Vaccinations: searching for the middle ground.

Each year millions of parents go to doctors' offices wondering if their decisions to vaccinate their children are right. This confusion over the past ten years has been heightened by the increasing polarity of pro-vaccination and anti-vaccination views. It appears that the fear of adverse effects from vaccination is matched only by the fear of infectious diseases from not vaccinating. There appears to be no middle ground.

Fuel has been added to the fire with recent changes in vaccination guidelines that modify the vaccine contents while promoting an ever-expanding number of required and suggested vaccines. While looking at the historical benefit of vaccination, this article will present an approach that seeks to empower parents in their decision-making to find the best answer for their children.

Interestingly, vaccination [from the Latin, vacca = cow] began in 1798 when Edward Jenner, an English surgeon, discovered that inoculating humans with material oozing from cows infected with cowpox could prevent smallpox. This is a good example of "like cures like," an early homeopathic treatment principle.

Homeopathic nosodes (substances derived from disease products, tissue samples, mucus, pus from discharges, or pure cultures of microorganisms) have been used to prevent disease since the early 19th century. Anecdotal evidence suggests that homeopathy may be effective on a short-term basis during epidemics. A Brazilian study showed a homeopathic nosode prevented 96% of children from developing meningitis during a 1974 epidemic, though treated children may have been from a healthier sub-group. This form of prevention does not convey long-term protection.

Protocols have been developed for long-term prevention with homeopathic nosodes given repeatedly. Homeopathic preparations have not been shown to raise antibody levels (as vaccinations do), thus the only way to measure the effectiveness of homeopathic prophylaxis is through clinical results. Parents need to understand that there are no studies to show that homeopathic prophylaxis provides lasting immunity from specific diseases.

Vaccination is an effective tool for protecting public health. During the Twentieth Century we eradicated smallpox worldwide and minimized the debilitating effects of polio. But public health data shows that incidence of many diseases such as diphtheria, pertussis (whooping cough), scarlet fever, and measles declined almost completely by 1945 ... before the implementation of the mass vaccination programs!

Parents have been raising questions about compulsory vaccination for more than a century. Recently, parental concerns have led to increased vigilance by public health officials in reviewing Vaccine Adverse Effect Reactions [VAER]. Examples include negative effects of the Diphtheria Pertussis Tetanus (DTP) vaccine, the presence of toxic levels of mercury in vaccines, and concerns about the relationship between the Measles Mumps/Rubella (MMR) vaccine and autism.

Public awareness of side effects, including brain injury, led to a decline in DTP vaccination rates during the 70's, particularly in England and Japan. The exact number of children injured by DTP will never be known. Japan's vaccination rate dropped from 80% to 10%, resulting in an epidemic of whooping cough, with 13,000 cases and 41 deaths. Thus, we see how decreased vaccination can lead to increased disease and death. Conversely, the pressures brought to hear by parents of children injured by DTP led to the creation of an acellular Pertussis vaccine, now conjugated with Diphtheria and Tetanus as DtaP.

More recently, questions have been raised about the presence of the mercury-containing preservative thimerosal in a number of vaccinations. The FDA recently acknowledged that in the first six months of life children get more mercury from vaccines than is considered safe by the EPA. In 1999, based upon parental concern, the US Public Health Service and the American Academy of Pediatrics issued a statement recommending the removal of thimerosal from vaccines. In May 2000, the FDA notified vaccine manufacturers that reducing or eliminating thimerosal from vaccines is merited. As of June 2002, mercury is still present in some vaccines. Mercury toxicity demonstrates symptoms similar to autism.

In the last fifteen years, autism rates have risen nearly fifty-fold to 1 in 150 (CDC data). Autism Spectrum Disorders are characterized by delayed neurodevelopment, pour use of language, repetitive behaviors, and social withdrawal. Dr. Andrew Wakefield has found that some children with autism cannot react to the live, modified measles virus present in the MMR vaccine. This data demonstrates a connection, but nut necessarily a causal relationship. The Institute of Medicine notes that the MMR vaccine could contribute to autism in a small number of children, but the population data is not precise enough to figure this out. The questions remain.

When I am speaking with parents about the vaccination decision that they are making for their children, I highlight the opportunity for choice. An educated choice requires the following information to help parents take responsibility for their own child's health care:

1. A fair representation of the risks and benefits of each vaccine:

2. A careful review of the birth, family history, and particular genetic risks of the individual child;

3. An evaluation of the environment within which the child lives or travels.

In short, one must consider the vaccine, the child, and the environment.

This unique and holistic perspective can he illustrated by the following example:

Haemophilus influenza B (HiB) is a type of bacteria present in the nose and throat of many children and adults. This common infection can invade through the lining of the throat and into the blond stream and spinal fluid. This form of 'invasive' HiB infection caused meningitis in approximately one in1000 infants before the dissemination of the HiB vaccines in the early 90s. The rate of HiB meningitis has dropped sharply over the past ten years.

