As the 2014 measles outbreak wound down, I quoted Albert Camus: “He knew what those jubilant crowds did not know but could have learned from books: that the plague bacillus never dies or disappears for good … and perhaps the day would come when, for the bane and the enlightening of men, it would rouse up its rats again and send them forth to die in a happy city.”

We are on the verge of something more ominous. The tipping point for measles again becoming endemic in North America is approaching, requiring expanded efforts against anti-vaccine ignorance. If we are not prepared to sacrifice time and money – lost clientele and friends – who are we?

Gandhi used the Sanskrit word “satyagraha,” meaning “clinging to truth,” in reference to his campaigns in South Africa and India. Satyagraha is the inner strength or “soul force” required for nonviolent acts. He never defined nonviolence as passive resistance because he saw nothing passive about it, believing that a dedicated adherence to nonviolent resistance by taking action to represent truth and working for a just cause would reach the heart of the oppressor. Satyagraha is a positive, spiritually based form of resistance that starts in the heart of the resister and inevitably produces creative action. It means both the principle of “clinging to truth,” which is necessary for nonviolence work, and direct action as in Gandhi’s campaigns as well as Dr. King’s in this country.

Education and negotiation have had limited success. Who knows if other methods will have value when dealing with “true believers” and their opportunistic political supporters? Conscience demands we try.

As I have done, all physicians could not sign exemption forms. We can consider a national day of office closure (except for true emergencies) to reflect on our values. Extra-medical consultation for travel can be denied in the absence of basic immunizations. Schools can deny participation and attendance at extracurricular activities for those inadequately immunized. Businesses of anti-immunizers can be boycotted, and we must encourage our pro-immunizing families to do the same, as engaging enlightened parents expands and fully legitimizes the struggle.

I hope it will not come to this: the ultimate act is to refuse any care to unimmunized children.

Mark Fishaut, MD FAAP

Friday Harbor