Reuters / Mike Segar | A woman opposed to childhood vaccinations wears a "No Vax" sign on her backpack as she takes part in a demonstration in Rockland County, New York on March 28, 2019.

In Rockland County, New York, a state of emergency has been declared over an outbreak of measles - a disease officially eradicated in the US in 2000, but whose re-emergence has triggered a backlash of blame and recriminations.

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Correspondent in New York

"All the customers have been coming in and talking about it," says the server at a half-full cafe in the small town of West Nyack in Rockland County, New York. "I don't have kids but all those guys in the kitchen do and we've been talking about it a lot, it's really scary, it can spread like wildfire."

Measles is the talk of the town in this leafy, otherwise quiet, suburban county of just under 330,000 people a few miles north of New York City.

Since October last year, at least 158 people in Rockland have fallen victim to the disease, which can in rare cases prove fatal. So far, no one has died.

But with efforts to contain the highly infectious disease proving futile, authorities in Rockland have resorted to desperate measures with County Executive Ed Day taking the extraordinary step of declaring a state of emergency on March 26.

“We must not allow this outbreak to continue indefinitely or worsen again,” Day said. “We will not sit idly by while children in our community are at risk.”

The 30-day order barred minors who are not vaccinated against measles from public places, including schools, restaurants, places of worship and shopping malls. Overnight, Rockland became ground zero in a nationwide and even global debate that, in this small corner of America, has outraged parents, divided religious communities and sparked fear and recriminations on all sides.

An eradicated disease re-emerges

Like smallpox and polio before it, measles is a disease that, in most of the Western world including the US, had been largely consigned to history. The US declared it eliminated in large part 19 years ago, "thanks to a highly effective vaccination program in the United States", in the words of the Centers for Disease Control and Prevention (CDC).

But in the years since, a growing anti-vaccination movement that started with fears over links between the MMR (measles, mumps and rubella) vaccine and autism has been blamed for a resurgence in measles outbreaks not just in the US but in dozens of countries around the globe.

In 2018, some 98 countries reported an increase in measles cases over the previous years, according to figures published by UNICEF earlier this year, including some rich nations with robust healthcare systems such as France.

In the US, the number of measles cases in 2019 has surpassed the total for the whole of the previous year, with the CDC confirming 387 cases across 15 states since January 1.

Links between the MMR vaccine and autism have been widely rejected by mainstream medical science. Nevertheless, parents refusing to get their children vaccinated due to religious and philosophical objections, as well as fears over serious allergic reactions – something the CDC describes as "extremely rare" – persist.

"There's a lot of psychology involved," says Sean O'Leary MD, associate professor, pediatrics-infectious diseases, at the University of Colorado School of Medicine.

"Once a fear is introduced into someone's mind, it's very difficult to get that fear out of their mind. So for a lot of these parents they have a greater fear of these rare side effects than they do of the diseases themselves."

The World Health Organization has labelled "vaccine hesitancy" among the top 10 most pressing global health threats for 2019.

It is a global issue, but one that in Rockland County is being played out on a very vocal stage.

A community divided

At the sprawling Jewish Community Campus in West Nyack, an Israeli flag flutters in the wind alongside the stars and stripes. In his office within the complex Gary Siepser, CEO of the Jewish Federation and Foundation of Rockland County, an otherwise smiling and affable man, seems flustered.

Following the emergency declaration in the county, Siepser's organisation published a statement on its Facebook page supporting the measures and urging members of the Jewish community to get vaccinated.

The backlash has been overwhelming.

The Jewish Community Campus in West Nyack, Rockland County, New York. Sam Ball / FRANCE 24

"We had 300-plus comments overnight, which is huge for us. There was this screaming, vicious, anti-vax ... 'Scream' is the only word I can think of to describe it. I've never seen anything like it."

Rockland County is home to one of the largest Orthodox Jewish communities in the country and it is within this community, where resistance to vaccination is reportedly highest, that authorities say most of the recent measles cases have been concentrated. It is also here that Rockland authorities have targeted their vaccination drive, seeking the support of local rabbis and setting up clinics in Orthodox Jewish areas.

But the focus on the Jewish community has sown division both within the Orthodox population – those who support vaccination and those who object often on religious grounds – and within the county itself.

Along with general anti-vaccination sentiment, responses to the Jewish Federation and Foundation's Facebook post have included those accusing the organisation of betraying the Jewish community and anti-Semitic rhetoric that Siepser fears will only get worse.

"We've already seen expressions of bigotry. I've had reports of visibly Orthodox Jewish people going into the mall or grocery store and getting comments like, 'Leave, you're spreading disease'," he says.

