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MICHELE NORRIS, host: From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.

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In some parts of the U.S., vaccination rates have been dropping. We're going to hear from Washington state, which has the lowest vaccination rate for kindergartners.

NPR's Martin Kaste reports on what public health experts call vaccine hesitancy.

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MARTIN KASTE: It's back to school in northeast Seattle, a prosperous, well-educated neighborhood with below-average rates of child vaccination. Around here, it's not hard to find parents who are openly skeptical of vaccines - parents like Jorge Gutman.

JORGE GUTMAN: We have this medical-industrial complex that is pushing vaccination. It's an enormous amount of vaccines. And, you know, I don't think it's justified.

KASTE: At one private Waldorf school, almost half the families claimed a personal exemption to the state's vaccination requirements. And exemption rates are high at some public schools, too, especially those with an alternative bent. Thornton Creek Elementary, for instance, has an exemption rate of 18 percent.

SHAWN WHATLEY: It's kind of exciting. Our kids are part of the petri dish.

KASTE: Shawn Whatley is one of the majority of parents who still do the full immunization schedule, but he accepts unvaccinated kids as part of the territory at an alternative school.

WHATLEY: You come here by choice, not by force. And we tend to attract people that might think twice about vaccines for a whole variety of reasons.

KASTE: Choice is what this really all about. Parents today expect to have choices, and that includes picking and choosing which vaccines to get.

Pediatrician David Grossman, of the Group Health Research Institute in Seattle, says this choosiness is a new phenomenon. Parents used to just accept vaccines.

Dr. DAVID GROSSMAN: Everyone had this common assumption, a shared agreement, that this is a public health good, that this is important for protecting not only my child but also my neighbor's children and other children, and that we're all in this together. That assumption can no longer be assumed.

KASTE: Public health officials say this vaccine-optional attitude is dangerous - not only to the unvaccinated kids but also to people who have weak immune systems or can't be vaccinated for medical reasons. Vaccine-preventable diseases are on the rise. Washington and California have seen outbreaks of whooping cough.

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KASTE: This outreach video by Group Health shows a small boy doubled over, gasping for breath.

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UNIDENTIFIED WOMAN: They have a spasm, and they can't stop. They cough, cough, cough; turn blue. And it can go on and on and on and on.

KASTE: Some vaccine hesitancy is blamed on the 1998 British study that famously, and fraudulently, linked vaccines to autism. But part of the problem may also be the ease with which some states, like Washington, have granted vaccine exemptions. When faced with a daunting immunization schedule, it's understandable that parents might just go for the exemption and be done with it.

So Washington state has now changed its law. This school year, parents requesting exemptions will have to get a note from a doctor, a doctor like David Grossman.

GROSSMAN: And I think the trick is really, to listen.

KASTE: So Grossman is researching how doctors should best handle parents and their vaccine fears. His study is partly funded by the Gates Foundation, which usually focuses on Third World immunization. But it turns out that even in First World Seattle, vaccination efforts require a degree of cultural sensitivity; in this case, for the local culture of self-confident parents with Internet access.

GROSSMAN: I think one of the most important reasons to listen is for parents - felt like they've been heard.

KASTE: Washington's schools are still processing this year's records. Once the numbers are crunched, public-health officials will know whether those doctors' office chats have had an effect.

Martin Kaste, NPR News, Seattle.

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