose an alternative schedule.
This effort included dozens of phone calls, emails and messages on social media, and we also reached out to several holistic health centers as well.
Despite our offer to give these families and advocates time to share and communicate their perspective, no one was willing to come forward and speak publicly on the issue.