As the academic year begins, parents seeking to register their child in a new school are legally required to show that their child has received immunizations against many common diseases of early childhood. For the vast majority of parents, this is no problem, because their child has been routinely receiving these vaccinations during scheduled visits to their pediatrician ever since they were born.
American society as a whole has accepted the view of the medical establishment that childhood vaccinations are both safe and necessary to protect the health of our children. But there are parents who accept the views disseminated over the Internet and social media by a small but vocal minority of doctors and researchers who claim that current vaccines, and the way in which they are administered, present significant risks to the health of very young children.
Most parents who cite such concerns are reassured by their pediatricians that their fears are unfounded, and that the vaccines have been scientifically proven to be safe. Public health officials also argue that parents who refuse to allow their child to receive all their vaccinations unfairly endanger other children as well as their own, by increasing the risk of outbreaks of preventable and potentially serious diseases.
But some parents remain fearful, and refuse at least some of the vaccinations prescribed for their child. Under the law in many states, parents are within their rights to refuse to allow their child to be vaccinated due to moral or religious objections, or fear that vaccinations may be unsafe. But as a practical matter, parents are likely to encounter major difficulties in registering their unvaccinated child in the Jewish school of their choice.
While there is widespread acceptance of the safety of vaccination in the scientific community and our culture today, there are parents who are outspoken in their belief that their child’s reaction to a vaccination was responsible for their development of a serious medical condition. One of them is actress Jenny McCarthy, who will gain an influential platform for her anti-vaccination views as a new co-host on the ABC television network’s popular daily talk show, The View, starting in September. McCarthy claims that her 11-year-old son’s diagnosis with autism in 2005 was the result of his reaction to a vaccination. ABC was harshly criticized for McCarthy’s selection by those who believe that her anti-vaccination views are unscientific and pose a real danger to public health. But even some who accept the safety of today’s vaccines suggest that questions and challenges to their safety raised by critics like McCarthy and other concerned parents deserve a fair hearing, and simply rejecting their objections as irresponsible and unscientific will not put them to rest.
Nobody denies that certain vaccines have been extremely valuable in protecting the health of our children. They have saved millions of lives by eliminating smallpox, and avoided the crippling of millions of children by polio. Most of the controversy concerns the safety of specific vaccines for once “routine” childhood diseases which leave the vast majority of children with little or no lasting ill effects.
The most intense controversy today is over the safety of the MMR vaccine, a combination vaccine developed in 1971 to protect against measles (rubeola), mumps and German measles (rubella). The first version of the DPT (diphtheria, pertussis and tetanus) vaccine was developed even earlier, in 1949.
By the mid-1980’s, many state and local jurisdictions had adopted laws requiring parents to show that their child had been immunized with the MMR, DPT and polio vaccines before being allowed to register the child for school. Children typically received five injections by the time they were two years old, and not more than one per doctor’s visit.
Before the introduction of the first measles vaccines during the 1960’s, it was considered to be the most contagious and dangerous of the “typical” diseases of childhood. The chances of developing the disease among those without immunity upon close exposure is 90%, and there is no specific treatment for those who have been infected. The vast majority of infected children will make a full recovery, but complications from measles are common and can be very serious. According to a study conducted in the US 20 years ago, 2 out of every 1,000 patients infected with measles died.
Before the first measles vaccine was introduced, there were 4 million cases, and about 500 deaths from measles reported in the US each year. As a result of the widespread use of the MMR vaccine, the number of measles cases reported in 2004 in the US dropped to just 37. The effort to wipe out measles through vaccination in other countries has been credited with a reduction of 70 percent in the number of cases reported worldwide since 2001.
Based upon decades of experience, the medical establishment believes the MMR vaccine to be safe for almost all children over the age of one. The typical side effects, including a fever or rash, appear in less than 15% of children, and are typically mild and temporary. Nevertheless, parents have a legal right to opt out of mandatory vaccinations for their child provided that they can satisfy the conditions for an exemption set by laws in their state. In addition to exempting children with certain specific conditions which put them at medical risk, an exemption can also be obtained in 48 states based upon a parent’s religious objections, and in 20 states based upon a parent’s personal or philosophical beliefs.
