Public officials in Oregon and Washington have repeatedly, consistently reminded their constituents that the measles is preventable — all you need to do is get vaccinated.
"Holy smokes, this is basic science," Oregon Gov. Kate Brown said last week. "It absolutely is."
But some people can’t get vaccinated — either because their immune systems are compromised from other health problems or because they're underage and their parents won’t let them.
That makes the ongoing public health emergency especially difficult.
“Try to avoid crowded places. Make sure that you take hand sanitizer everywhere," said Shona Carter, a Vancouver, Washington, woman with leukemia. "Sometimes I still wear the mask, depending on where I’m going.”
Related: NW Lawmakers Consider Limiting Exemptions As Confirmed Measles Cases Top 50
Carter spent months in the hospital on chemotherapy last year as doctors killed off her white blood cells. They’re the ones that were cancerous — and they’re the ones that gave her body its immunity.
She received a bone marrow transplant from her sister, so her immune system essentially needs to be rebuilt from scratch.
“You’re a baby. You’re brand new," she said. "You have to get all of your vaccines redone. And some of them you can’t get done immediately because they’re like live, weakened vaccines.”
Her immune system isn’t strong enough to deal with those live vaccines, including the one for measles. So for now, she's following her doctor's orders and trying to avoid crowds.
“It makes me very nervous," she said.
"I had a rough year, and I’m getting better, and I can see the progress, and I don’t want any setbacks," she said. "And this is one of my fears, getting something like the measles, which could potentially kill me because I’m not strong enough to fight it off.”
There's another population at risk, through no fault of their own: Children whose parents have chosen not to have them vaccinated.
Nurse practitioner Nancy Casey runs the Multnomah County Student Health Center at Portland's Roosevelt High School.
About 95 percent of her students have their vaccinations. But Casey says she’s had several ask her about catching up on their vaccinations since starting at the school six years ago.
She remembers one 16-year-old in particular.
“The child said: 'You know my mom really doesn’t believe in vaccines, but I’m thinking that I want to start,'" Casey said. "And so we get into a conversation because a lot of what happens here is: ‘Well, why doesn't your parent want you to have vaccines?’ And: ‘Do they know that you’re here? And what would they say if they knew you were here?’”
Oregon law allows anyone 15 or older to consent to physical health care. So Casey can vaccinate most her of high schoolers without first informing their parent.
She tells students that if they want to start dealing with their own health care, they have to educate themselves.
"'Do you know what the illnesses are that we're preventing? Why do we want to prevent them? What are the things?'" she tells them. "So it's helping them be advocates … We do go over scenarios: 'What if your mom finds out because you tell them?' We're not going to send any information home, but what would it look like if you decided to tell your mom: 'Look, I went in for a measles shot?'"
In the case of that 16-year-old, Casey put her on a waiting list for a series of vaccines. Each time she became eligible for another shot, she’d come into the school health center.
Her parents never saw a bill. Instead, the costs were covered by either a state vaccination program or the ‘Oregon Health Plan.’
“We had this really nice rapport and trust," Casey said. "And by the end of her catching up to her immunization schedule, over like a year and a half period, she had told her mom. And her mom was not thrilled, but she respected it.”
Back in Vancouver, leukemia patient Shona Carter tears up at her current situation: stuck at home to stay safe from the measles.
She said she appreciates students and everyone else who gets vaccinated.
“You’re part of an entire community," she said. "And there are people who are elderly who have compromised immune systems that you are also helping to protect.”