Defense manufacturing

When Kate Morrow gave birth to twins eight years ago, they were very premature with compromised immune systems.

"We counted on the community to keep our children safe," Morrow says. She trusted that her neighbors were vaccinating their children to protect vulnerable people in her community — including her twins. But that trust has eroded.

Morrow and her family moved to Spartanburg County, S.C., in 2019. The area is now the epicenter of the largest measles outbreak in the U.S. in over three decades, with nearly 1,000 confirmed cases. Measles — one of the world's most contagious diseases — was declared eliminated in the U.S. in 2000 due to widespread vaccination and school vaccine requirements.

However, with the current resurgence, the country is at risk of losing that elimination status.

In Spartanburg County, school vaccination rates have dropped to just under 89% — well below the 95% threshold needed to prevent community outbreaks.

This decline is not unique to Spartanburg. Across the country, vaccination rates have fallen to levels that allow outbreaks to flare, says Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy.

"There are a lot more South Carolinas waiting to happen," he warns.

Morrow finds it difficult to understand why so many parents in her community are turning against vaccines.

"How did we get here?" she asks. "How did we get to a place where we don't trust our doctors to do the very best thing for our children? How did vaccinations become political?"

The answer lies in a mix of widespread misinformation, lingering resentment over COVID mandates, and politicians at local and national levels sowing mistrust of vaccines.

'I don't trust anything anymore'

Margarita DeLuca, a mother of three from neighboring Greenville County, says she didn’t think much about vaccines until COVID-19. When the COVID vaccine was first introduced, she feared it was developed too quickly to be safe and opposed vaccine mandates.

"I think it should have been a choice. It shouldn't have been shoved down your throat like you have to do it," DeLuca says.

She is not alone. Resentment over vaccine mandates and other public health measures during the pandemic led more parents to question vaccine requirements, says Dr. Martha Edwards, president of the South Carolina chapter of the American Academy of Pediatrics.

"COVID hit and people really didn't like the mandates, and that was a big boiling point," Edwards explains. "In South Carolina, that really escalated feelings of 'don't tell me what to do.'"

DeLuca vaccinated her eldest child, Nikko, born in summer 2021, with routine shots during his first two years. But about a week after his 2-year vaccinations, Nikko developed a fever and had a seizure.

"He froze up and then started convulsing right in my arms — the scariest thing ever," she recalls.

Nikko recovered. Her pediatrician explained that febrile seizures can occur in toddlers with high fevers and are unlikely related to vaccines. Still, DeLuca remains skeptical.

"He hasn't had any seizures since, but he hasn't had any vaccines either. I'm not saying it's from that, but there is a chance," she says.

Like many parents nationwide, DeLuca decided to forgo vaccinations for Nikko, now 4, and his infant twin siblings.

"I'm grateful I did not vaccinate them right now," she says. "Maybe at 5 years old, their bodies are bigger and their immune systems stronger. They can handle things."

Local pediatrician Stuart Simko with Prisma Health in Greer, S.C., hears similar concerns from parents and tries to explain why delaying vaccinations is risky.

"This is when children are at higher risk, the younger they are, for complications from many diseases we vaccinate against," he says.

For example, the measles, mumps, and rubella (MMR) vaccine prevents serious complications like brain swelling and pneumonia, both documented in this outbreak. Vaccines also prevent immune amnesia, where the virus impairs the immune system, leaving children vulnerable to infections for years.

Measles can be deadly. Before vaccines were developed in the 1960s, measles killed hundreds of U.S. children annually.

Simko emphasizes listening to parents' fears without judgment.

"Parents choosing not to vaccinate aren't making bad medical decisions; they want what's best for their child. We have to understand where they're coming from," he says.

Social media complicates matters. Many patients are overwhelmed by information—some accurate, some not scientifically supported.

DeLuca admits, "I don't trust anything anymore. I really don't."

Exemptions rise, vaccination rates fall

Spartanburg County is a conservative area with small towns, rural communities, conservative faith groups, and a sizable Slavic immigrant population—all groups that tend to have lower vaccination rates nationwide.

In most states, parents can apply for nonmedical exemptions for religious, personal, or philosophical reasons. In Spartanburg County, religious exemptions have surged since the pandemic. Nearly 10% of students now have a religious exemption—up from 3.4% at the start of the 2020-21 school year.