The level of parental opposition varies depending upon the seriousness of the disease the vaccine immunizes against, and the safety record of the vaccine. That is why many parents who have opted out of the MMR vaccine have insisted that their be child immunized against polio.
Some parents also insist that vaccines they approve be given to their child one at a time, rather than ganged up in a single multiple formula, or be given simultaneously with other injections. They are aware that their child’s body will have its own reaction to each vaccine, and are concerned they that if given simultaneously, they could combine unpredictably to harm their child’s health. If there is a negative reaction, it will also be difficult to determine which of the vaccines administered at the same time was responsible.
Their problem is complicated by the fact that the vaccines that combination immunizations, such as the MMR, have replaced, are no longer available individually. That means that if a parent wants to immunize their child against measles, their only choice is the MMR vaccine.
There are more diseases today for which childhood vaccination is now mandatory, including influenza and hepatitis. As a result, children are now required to receive as many as 24 shots by the age of two, and up to 5 shots in a single visit to the pediatrician.
Parents who have serious concerns about the safety of vaccines believe that all schools should respect their right to opt out. However, many schools in the Jewish community do not want to be bothered. They simply assume that the law would not require all children to receive these vaccinations if they weren’t safe, and insist that every new student receive all their required shots as a precondition for registration.
One parent who, after researching the topic for himself, decided that vaccines now in use present “too much risk for me to force on my child,” has complained in a letter to the Jewish Press about the major obstacles he has encountered from Jewish schools over this issue.
He understands that his is a minority opinion. Nevertheless, he asks that school administrators respond to his concerns with more “civility and an acceptance that there are two sides to this story; that people who do not vaccinate their children have very justifiable reasons for their concern. It is hard enough without having [to deal with] others who have not done the research and yet are more strident than the government, doctors or the [vaccine] manufacturers. When a Jewish school says, ‘We don’t care what the law is. Unless your child is vaccinated you can not send your child here,’ something is wrong.”
There were always those who questioned the safety of the vaccines. In the late 1990’s, concerns were raised about the possibility of more serious side effects due to other ingredients added to these vaccines, specifically thimerosal, a mercury-containing preservative. In 1999, various federal public health agencies and the American Academy of Pediatrics asked vaccine makers to find a substitute and eliminate thimerosal from their vaccines. The vaccine makers gradually complied, but there are other suspicious “adjuvants” being added to today’s vaccines, such as aluminum and squalene.
As early as 1974, there were concerns raised about neurological side effects from the form of the pertussis (whooping cough) vaccine then in use. The percentage of parents immunizing their children against pertussis quickly dropped from 70%-30% in Great Britain, as well as other Western societies. This led to major whooping cough outbreaks in Japan and Sweden. Subsequent research found very little evidence to support the theory that the pertussis vaccine could cause brain injury, but they failed to fully calm the fears that many parents had developed about the vaccine. Today, a much simpler and less dangerous form of the pertussis vaccine is included in the combined DPT (Diptheria-Pertussis-Tetanus) vaccine that is part of the standard immunization schedule for school-age children in the US, but a small percentage of parents still remain suspicious of it.
A more serious concern was raised in 1998, when the widely respected British medical journal, The Lancet, published a controversial research paper by British surgeon Andrew Wakefield and 12 other investigators. It reported the discovery of a potential link between the MMR vaccine and symptoms of autism diagnosed in eight of twelve children Wakefield studied at the Royal Free Hospital in London. Wakefield proposed his so-called “leaky gut” theory. It suggests that something in the MMR vaccine creates an inflammation in the walls of the intestines that enables toxins and pathogens to enter the rest of a young child’s body. These cause a variety of conditions in these children, ranging from Crohn’s disease to pancreatic or liver disease, to chronic fatigue syndrome, fibromyalgia and autism.
In a video released to the press just before his paper’s publication in the Lancet, Wakefield called for the use of the combined MMR vaccine be suspended. The public reaction was immediate, particularly in Great Britain, where the rate of parents permitting the MMR vaccine to be given to their young children plummeted from over 90% to about 60% in some parts of London. However, subsequent, independent research was unable to verify Wakefield’s findings, casting them into doubt in the medical community.
