A Shot in the Dark
It has been a rite of passage for more than a generation of American children:
That (generally dreaded) doctor’s visit for the “shots” meant to protect kids against
such once-common scourges as measles, whooping cough and chickenpox. But now
some parents and healthcare professionals—alarmed by the incidence of autism
and other disorders that they feel have been triggered by vaccines—are resisting
the mass-inoculation movement that has undergirded public health for decades.
Here, Energy Times presents both sides of the story.
From January, 2008
Whenever you see a gaggle of little ones heading into kindergarten for the first time, it’s likely that nine out of every ten have had their “shots”—the vaccines that have helped make epidemics of such diseases as measles almost as rare as jacks and jump ropes in this video-game age. But childhood vaccination is not without controversy, as demonstrated by a handful of cases currently before the federal court system: In each case, parents have claimed that their child developed autism—a developmental disorder marked by socialization difficulties and compulsively repetitious behaviors—after receiving vaccinations during infancy. Most of them blame thimerosal, a mercury-based preservative that has since been removed from most vaccines, even though the mainstream scientific community has found no link between thimerosal and autism.
These cases, referred to as the Omnibus Autism Proceeding, are being heard by a part of the US Court of Federal Claims that deals with the National Vaccine Injury Compensation Program. Under this system, which bypasses the lawsuit process, cases are argued before special masters, judges who then decide whether a plaintiff who claims to have been harmed by vaccination deserves compensation from a government-administered fund.
While nearly 900 plaintiffs claiming vaccine-related injuries other than autism have received settlements over the past 19 years, autism claims are by far the most numerous: The cases now before the court, in which briefs are still being filed, are just the vanguard of roughly 5,000 similar cases that have been brought by parents of autistic children. And behind the dry legal paperwork lie the stories of kids—and families—who have endured years of suffering.
No one wants to see any child suffer. But many doctors argue that mass vaccination is one of public health’s biggest success stories. Other people believe that the routine administration of vaccines is not without dangers of its own, particularly in children who are genetically susceptible to poor vaccination reactions. We’ll present the arguments made by both sides; first let’s look at how vaccines developed.
The Drive Towards Universal Vaccination
Epidemics have threatened humankind since the dawn of time; eventually some people learned how to use mild cases of a disease to prevent more severe ones. It is believed that inoculation, in which weakly infectious material is introduced into a living organism to stimulate an immune response, was first practiced in either Asia or China thousands of years ago as a defense against smallpox, a highly contagious infection of the skin and other organs that often permanently disfigured those victims it didn’t kill. In 1796 English doctor Edward Jenner, building on the then-common knowledge that milkmaids often got a mild disease called cowpox but were generally spared from smallpox, inoculated a small boy with the former and then exposed him to the latter; the boy remained healthy. Jenner called the process vaccination (vacca means “cow” in Latin).
Over time a two-pronged public health effort developed. One was a drive to improve sanitation through large-scale sewer and water management systems, and to encourage such advancements in personal hygiene as regular hand-washing. The other was an effort to first isolate the bacteria that caused various epidemic illnesses and then create vaccines to combat them. This effort intensified through the 20th century when scientists discovered viruses, bits of protein-wrapped genetic tissue that can also cause disease.
During World War II the US military tried to avoid the illness-related deaths it experienced in World War I by making vaccination mandatory for all military personnel. That roll-up-your-sleeve mentality carried through to the postwar period, culminating in development of the polio vaccine in 1955. At a time when polio-stricken children in leg braces and iron lungs were not an uncommon sight, mass vaccination was seen as the gateway to a future free of infectious disease. Today vaccines may contain killed microbes, live microbes that have been made less likely to cause disease or inactivated microbe toxins; some of the newer vaccines contain only microbe fragments or use other sophisticated microbe-manipulation techniques.
The Centers for Disease Control and Prevention (CDC) recommend that vaccinations (which are given in multi-dose series) be started by the time a child is a year old; a number of them begin at six weeks:
• Hepatitis A and B
• DTaP (diphtheria, tetanus, attenuated pertussis)
• Hib (Haemophilus influenzae type b)
• PCV (pneumococcal polysaccharide vaccine)
• IPV (inactivated poliovirus)
• MMR (measles, mumps, rubella)
• Varicella (chickenpox)
In addition, the CDC recommends a diphtheria, tetanus and pertussis booster for 11- and 12-year-olds, along with shots to protect against meningitis (PPV vaccine) and, in girls, human papillomavirus (HPV), the main cause of cervical cancer.