In the late 1980's the Yup'ik Eskimo people in Western Alaska had the highest rate of HiB meningitis ever recorded [30 cases in every 1000 infants]. The HiB vaccine was introduced in 1989. The vaccine was a tremendous benefit to the Native Alaskan population and produced steady decline in the rate of meningitis. I worked with the Yup'ik people from 1992-1994, during which time there were no cases of HiB meningitis.

The much smaller Caucasian population that lived in Western Alaska did not experience any HiB meningitis, even before the introduction of vaccination. This protection may have been due to genetic protection, better nutrition, or the availability of toilets and running water with the affluent Caucasians.

We see that vaccines are of great benefit for people at risk. Defining the at-risk people (especially children) becomes the critical factor. This raises the question: Should all vaccinations be universally required?

Unfortunately, the data required for us to 'do the right thing' in all cases does not exist. In fact, few studies have ever been done to evaluate the before and after effects of vaccination on the immune system--much less on the child's developing immune system. Has the mass use of multiple vaccines in early childhood, when the brain and immune systems are developing at their most rapid rate, been a co-factor in the brain and immune dysfunctions seen in so many young children today?

Vaccines have driven infectious diseases out of childhood, but over the past quarter century there has been a simultaneous and unprecedented increase in the numbers of children suffering from chronic disease and disability. There are repeated calls for research on the link between vaccines and neurological and immunological disorders in adults told children. The incidence of learning disabilities, attention deficit/hyperactivity disorder, and asthma has doubled, childhood (Type 1) diabetes has tripled, and autism soars. The number of children suffering with these chronic disabilities is in the tens of millions in the US, Canada, and Europe.

It would seem intuitively obvious that studies to evaluate these relationships would be required before any new vaccine is put on the market, recommended by the CDC, or mandated by state law. Without proper scientific investigation and proof, we don't know if the increase in childhood chronic diseases is attributable to increases in vaccinations, environmental toxins, exposure to chemicals, antibiotic abuse, or other unknown agents.

The Institute of Medicine, in its 2002 report Multiple Immunizations and Immune Dysfunction, discusses biologic mechanisms by which vaccinations influence the risk for allergy and additional infection. It emphasizes the need for research on genetic variability, in immune system development and encourages a more flexible schedule for a reduction in the number of vaccines administered at one time.

Study of the developing immune system shows that immunizations during the six months of life require recurrent 'boosting' because the infant's immune system is unable to sustain an immune response. This is why vaccines are required repeatedly during the first year of life.

Given this information it is logical for many patients to ask, "Why do I need to give my child the Polio Vaccine (IPV) three times in the first year of life when there has been no wild-type polio in the U.S. in over twenty years? Do I need to give the Hepatitis B vaccine (now outlawed in France) during the first year of life? Can I delay the MMR to prevent the possible risk of autism?"

Nearly one-quarter of parents in a recent survey believe that children receive more vaccines than are good for them, and that too many vaccinations could overwhelm an infant's immune system. The average child receives fifteen doses of five vaccines in the first six months of life, and a total of 22 shots against eleven diseases by eighteen months of age. It appears that modifying the schedule to allow for flexible scheduling of vaccinations throughout childhood may be of benefit. Studies to assess the risks and benefits of such approaches with parents would allow for 'ground-breaking research' on the differences between partial and/or delayed vaccination versus current vaccination schedules.

Parents who ask more questions and who actively seek to protect the health and wall-being of their children want more information, better research, clearer guidelines, and fairer practices in the use of vaccinations. Over the past fifteen years, questions from concerned parents have led to the development of the VAER, legislation to begin the Vaccine Injury & Compensation Program (VICP), changes in the pertussis vaccine, phasing out of the oral polio vaccine, rejection of the rotavirus vaccine, moratorium on the administration of Hepatitis B vaccine at birth, removal of mercury from vaccines and more thorough research on vaccines. Vaccines are safer because of parental questioning and concern. We see that 'when the people lead, the leaders will follow.'

As we listen to parents with heart-breaking stories from adverse reactions to vaccines, we must also remember the countless lives that have been saved from vaccination. The images of friends and family suffering from poliomyelitis have faded from our collective memory. We are fortunate in reaping the societal benefits of vaccination. As fewer causes of vaccine-preventable diseases are present, our focus moves toward the complications from vaccines--for no vaccine is perfectly safe.

When a sufficient percentage of the population is vaccinated for a given disease, ram-vaccinated individuals are less likely to catch the disease. This idea of "herd immunity" leads to unvaccinated individuals reaping the benefits without facing the small, but real, risk of vaccination. Data from measles in California shows that unvaccinated individuals are at a 35-fold higher risk of developing infection. They represent a significant source of transmission of disease to those in the general population whose immune systems have not been able to fully integrate the vaccination. The more people choose not to vaccinate, the more all of us are at risk.

An ethical dilemma is created: the rights of the individual versus the needs of society. We have the luxury of having this discussion because of the decline in infectious disease over the past century. Vaccination appears to be helpful, but the current form is problematic at best. We must refine the use of these vaccination tools to apply them with discretion rather than a 'one-size-fits-all' approach.

