There is nothing that makes you more aware of the fragility of existence than seeing your own baby's life drain away in front of your eyes.

Dr Michelle Conning will never forget that feeling. Of seeing tubes coming out of her 14-month-old as he lay in Auckland's Starship hospital, struck down with an illness that could have been eradicated years ago.

"I thought he was going to die," the Titirangi GP says now. "That was the worst week of my life, and if I wasn't convinced then, I was after that."

Danny, now 12, recovered from the measles he caught before he was old enough to be vaccinated. But it's left an indelible mark on the Conning family, who still remember how close they got to losing a child. At primary school recently, Dr Conning's other son, Zach, 9, chose to do his speech on the importance of immunisation.

As a GP at the local medical centre, it's Dr Conning's job to speak to families about immunising their children. But it's not always an easy one.

Titirangi, in West Auckland, is one of the pockets of the country where some parents are refusing to vaccinate their children.

It's also one of the richest areas. Yet immunisation rates have long been stubbornly immovable, with Ministry of Health data showing 69 per cent of six-month-olds were immunised in 2018. 

In Ellerslie, another high-income suburb half an hour away, 92 per cent of parents had their children fully immunised at the same age.

The national health targets, discontinued under the current Government, were that 95 per cent of all eight-month-olds were fully immunised.

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"Our analysis suggests vaccine hesitancy is increasing in the Waitemata region and is a significant contributory factor in the failure to reach that target," a Waitematā District Health Board meeting was told in late 2017, after a report highlighted clusters of parents who were declining vaccinations.

Titirangi, a leafy suburb on Auckland's fringes, has long been known as a bohemian haven for artists and free-thinkers. This aligns with the belief system of many anti-vaccination proponents, who tend to have a lack of trust in authorities and view those who get their kids immunised as sheep. 

Rates for Māori in the area have been dropping quicker than for Pākehā. These families were often poorer and struggled to get to the doctor, while also being influenced by misinformation, the DHB report said. 

And more people were choosing to delay vaccinations until the child was older, due to a fear of what was in them.

The current measles outbreak in Auckland is the worst this country has seen in more than two decades. At the start of this month, there were 963 confirmed cases nationwide since the beginning of 2019.

One of the first cases was a child in West Auckland. In the first two months of the outbreak around ten cases were confirmed a week, usually from West Auckland. 

"​The measles virus will 'find' unvaccinated populations and take hold," says Auckland Regional Public Health Service clinical director Dr Julia Peters. "The likelihood of a measles outbreak increases with vaccine hesitancy, outbreaks in other countries, and high levels of global travel. Measles is very infectious; one person with measles can infect 12 to 18 people if they are not immune."

Public health services have been in outbreak management mode, recalling young children to doctors, offering "catch-up" vaccinations to older people who might have missed doses, and bringing the age for the first MMR vaccine forward from 15 to 12 months.

Still, the rise in cases has been unrelenting, Peters says.

IT'S A TRICKY AREA

Research has shown when it comes to vaccination, trusting in authority is key. Parents who have been failed by the system historically, or who believe government is corrupt, are less likely to want to immunise. Those who get their information about vaccination from social media are also more likely to refuse.

Immunisation Advisory Centre director Dr Nikki Turner says the rise of what's known as "salutogenic parenting" – the more intensive parenting style common among this generation of parents, who feel it's their job to advocate for their child – has dented the incentive to vaccinate for the common good.

"Now the attitude is more 'I'm responsible for my child, not the community'."

A DHB-commissioned inquiry into how to influence attitudes found key concerns around hesitation were misconceptions about the safety of vaccines and "negative stories" floating around on Facebook and in mothers' coffee groups. The chance of the catching the disease was also thought to be low. "I'm 120 per cent sure my babies won't get anything," one Pākehā respondent said.

Among Māori, mistrust was more likely to be a factor. "Government in history hasn't really made good decisions, so why should we trust it's a good thing?" said a Māori mother.

Dr Conning says Titirangi is a "tricky area", with a group of parents who definitively refuse vaccinations.

"They believe vaccines are dangerous and shouldn't be given to their children. It's a difficult group, they won't change their minds. No amount of scientific evidence will do it - but they are generally well-educated people."

As a doctor, she has to evaluate how far to intervene. This can be frustrating, particularly when a parent's choices impact on other kids - like vulnerable children who can't be vaccinated as they're having chemotherapy for cancer or have immune system diseases, or whose parents struggle with access.

These are the children most at risk, and who need the protection of herd immunity.

"I've worked here a long time and I know my patients well, and I know when to leave it because you're going to ruin a relationship by going on about it. These are not bad parents – they love their children, and they really believe that they are doing the right thing."

When people ask if she vaccinates her kids she will sometimes tell them about Danny, not as a "sob story," but just so they know there's no doubt in her mind.

"My view is that people of our generation have mostly not experienced these diseases, so the reality of them is lost."

During measles epidemics, such as the current one, they see a rush of people come in to get vaccinated - including those who have previously declined, she says.

"Some people do change their minds, in the face of an outbreak."