US vaccination rates are at historically high levels—but that could change. Gaps in private insurance coverage are leaving an estimated 15% of all children under-insured for vaccines, according to a recent article in the Journal of the American Medical Association, and protecting preteen girls against HPV, which is transmitted sexually, has triggered an ethical and moral debate.
However, the autism cases currently before the federal claims court exemplify the biggest challenge to vaccination-as-usual: Parents, along with some health practitioners, who are concerned about the side effects of giving vaccines to infants automatically on a mass scale.
Mass Vaccination: An Unwarranted Hazard
Opposition to vaccines is nothing new: An anti-vaccination society sprang up in Boston only two years after Jenner’s first smallpox experiment. But many of today’s concerned parents are—thanks in large part to the Internet—better educated, better connected with each other and more vocal than ever.
Barbara Loe Fisher of Virginia is one of those parents; she is the co-founder of the
National Vaccine Information Center (NVIC) and writes extensively on the subject (www.vaccineawakening.blogspot.com). She says that NVIC doesn’t tell people not to vaccinate. But “all consumers should have the right to full information about the risks and benefits,” Fisher says, “and to make a voluntary informed choice to take the risk.”
One of the problems, as Fisher and others see it, is the fact that children are now given so many doses of vaccine so early in life: “We’ve seen a doubling of learning disabilities, ADHD and asthma [and] a tripling of diabetes [type 1, formerly known as juvenile diabetes].” While no responsible individual would claim that vaccination is solely responsible for these disease increases, many believe that such a heavy vaccination schedule stresses a child’s developing immune system, especially in children who are genetically prone to bad vaccine reactions. What’s more, the increase in the number of vaccines given translates into an increase in the number of “genetically vulnerable” kids being vaccinated. The result? “More and more people suffering from brain and immune system dysfunction,” says Fisher.
Researchers are only starting to scratch the surface of the genetic susceptibility issue. For instance, one study found that some children carry a mutation of a sodium channel gene that could cause a brain disorder called severe myoclonic epilepsy of infancy (SMEI), which the researchers thought could be mistaken for vaccine-triggered brain damage (Lancet Neurology 6/06).
Autism is, in many ways, the poster disease for people worried about mass vaccination; in
a number of cases, parents claim that their children were happy, healthy and progressing normally—until they were vaccinated, when all the problems started. Marvin Boris, MD, is a pediatrician/immunologist in Woodbury, New York, who treats a lot of autistic children. “Autism, to me, is caused by environmental factors in children who are genetically susceptible,” he says. “We don’t know if this population can handle attenuated (low-virulence) live viruses. A lot of physicians have isolated that live virus from the GI tracts of autistic kids; now whether that has a relation to their autism, that’s something that has to be evaluated.” And thimerosal, the mercury-based preservative, could pose problems of its own. “Many autistic kids don’t have the ability to break down and secrete mercury, and this can be a problem,” says Boris. Thimerosal has been out of most vaccines since 2002; Boris hopes that means less autism in the future, but adds, “These children are susceptible to a huge variety of environmental toxins.”
Boris is not a vaccine enemy: “You look at all the diseases vaccines have helped and it’s impressive.” The problem, as he sees it, is one of acceptable risk. “If you have an autistic child your chances of having another autistic child are high,” he explains. “The question is, should or should you not vaccinate these children?”
In 2005 Dan Olmsted, reporting for UPI, went to look for autism among the Amish in Lancaster County, who choose to live in self-reliant enclaves separate from the modern world and often refrain from vaccinating their children. Olmsted claimed to have found only three cases of autism among the Amish—and one of those cases in an adopted child—when statistically there should have been well over 100 people with various degrees of autism. (The Amish have, however, experienced several outbreaks of infectious disease, including Haemophilus, pertussis and polio.)
The religious exemption that allows the Amish to avoid vaccination is available in all states but Mississippi and West Virginia; 17 states also allow a philosophical or conscientious exemption. In addition, all 50 states allow a medical exemption as verified by either a conventional MD or a DO (osteopathic doctor). But Fisher says that it is now “almost impossible to get a medical exemption” because doctors who give such exemptions are “often questioned by state health authorities.” She believes that there will be “a push to rewrite state laws so that every time the CDC recommends a vaccine for universal use it is automatically added to the state mandated lists,” the lists of vaccines that children must have to be enrolled in all public and most private schools.
Both Fisher and Boris call for more rigorous safety testing of vaccines before they hit the market.
