Ohio's low immunization rates and recent disease outbreaks have thrust the state into the middle of a national debate.

The morning of April 20, Columbus Public Health was in crisis mode. A local hospital had just alerted the city department that one of their patients had been diagnosed with bacterial meningitis. Because the disease is highly infectious, an investigation was launched to find out whether anyone else may have been exposed.

"We have a very sad situation of a woman who's probably going to die from a vaccine-preventable disease," says Columbus Health Commissioner Dr. Teresa Long.

These situations come up several times a year, says Jose Rodriguez, Columbus Public Health spokesman. The tragedy of lives lost fuels the department's mission to improve Ohio's immunization rates: According to the Centers for Disease Control and Prevention, Ohio (along with West Virginia and Colorado) has the lowest measles, mumps and rubella immunization rate among toddlers in the country.

Along with the state's immunization rate, recent disease outbreaks have launched Ohio into the national spotlight in the midst of a polarizing vaccination debate. Last year, a mumps outbreak began at Ohio State University and spread through Central Ohio, infecting nearly 500 people. And a measles outbreak in Ohio's Amish Country that hit in March 2014 preceded the measles outbreak that was traced back to Disneyland, sparking a national debate about the merits of vaccines and immunization laws. On one side are "anti-vaxxers"-people who oppose vaccines for various reasons, most notably because some believe they lead to other health issues-while popular opinion, backed by several scientific studies, is that vaccines are safe and effective in preventing disease. Still others remain unvaccinated because of lack of awareness or resources.

Columbus Public Health works to improve Ohio's immunization rates through policy change, focusing on school requirements. Most recently, the department advocated for two bills that have both passed the state legislature: a new immunization requirement for children in licensed daycares and the addition of the meningitis vaccine to the list of required vaccines for K-12 students. "Ohio has some of the poorest childhood immunization rates in the country, and it is that that's made us in Columbus, Franklin County and, really, Central Ohio vulnerable," Long says. "And that's why we've seen the measles and mumps outbreaks in the last year."

The recent outbreaks led to Ohio State's decision to require all new students who are taking at least one class on the Columbus campus or who are new to university housing to submit vaccination records, starting this fall. By the time they enroll in classes for the spring semester, students must submit proof of vaccination against tetanus, diphtheria, pertussis, hepatitis B, measles, mumps, rubella, chicken pox and polio, and new students living on campus must also be vaccinated against meningitis.

The new requirements don't apply to returning students. "It's a gradual rollout," says Dr. Gladys Gibbs, director of Student Health Services. "This will impact 7,000 to 12,000 students, and then by the time four years has gone by, the entire student body. So really it was about the sheer volume, and we want to make sure we do it right.

"We want to try to keep our students in the best health in order to achieve success at the university," Gibbs continues. "I think this is an important step."

Says Long: "We looked very closely at policies in Central Ohio; very few of those universities had vaccination policies. Ohio State now has a smart policy for all of their incoming students. We're hoping that becomes a platform for all of the other colleges in our state."

Like Ohio's K-12 school vaccination requirements, Ohio State's new policy includes a medical exemption as well as an exemption "based upon good cause, religious beliefs, philosophical or moral convictions." Gibbs says the university doesn't expect a large number of exemptions. "We anticipate that because the state of Ohio has a K-12 requirement, that this won't impact most students," she says, adding the vast majority are in-state students.

Kent Schwirian, a professor at Ohio State who studies the sociology of contagious diseases, says vaccine exemptions have a long history. "In the late 1770s and 1800s, there was a big fuss over vaccinations," he says. "And way back then-now this was in the context of smallpox-a lot of people thought it was immoral to be using an injection of some kind of animal product into your body. So in the late 1800s, in the U.S. and England, a lot of states and cities passed laws for mandatory vaccinations. There was a lot of opposition to it, and the Supreme Court said states and cities do have the right to require their citizens to get vaccinated but they need to make allowances to people."

Schwirian and Gustavo Mesch, a doctoral graduate of Ohio State who is now a professor of sociology and dean of the faculty of social sciences at the University of Haifa in Israel, recently conducted a study that provides some insight into the debate. The two analyzed Pew Research Center data from 2009 on Americans' opinion of the swine flu vaccine. "This is part of an ongoing project, in which we're looking at sociological and political aspects of contagious diseases," Schwirian says. "Because of the scale of [swine flu] worldwide, we began studying that. But before that, we had been researching SARS. And we are currently following the Ebola breakout."

The study revealed Democrats were much more willing to take the swine flu vaccine than Republicans and Independents. "The bottom line is it's the trust in the government," he says. "In other words, the Democrats are more willing to trust the government to pull off a good program to handle the flu outbreak." They also found people who follow the news were almost four times more likely to get the vaccine than those who don't.

While the debate continues, Columbus Public Health is focused on raising awareness here in Central Ohio. "It's really a shared responsibly for all of us to protect ourselves and our families and each other," Long says. "No vaccine is 100 percent effective. So we in Central Ohio are only as safe as our weakest link. When we have an individual who's not vaccinated, that puts all of us at risk."