Then, in February, 2004, Wakefield’s scientific objectivity was challenged by Brian Deer, a reporter for the Sunday Times of London. Wakefield was accused of taking a substantial amount of money from lawyers representing the parents of some of the children in his study. They were seeking evidence to sue the manufacturers of the MMR vaccine. One month later, 10 of Wakefield’s 12 collaborators in the paper published by The Lancet retracted their support for its conclusions.
Nevertheless, there were still some in the medical community who were unwilling to totally dismiss Wakefield’s findings, and the safety of the MMR vaccine remained under a cloud.
However, when reporter Deer published new evidence in 2009 that Wakefield deliberately falsified the patient data upon which his 1998 paper was based, his reputation in the British medical community was further discredited. Great Britain’s watchdog for medical ethics, the General Medical Council (GMC), expanded its ongoing investigation into the way in which Wakefield and two of his collaborators had conducted their research on the MMR vaccine. A GMC panel concluded that Wakefield acted “dishonestly and irresponsibly” and had conducted unnecessary invasive tests in “callous disregard” for the children in his study. The editors of The Lancet then announced the formal retraction of his 1998 paper from their published record.
Later that year the GMC formally stripped Wakefield of his right to practice medicine in Great Britain, having found him guilty of professional misconduct, dishonesty, and the abuse of the developmentally challenged children in his study.
Today, there are still those who consider Wakefield to be the innocent victim of attacks by a vengeful medical establishment and the vaccine manufacturers with their own vested interests in discrediting his findings. Wakefield has written a book, called “Callous Disregard,” in which he defends the validity of his research against his critics.
There are those who see the attacks on Wakefield as part of a larger conspiracy between government health officials and pharmaceutical companies. There are also still a significant number of parents who cite Wakefield’s research to justify their decision to withhold the MMR vaccine from their child.
Vaccine manufactures have been granted special legal immunity against lawsuits by the families of those who have been injured by their vaccines. Instead, the federal government established the Vaccine Injury Compensation Program (VICP) in 1988 to compensate those who feel they have been harmed by a vaccine, if they can back their claim with a biologically plausible theory.
Federal courts require a higher level of proof. In a landmark 2009 ruling, the US Court of Federal Claims rejected a suit for damages from three families who believed that the MMR vaccine caused neurodevelopmental harm to their children, The court studied the available scientific research presented by both sides in the case for two years before issuing its ruling.
There are those who accept the criticism of Wakefield’s research methods who still argue that his conclusions are valid. They support his “leaky gut theory,” based upon other research. They believe that “leaky gut syndrome” may be a factor in many different disorders, ranging from asthma and diabetes to multiple sclerosis and Crohn’s disease, as well as autism. They also say the theory explains why they find gluten-free and casein-free diets and other nutritional approaches to be effective in alleviating some of their children’s symptoms. The theory remains very controversial, and the scientific debate over it continues.
Once Wakefield’s findings started to come under attack in the media, MMR vaccination rates began to recover. But in the interim, an estimated 1 million children in Great Britain did not receive the MMR vaccine. Those children were and remain at risk of infection. In the years following the publication of Wakefield’s paper in 1998, the rate of children contracting measles or the mumps in that country, which had been near zero, exploded. In 2012, Great Britain reported nearly 2,000 cases of measles, ranking second in Europe behind only Romania. In Wales, the epicenter of the latest outbreak of measles in Great Britain in April of this year, an emergency public health campaign has been launched to immunize those who are now between the ages of 10 and 16 whose parents did not permit them to receive the MMR vaccine when they were younger.
Many doctors and public health experts consider Wakefield to be the perpetrator of one of modern medicine’s greatest and most damaging hoaxes. Specifically, they hold him responsible for the fact that measles remains a threat to public health, because large numbers of children in Great Britain and other Western countries remain unvaccinated against it. This has enabled recurring measles outbreaks to continue to this day, causing needless suffering and deaths.
Even many communities in the US and Canada, where immunization is mandatory for school age children, are still vulnerable to such outbreaks by highly contagious diseases such as measles. Dr. Paul Offit, chief of the Division of Infectious Diseases and director of the Vaccine Education Center at Children’s Hospital in Philadelphia, says it is necessary for more than 95% of children to be vaccinated in a community in order to fully protect it. He explains that some people may not be able to safely take the vaccine because they are getting chemotherapy or immune suppressant therapy. They may have an allergic reaction to it, or they may simply be too young. There will also be a small percentage for whom a given vaccine simply doesn’t work to create immunity. Offit says, “they need those around them to protect them,” using what is known as “herd immunity.” This occurs when there are not enough people in the population without immunity to sustain the chain of transmission of the infection from one victim to the next.