“You look at the clinical trials the companies put forth to prove that vaccines are safe and the methodologies are shockingly flawed and inadequate,” says Fisher. She cites the case of Prevnar, a vaccine against pneumococcal bacteria, as someone who served for years as
a consumer member of a committee that examines vaccine research provided by the manufacturers: “In the clinical trial they compared Prevnar…to another experimental vaccine and they used each as the other’s control. And then when there were more seizures and high fevers in the pneumococcal group, they said it didn’t matter; that vaccine was licensed.” Boris adds, “I think the vaccines should have been evaluated for a much longer period of time to see if there’s any potential effects before they are released.”
Still, Fisher is hopeful that change is in the wind. “People are moving toward a more natural, less invasive lifestyle,” she notes. “They are questioning, ‘Why is my child getting 10 vaccinations on one day?’ I think you will see this becoming one of the biggest controversies in medicine.”
Mass Vaccination: A Public Health Necessity
For many physicians, the only controversy about vaccination is why anyone would refuse it for their children. Robert Frenck, MD, professor of pediatrics at Cincinnati Children’s Hospital and member of the American Academy of Pediatrics (AAP) committee on infectious diseases, is old enough to remember seeing children in iron lungs. “When the polio vaccine came out there was no one who even considered refusing to get it because you could see the horrible results of the disease,” he says. Now people don’t see the results of the disease; they are now focusing more on the risk (of vaccines) than the benefit.”
Doctors also realize how helpless autism can lead parents to feel. “I think that if you’ve ever had a child with autism you realize what a curse this is—and it lasts for a lifetime,” says Samuel Katz, MD, former pediatrics department chair at the Duke University School of Medicine and long-time vaccine researcher. “I think the parents have been looking for a villain to blame, but the autism/ vaccine link has been disproved over and over and over again.”
So why was thimerosal taken out of vaccines? “There were four different agencies, all of which listed different levels of mercury that they felt were to be avoided; one of the four could have been exceeded by the ethylmercury in vaccines in the first six months of life,” Katz explains. “We felt that, strictly as a precaution, it should be removed. This was misinterpreted as, ‘Oh, this means thimerosal must be causing problems.’ Even though thimerosal has been removed, autism has continued to increase.”
The idea that there’s no association between thimerosal and autism simply cannot be proved, according to Frenck. “From a mathematical standpoint, you can’t prove a negative,” he says. “There’s a big difference between association and causation: Association just means two things happen at the same time, causation means that one thing causes the other.” Some researchers attribute rising autism rates to a widening definition of how the disorder is defined and to parents and doctors being aware of the signs.
What many doctors fear is a disruption of herd immunity, in which unimmunized people indirectly benefit from immunization because the more people who get the shots, the lower the general risk of disease transmission. “We’ve already seen evidence that when there’s disruption in vaccine usage that there’s a disease outbreak,” says Frenck. “The best example is in Nigeria, where there was a polio outbreak and hundreds of people got it in a year.” And nowadays it’s very easy for infections to travel: “People can get on a plane and be anywhere in the world in less than a day.”
Conventional medicine does acknowledge that vaccines are not without risk. “No one sensible can say that vaccines are 100% safe,” says Katz. “There’s no doubt that there are children who are probably going to have unusual responses to vaccines. I think we need to search for those answers and predict in advance that child X might have an unusual response.” He believes this should be a governmental effort made through the National Institutes of Health.
Frenck points out that while vaccines may have side effects, so do the diseases they prevent. “Every year in the 1980s we used to see cases of Haemophilus influenzae—meningitis, pneumonia, swelling in the throat—it was a horrible infection. People were in intensive care,” he says. “Now we have to show residents cases of meningitis because they just don’t see it anymore.
And the only thing that changed in this country was the use of the vaccine.” Today’s vaccines are also safer than those of previous years. “The vaccines we give now, even though we give more of them, are more purified,” says Marc Grella, MD, of the Pediatric Group Practice at Massachusetts General Hospital in Boston. “In the DPT combination, for example, the pertussis vaccine has a lot less bacterial material in it than it used to.”
Katz wants to see people discuss this issue with their pediatricians—and that doctors should respect their patients’ concerns. “There are some physicians who say, ‘You can’t come to my practice anymore,’” he says. “I would say that’s wrong; I say you have work with parents.” Katz points to his own family, in which all eight of his children and all 15 grandchildren have been fully vaccinated. But he has “nieces and nephews who have never been vaccinated because their mother doesn’t believe in them. I don’t beat on them, but when they go to places like Tanzania, I do explain what they can be exposed to.”
The passion with which both sides argue their cases makes it clear that vaccination will be a contentious issue for some time to come, which doesn’t make things any easier if you find yourself facing this important decision. Our best hope lies in impartial, thorough research on vaccine safety—for every child’s sake.