Deliberately targeted

A similar outbreak of measles recently struck another Orthodox Jewish community in the Williamsburg neighbourhood of Brooklyn. But as both Siepser and O'Leary point out, other outbreaks across the US have affected communities of varying demographics, including among a mostly Somali-American community in Minnesota in 2017, California in 2014 and an ongoing outbreak in the religiously diverse Clark County of Washington.

Siepser is adamant that there is nothing in rabbinical literature to support not getting children vaccinated while O'Leary says there's no specific reason for Orthodox Jews to be particularly vulnerable to what he describes as anti-vaccination "misinformation".

But while it is not unusual for outbreaks to be clustered within a particular community, in the cases of Rockland and the Williamsburg outbreak there's evidence to suggest the Orthodox Jewish community has been specifically targeted by anti-vaccination groups, says O'Leary.

He highlights an anti-vaccination pamphlet published by an organisation known as PEACH (Parents Educating and Advocating for Children's Health) that has been widely circulated in both areas.

"They tailored it for this Orthodox Jewish community, to play on the scripture in the Torah to convince them both with their usual anti-vaccine arguments – based on pseudo-science, and also based on the Torah."

A school bus passes in the Orthodox Jewish community of Monsey, Rockland County, New York. Sam Ball / FRANCE 24

"In a very close-knit community, this kind of misinformation then gets spread by word of mouth," O'Leary explains.

Siepser says he is also aware of the PEACH pamphlet and, although he has not seen it himself, says he's sure it's been spread around the Rockland community, particularly on social media.

'No right to intervene'

In the streets of Monsey, an almost entirely Orthodox Jewish hamlet that forms part of the town of Ramapo, men and women in traditional Hasidic dress shop at the supermarket, take their children to school and chat with friends on street corners.

"It's a very small minority who aren't getting vaccinated, maybe five to ten families," says Sarah, on her way home from her job at a local supermarket. "I think it's been blown completely out of proportion," she says of the focus placed on the Orthodox Jewish population.

Nevertheless, she supports the local government's emergency declaration.

"Vaccinations are absolutely a good thing. I've got 13 children and 24 grandchildren and they've all been vaccinated.

Not all agree.

"I think (County Executive) Day stinks, he doesn't do anything good," says another woman who declines to give her name. Even if her children have all been vaccinated, she argues that "the government has absolutely no right to intervene in people's lives this way, they're always telling us what we can and can't do".

Others have deferred to higher authority when it has come to the rights and wrongs of getting vaccinated.

Children play in the street in Monsey, Rockland County, New York. Sam Ball / FRANCE 24

"My four kids have all had their measles shots," says a man who also asks not to be identified by name as he loads groceries into his car. "I asked my rabbi and he said it was OK."

For Siepser the irony is that a lot of the most fervent anti-vaccine rhetoric on social media in the wake of the emergency declaration has come from outside the Jewish community and often, he suspects, from people outside Rockland County altogether.

Death threats

Two days after the declaration, a small group of protesters gathered at the Palisades Center shopping mall in West Nyack.

Some wore T-shirts with slogans such as "#VaxWoke" and "Research Before Vaccinating".

The protest was organised by a Facebook group named Pro-Informed Consent. The creator of the group is a 35-year-old woman from outside Albany, New York, who when contacted by FRANCE 24 gave her name only as Kristen. She wants to conceal her identity, she says, because another protester received death threats online after she was named in the media.

Kristen became involved in the anti-vaccination movement after one of her four children suffered a severe allergic reaction to the MMR jab. Three of her children had already been vaccinated but the youngest "has not been and never will be", she vows.

When she heard the news about Rockland, she got in touch with like-minded parents and helped coordinate a response, which resulted in the protest at the Palisades Center.

"I never called it a rally. We weren't out there trying to 'storm the beaches' or something like that – just a group of mostly moms concerned about government overreach.

But though she may profoundly disagree with Siepser and others who support the emergency declaration, she too has felt the blowback from her decision to take a side in this debate.

She says she has received threatening and abusive messages on social media, including one saying that "vaccine-injured" children – those who have suffered adverse reaction to vaccines such as Kristen's daughter – "deserve to die".

"It's mass hysteria," she says. But for her, the blame lies squarely with Ed Day and the Rockland authorities.

"Ed Day has blown this out of all proportion by declaring a state of an emergency. When you step back it's a really terrifying state to be in when you're told what you can't do – when you can't take your kids to the grocery store to get your groceries."

O'Leary says while he sympathises with parents like Kristen who he says have been "fed misinformation", and in most cases are just trying to do what is best for their children, authorities in Rockland had little choice in taking drastic action.

"My understanding is that it was a last resort," he says. "I can understand their frustration that a lot of these people still weren't getting vaccinated and spreading disease – and let's be clear, this is a life-threatening disease."

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