While each parent has the right to put their concerns for their child’s health first, public health experts believe that today’s vaccines are safe, and worry about the impact of anything which will result in a lower rate of immunization. Outbreaks of measles are their greatest concern. In developing countries which have not yet adopted a policy of universal vaccination, measles remains one of the leading causes of death for children under age five. It still kills more than 150,000 people a year worldwide.
Even in the North America, where measles vaccination rates are above 90%, herd immunity is incomplete. For example, in July, there was an outbreak of measles in three communities in Canada’s British Columbia province, with at least eight confirmed cases. There were 82 cases of measles reported in British Columbia after it hosted the 2010 Winter Olympic Games, which attracted more than 600,000 visitors from around the world.
Orthodox communities are particularly vulnerable, because their families often have large numbers of young children who live in very close proximity. There have been significant measles outbreaks reported in Boro Park in 2008, 2009 and 2011.
One was traced to a child from Great Britain who was not vaccinated and was exposed to the disease shortly before leaving to attend a summer camp in the Catskills. The child was still in the incubation period and appeared to be healthy upon arrival at camp. When the symptoms emerged, the child infected everyone who was not immunized in their bunk, including the counselors. Some then brought the disease home with them, starting mini-outbreaks in Orthodox communities throughout the Northeast.
Most recently, starting in March of this year, there was an outbreak of measles in Borough Park and Williamsburg that was ultimately traced to a visitor from London. According to Dr. Leonard Krilov, the chief of Pediatric Infectious Diseases at SUNY’s Winthrop University Hospital, there were 56 confirmed cases reported to the New York City Department of Health through the third week of June. All of them involved individuals who were not vaccinated. The median age of the victims was 2 years. The youngest was 10 months old. Two of them were hospitalized for complications, but fortunately, no deaths were reported. To halt the outbreak, the Department of Health has moved up the age at which it recommends that children in three of Brooklyn’s large Orthodox communities should receive the MMR vaccine from one year to 6 months, as well as other preventive measures.
This history is why a number of pediatricians serving the Orthodox community are vehement in their insistence that every child in their practice receive a full schedule of immunizations.
But Dr. W. Keith Stafford, a pediatrician with a practice in South Carolina, writes that even though he personally is “in favor of vaccines, and all of my children have been immunized according to the standard schedule. . . I believe it is wrong for a physician to coerce a parent into vaccinating, when they are uncomfortable with it. . .
“It grieves me, when I see the guarded or fearful look come into the eyes of a parent when I start asking questions about a child’s immunization history, because they are afraid of what will happen when I discover they are not immunizing according to the established rules.”
Dr. Stafford believes that parents have a basic right to give or withhold their “informed consent” for their child’s vaccination. Based upon his experience with such parents, most have done some investigation on the Internet on their own. Even though the quality of the information upon which they are basing their decisions may be questionable, Stafford argues that they are generally not acting out of ignorance. “They are trying to protect their children from unnecessary risk. The fact that a majority of the medical establishment does not agree with their conclusions does not make them weirdos or troublemakers,” Stafford writes.
Stafford contends that such parents “are mostly looking for a physician who will listen to their concerns and allow them the time and freedom to move forward with immunizations when they feel comfortable. . . If the real goal here is to keep children as healthy as possible, treating these parents respectfully will get much more accomplished.”
There is no “one-size fits all” approach to reach these parents. Some will respond to a clear presentation of the scientific evidence supporting the safety of vaccines. Other parents will remain deeply distrustful of the claims by the medical and public health establishments that vaccination is safe for their child.
The public health argument is that allowing children to remain unvaccinated increases the danger of outbreaks in our communities. It says that parents have no right to place other children at greater risk through their decision not to immunize their own child.
But one may also question whether society has the right to force parents to vaccinate their young children against their will, and whether such efforts may be counterproductive in the end.
Ultimately, the question remains a dilemma.Yaakov Kornreich
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