VASHON ISLAND, Washington. – Sarah Day is a school nurse who deals with the issue of vaccine polarization on an idyllic Washington State island renowned for its rural beauty, counterculture lifestyle and low vaccination coverage.  Ever since she started living on Vashon Island more than 20 years ago, the nurse has been campaigning for children to fire their shots against a massive contingent of anti-vaccine parents in the close community of some 11,000 people Accessible by ferry Day said, a quiet 20-minute drive from Seattle.
And it might work now, thanks to a "perfect storm" of the changes that are happening on the island.
The school district of Vashon Island has seen a significant development increase in fully immunized children. The number of nursery school children who received the required state-mandated vaccines rose 31
"With the largest measles outbreak in 25 years, vaccine advocates are cheering on this apparent change that challenges Vashon's reputation as a hotbed of highly educated, anti-establishment parents who choose not to protect their children against preventable and potentially devastating diseases to vaccinate.  "We have been the flagships of the anti-vaccine or vaccine delay movement for so long," said Day.
It attributes rising numbers to increasingly visible pro-vaccine information, expanded access to images and media coverage of measles outbreaks in the Pacific Northwest and New York this year.
The island city, with its deep roots in organic farming, has long attracted those who want to escape the city's urban sprawl and others who are wary of putting chemicals into their bodies, be it in their food or in health care. Children run barefoot through untamed forests, and the families still grow fruit and vegetables without pesticides to consume in community homes.
Today, it also has a share of commuters, tourists and million dollar vacation homes with sweeping views of Mount Rainier and locals pushing for science that vaccines are safe.
Although the gains are remarkable, the Vashon School District still has one of the lowest vaccination rates in the US. It is well below the 95 percent target that a majority of schools achieve. Floating anywhere in the country, they are needed for herd immunity, which protects those who, for medical reasons or because they are too young, have not been vaccinated.
The majority of Vashon parents agree to some vaccines, especially the tetanus shot for their children playing outside on the wooded island. But many still stick to the official timetable of health officials' recommended shots. You can select some, but not all, and distribute them over a longer period of time.
Nicky Wilks, who grew up in Vashon and has three small children, said the change in attitudes meant that some pro-vaccine parents were excluded from rallies children who may not have their shots while teenagers who are not vaccinated, mocking openly.
"This is the worst scenario if we create physical barriers in our community," Wilks said.
He declined to say if his family is fully vaccinated, but he does not agree that dozens of shots are necessary from birth, though health authorities insist.
Gator Lanphear says he is "very judgmental" towards parents who do not vaccinate. He said that not only does he immunize his six-year-old twin daughters, but he also instils in them the importance of making their shots heroic.
"They understand that what they did benefits humanity. Yes, they got their ice cream for it, but they also kill polio, "said Lanphear.
The number of philosophical exceptions in Vashon has dropped dramatically, but overall, there are still 11.6 percent of students whose families do not choose to vaccinate. This is five times higher than the median nationwide.
Nonetheless, Vashon's progress can not be ignored, as it is unusual for immunization to so rapidly increase in a few short years if there is a deep-seated anti-vaccine vibe in the community. said William John Moss, a professor of epidemiology at Johns Hopkins University.
"It's a big climb, but they still have a long way to go," Moss said. "That's a lower vaccination rate than in many sub-Saharan Africa."
Day, the school nurse, has worked closely with the new Neighborcare Health clinics, the island's largest healthcare provider. Together, they aggressively remind families of when vaccinations are due and advise them on their concerns, whether based on scientific evidence or not.
"The message really comes through. I feel the tide is really spinning on the island, "said Day.
A two-year high school health center was particularly successful. The charitable clinic is partly funded by a grant from the county, which allows free funding for all low-income or uninsured students on the island. Today, about half of the 1,615 students in the school system are registered patients, and another 43 children who attend a private school or teach at home use the clinic.
Manager Stephanie Keller said the center has received an increase in calls from concerned parents like Washington State battles to stem a measles outbreak that affects at least 78 people, including seven reported near Vashon. According to the Centers for Disease Control, on May 10, 839 people in 23 states were infected with measles.
The outbreak prompted Jay Inslee to declare a state of emergency and to sign a law that eliminates personal or philosophical issues exceptions to the measles, mumps and rubella vaccine needed before attending a daycare or school. However, parents can still apply for a medical or religious exemption.
Some critics say the Vashon school system data are not representative of the population, as there are many families on the island that are disconnected from the power grid. Advocates of vaccines argue that this is an important benchmark, as the numbers from a previous island-wide survey were in line with public-sector data.
And there are other signs as well. The best services in the student health center are vaccinations, said Keller.
"That surprised us," said Keller. "They think Vashon is a hippie place where no one is vaccinating."