This has caused vaccination rates among schoolchildren to drop. The majority of schools in Spartanburg County now have vaccination rates below the 95% threshold needed to prevent measles outbreaks. One public charter school, which quarantined dozens of students for measles, has a vaccination rate as low as 21%.

Republican state Sen. Josh Kimbrell, a lifelong Spartanburg resident, understands why parents have grown skeptical after what he calls the government's "overbearing" COVID response, but says the distrust has "gotten out of control."

Exemptions are easy to obtain—parents can download a form and only need to have it notarized without stating a religious reason.

"I know people who haven't set foot in a church in five years who suddenly claim a religious liberty exemption without a religious reason," Kimbrell says. "They just don't want to vaccinate. That's fine, but just say that."

Public health experts say eliminating nonmedical exemptions could raise vaccination rates. However, in South Carolina, where opposition to government mandates is strong, this is unlikely. Last week, the state legislature rejected a bill that would have excluded unvaccinated children from schools.

This trend is nationwide. A recent study found nonmedical exemption rates have steadily risen in most U.S. counties, accelerating since the pandemic.

Parents changing their minds

Gene Zakharov, a Spartanburg parent and cafe owner, obtained religious exemptions for his children. He is part of the large Slavic community attracted to Spartanburg’s conservative politics and sunshine. Many from the former Soviet Union distrust vaccines.

"People who lived there have a big distrust in the government, to say the least," he says.

He and his wife initially did not vaccinate their two youngest children due to concerns about side effects. But after their 13-year-old daughter was exposed to measles and quarantined, they reconsidered.

"It doesn't hit you until you actually come in contact with something like this. You're like, thank God my kid is all right. But what if she wasn't?"

Zakharov is not alone. As the outbreak worsened in January, pediatrician Stuart Simko received calls from parents reconsidering vaccinations.

"Several patients who previously said no to vaccines asked, 'What do you think of the MMR? What about measles? It's in our backyard,'" he says.

Simko explains the dangers of the measles virus and notes, "a lot of people are changing their minds."

Combatting myths and fears

Tracy Hobbs recently changed her mind about vaccines.

Last month, she brought her 5-year-old twins, Joseph and Alice, to a mobile vaccine clinic for their first MMR dose. They should have been vaccinated around 12 months, but she initially declined because her oldest child, now 7, was diagnosed with autism shortly after his first measles vaccine.

Hobbs encountered conflicting information about whether vaccines cause autism.

"We were afraid the vaccines might cause autism," she says. "That's really messed us up because what are you supposed to believe?"

Claims linking vaccines to autism stem from a 1998 study thoroughly debunked by extensive research. However, misinformation persists. Health Secretary Robert F. Kennedy Jr. has promoted the discredited claim and recently urged the CDC to change its website to suggest the link cannot be ruled out. Hobbs finds the conflicting information confusing.

"One person says this could cause autism, another says no. I've gotten conflicting information since the day they were born," she says.

When her twins were also diagnosed with autism despite not being vaccinated, Hobbs changed her mind. With measles spreading rapidly nearby, she decided to vaccinate them. "Measles aren't something to play with," she says.

'Not an outlier'

Kate Morrow, a Spartanburg mother, is pained that misinformation about vaccines and autism still circulates. One of her twins has autism, and both are fully vaccinated.

She encourages parents to trust science and speak openly with pediatricians about their fears.

She is helping launch a pro-vaccine advocacy group, South Carolina Families for Vaccines, to support parents feeling lost and scared.

There is some evidence outreach is working. State epidemiologist Linda Bell reports vaccination rates in Spartanburg County rose 133% in February compared to the previous year, and new measles cases have slowed significantly.

However, the danger remains, says Scott Thorpe, executive director of the Southern Alliance for Public Health Leadership.

"What keeps me up at night is that Spartanburg is not an outlier," he says. Nearby counties in western North Carolina also have low vaccination rates, and cases have already appeared there.

Across the U.S., there have been 12 new measles outbreaks this year, with more than 1,280 confirmed cases, according to the CDC.

"It's percolating in many places," Thorpe warns. "Eventually, it will catch on and turn into a big outbreak like Spartanburg. This will continue as vaccination rates decline."