Every' book or paper I have read on this subject has presumed to know the 'right' approach to vaccination. But the truth in medicine is that there is not one right way to treat (or prevent) cancer, heart disease, auto-immune problems, or epidemic infections.

Thus, there is no easy answer to the question, "Are vaccinations safe and effective?" We must recognize that through education and awareness we, as parents, must make individual decisions for which we are willing to take responsibility. We must ...

Continue to ask questions until we are clear.

Reject doctrine as a sufficient answer.

Develop consensus as parents.

Make choices for the health of our children.

When these guidelines are followed with wisdom and compassion, then we will have found the middle ground.

RELIGIOUS EXEMPTION:

All states allow a religious exemption to vaccination except Mississippi and West Virginia.

The religious exemption is intended for people who possess a sincere religious belief against vaccination to the extent that if the state forced vaccination, it would be an infringement on their right to exercise their religious beliefs. Some state laws define religious exemptions broadly to include personal religious beliefs, similar to personal philosophical beliefs. Other states require an individual who claims a religious exemption to be a member of The First Church of Christ, Scientist (Christian Science) or another bonafide religion whose written tenets include prohibition of invasive medical procedures such as vaccination.

Some laws require a signed affidavit from the pastor of the church while others allow the parent to sign a notarized waiver. Prior to registering your child for school, you must check your state law to verify what your health department requires to prove your religious beliefs. The religious exemption is granted based on the First Amendment of the Constitution, which is the right to freely exercise your religion.

Because citizens are protected under the First Amendment of the United States, a state must have a "compelling State interest" before this right can be taken away. One "compelling State interest" is the spread of communicable diseases. In state court cases that have set precedent on this issue the freedom to act according to your own religious belief is subject to reasonable regulation with the justification that it must not threaten the welfare of society as a whole.

8 Questions to Help Prevent Vaccine Reactions

1. Is my child sick right now?

2. Has my child had a bad reaction to a vaccination before?

3. Does my child have a personal or family history of vaccine reactions? convulsions or neurological disorders? severe allergies? immune system disorders?

4. Do I know if my child is at high risk of reacting?

5. Do I have full information on the vaccine's side effects?

6. Do I know how to identify a vaccine reaction?

7. Do I know how to report a vaccine reaction?

8. Do I know the vaccine manufacturer's name and lot number?

Source: National Vaccine Information Center website (www.909shot.com).

REFERENCES

Institute of Medicine. "Immunization Safety Review: Measles-Mumps-Robella Vaccine and Autism." 2001. National Academy Press, Washington, DC.

Institute of Medicine. "Immunization Safety Review: Multiple Immunizations and Immune Dysfunction." 2002. National Academy Press, Washington, DC.

McQuillan GM et al. "Serologic Immunity to Diphtheria and Tetanus in the United States." Ann Int Med. 2002:136:60-65.

Regan L. "Show Us the Science: Report on the Second International Public Conference of the National Vaccine Information Center," Mothering. 2001; 105:39-53.

Salmon DA et al. "Health Consequences of Religious and Philosophical Exemptions From Immunization Laws: Individual and Societal Risk of Measles." JAMA. 1999;282:47-53.

Singleton RJ et al. "Decline of Haemophilus influenzae type b disease in a region of high risk; impact of passive and active immunization." Pediatr Infect Dis J. 1994;13:362-67.

FOR FURTHER READING:

MEDLINEplus Health Information http://www.nlm.nih.gov/medlineplus/immunizationvaccination.htm

Understanding Vaccines; Brochure in Adobe Reader

http://www.niaid.nih.gov/publications/vaccme/undvacc.htm

A Shot in the Dark by Harris L. Coulter, Ph.D. & Barbara Loe Fisher 

Read the book that started it all. Coulter and Fisher didn't intend to write critically of vaccination but the more they researched, the more the reality was revealed. Impeccably documented, meticulously researched, a must read for anyone wishing to understand childhood vaccinations.

Vaccination: The Issue of Our Times

The most comprehensive collection ever printed of articles, research, and references, challenging the conventional viewpoint on vaccinations. Contributors include physicians, public health workers, and parents, Edited by Mothering magazine publisher and editor, Peggy O'Mara. 314 pages

THE VACCINE GUIDE: Making An Informed Choice by Randall Neustaedter, O.M.D.

Excellent reference source. Discusses all vaccines, alternative vaccine methods, exemptions, vaccine reactions (short and long-term) and treating vaccine reactions.

WHAT EVERY PARENT SHOULD KNOW ABOUT CHILDHOOD IMMUNIZATION by Jamie Murphy

Do you know what's inside the vaccine your infant is receiving? Murphy explains what vaccines are, how they are made, what little-known toxic chemicals are used and the reactions that may follow then injection.

Patrick Hanaway, MD co-founded FAMILY to FAMILY: Your Home for Whole Family Health in Asheville, NC. He has two children and has struggled with these same questions.