Public health, family freedom clash at the pediatrics office
Should parents be able to choose whether or not to have their child vaccinated?

Ellen Rosner
Special to The Mirror

A new state mandate, set to go into effect in September 2008, will make New Jersey the first state in the nation to require flu vaccination for preschoolers and Meningococcal vaccination for sixth-graders. Critics of mandatory vaccination say there is a dearth of comprehensive, long-term scientific studies of the safety of vaccines. Vaccination proponents claim that immunizing children prevents disease epidemics, and for the public safety the individual should not be allowed to opt out.

A bill currently pending before the New Jersey Legislature (Assembly Bill 260 and Senate Bill 1071) would allow parents to opt out of mandatory vaccination programs by creating a conscientious exemption. At the present time N.J. law allows for exemption only on religious or medical grounds. Twenty other states currently allow a conscientious exemption.

This may be of particular concern to residents of New Jersey, a state which mandates 35 doses of 13 different vaccines for children and adolescents, more than any other state in the nation.

An organization has been established to support the bills: New Jersey Coalition for Vaccination Choice. [http://njvaccinationchoice.org]. This coalition also calls for Governor Corzine to repeal the four recently added mandated vaccines until unbiased, rigorous scientific studies demonstrate a case for mandatory immunizations.

Are these vaccines necessary?

Are they safe?

Are they effective?

The public health issue

Proponents claim that vaccines prevent death from illness. The World Health Organization [WHO] estimates that two to three million deaths a year worldwide are prevented by immunization. The Centers for Disease Control [CDC] says that the more members of a community are vaccinated, the greater the protection from vaccine-preventable diseases.

The CDC goes on to state that, although any medical procedure carries some risk, vaccines are safe and effective: they are tested before they are marketed, and once distributed to the public, they continue to be monitored for safety and efficacy.

In sum, the CDC hails the reduction and/or eradication of infectious disease by vaccination as “perhaps the greatest success story in the history of public health.”

The case against vaccination

Anti-vaccination websites list adverse reactions to injections -- ranging from runny nose to autism to death. The most hotly debated issue regarding reactions is whether or not there is a causal relation between thirmerosal, a preservative until recently used in most vaccines, and autism. Currently there are 4900 cases before the U.S. Court of Claims alleging a link between vaccines and autism and other neurological problems. The first of these test cases was heard last year, but no decision has yet been reached. In May of this year, another case will be heard.

Although manufacturers of vaccines claim a 95 to 99% rate of efficacy for the various vaccines, critics of vaccination dispute this. They point, for example, to outbreaks of whooping cough among vaccinated persons in Westchester County in 2003. Pediatricians emphasize that among the original stricken were 4 people who had not been vaccinated; still, the majority of the people who caught the disease had been immunized.

Research bolsters both positions

Critics of vaccination like Barbara Loe Fisher point to studies by the Institute of Medicine which found “compelling scientific evidence” that the Measles, Mumps, Rubella [MMR] vaccine can cause arthritis and anaphylaxis that can end in death. On the other hand, a 2004 study by the Institute of Medicine found “no credible evidence that vaccines containing thimerosal caused autism.” Proponents of vaccination say that adverse reactions result from differences in the way individual immune systems react to a vaccine, not from any inherent flaw in the vaccine.

Critics contend that the number of vaccines given to a newborn or a child can weaken their immune system. Pro-vaccination groups such as the National Network for Immunization Information [www.immunizationinfo.org] and the American Academy of Pediatrics [www.aap.org] say that, to the contrary, vaccines strengthen, not weaken, the child’s immune system.

Responding to the claim that vaccinations have eradicated many infectious diseases, some critics cite improvements in living conditions -- improved hygiene and sanitation, and better nutrition -- as causing the decline in disease.

A question of choice

The question of vaccination choice has even entered into the U.S. presidential campaign. Nineteen anti-vaccination groups have urged all the presidential candidates to pledge to:

(1) remove mercury from all vaccines, by Jan 1. 2010; and (2) freeze the list of recommended childhood vaccinations, until the current vaccine schedule can be proven safe.

Barbara Loe Fisher says that until the safety of vaccines is assured for all children, vaccinations should not be mandatory. She calls for the federal government to identify children who are genetically and biologically vulnerable to the adverse reactions of immunizing. Until such screening is done, she says it is immoral to write off some children in the name of the “greater good”.

Whenever fundamental assumptions are challenged the debate is hot, and not always rational. Dr. Sherri Tenpenny (a critic of immunization) says that “challenging the validity of vaccines challenges long-held foundational beliefs.” Perhaps any individual’s stance in this debate on freedom and responsibility has more to do with faith than with science. Those who are skeptical of the medical profession may be more receptive to the anti-vaccination arguments; while a person with greater faith in the medical establishment probably accepts the need for mandatory vaccinations.