The Great Debate: Childhood Immunization
Date: November 1, 2005
|Imagine a time when late summer meant fear. Public swimming pools were empty. Playgrounds were silent. Children played indoors, away from large crowds, while parents held their breaths. Just a little more than 40 years ago, late summer was polio season, and for the unlucky 13,000 to 20,000 children each year in the U.S. who contracted polio, the disease could mean a life-long sentence to an iron lung — a huge cylinder that used mechanized pressure to keep a paralyzed child breathing when muscles refused to move. Others escaped the iron lung, but would use leg braces or wheelchairs for the rest of their lives. Even those who seemed to recover completely now know that Post-Polio Syndrome haunts survivors with muscle weakness and other debilitating symptoms that arise in middle age.
With the advent of a polio vaccine, polio rates in the U.S. plummeted. In 1999, there were only 2,883 cases of polio in the world according to the Centers for Disease Control and Prevention (CDC).
Other childhood diseases have seen similar dramatic reductions due to vaccination. While we now tend to think of measles, chicken pox and mumps as "harmless" rites of passage, nearly 450 children died each year due to measles between 1953 and 1963. Outside of the U.S., the World Health Organization reported over 900,000 measles-related deaths in 1999. Whooping cough once killed up to 9,000 children a year in the U.S. prior to immunizations. By contrast, now that vaccinations are common, only 57 children died of whooping cough in the U.S. between 1990-1996. Diphtheria killed over 15,000 in the U.S. in 1921. Only one case of infection was reported in the entire country in 2000.
"Prior to the development of many of today's vaccines, children as well as adults became infected with diseases that often resulted in lifelong disabilities, or all too often death," says Dr. Carol Berkowitz, president of the American Academy of Pediatrics (AAP). "The fact that we no longer see certain diseases doesn't mean they no longer exist — it simply means the vaccines are working," she continues. "They will only continue to work, however, if we continue to immunize our children."
While worldwide incidence of killer diseases is falling due to global vaccination programs, many diseases that are currently rare in the U.S.— such as tuberculosis, Rubella, mumps and HiB meningitis — are rampant in other parts of the world.
Pediatricians, national medical associations and the CDC urge parents to make sure all children complete the full-recommended schedule of vaccinations. But in the last 15 years, some voices have arisen to question the necessity — and even the safety — of childhood immunizations. One particularly heated debate rages over the potential role — if any — that immunizations containing the preservative thimerosal, which has a high mercury content, may have played in recent increases in the incidence of autism.
Stakes are high, tempers are short and battle lines are drawn in the debate, with advocates of both sides investing in research, expert analysis and media campaigns. On one side, government health agencies, the AAP and other medical associations, most pediatricians and health advocates strongly urge parents to vaccinate. They fear that a reduction in immunizations would make the overall population more susceptible to now-eradicated diseases, either brought by errant travelers or intentionally sent by terrorists. The resulting deaths and long-term disability, health advocates argue, far outweigh the unfortunate but small number of deaths each year due to adverse reactions to vaccines.
On the other size, vocal parents, grassroots organizations and some in the scientific and medical community have raised questions about the testing and composition of vaccines. They believe that autism and other developmental delays may be caused by high levels of mercury in vaccines given to infants. Concerns that some children are at higher-than-average risk for adverse reactions, illness or death because of an inability to process the vaccines or their additives fuel a debate on when, whether and how frequently to vaccinate.
Between the two sides — and often bewildered by the shouting — stand parents, who want to do the best for their children. Unfortunately, there are no easy answers. Parents concerned about the vaccine debate are encouraged to research both sides — as well as to seriously consider how prepared they might be to care for a child who became seriously ill due to a vaccine reaction or who contracted a potentially deadly disease if unvaccinated.
Here's what some experts told Charlotte Parent:
Bryan Adams, M.D., at University Pediatrics is a believer in immunizations. "A link between autism and childhood immunizations has never been supported by any scientific evidences; in fact, numerous studies have demonstrated that no such link exists. All the M.D.s and nurse practitioners in our office have children of their own, and all of them have been fully immunized. If a risk of autism existed, pediatricians would certainly be aware of this and would withhold vaccines from their own children," says Adams.
Lisa Jillani heads People Advocating Vaccine Education (PAVE), a Charlotte-based advocacy group that questions the safety of routine vaccinations. "I started PAVE in 1996 in response to the abrasive treatment I received . . . after the birth of my second child. I had declined the hepatitis B shot and this was not well-received by the hospital staff and the pediatrician assigned to me."
She sees a lack of large groups of autistic adults as evidence that something triggered increased rates of autism in today's children. "Where are all the autistic adults?" Jillani asks. "If they weren't in regular schools, where are the special schools they were hidden in? This (the theory that increased rates of autism today represent better reporting and not more cases) is simply hogwash by the medical community trying to engage in damage control and public relations."
Dr. Amina Ahmed, a specialist in Pediatric Infection Disease at Carolinas Medical Center, sees a lack of conclusive proof linking autism with vaccines as reason to err on the side of vaccinations. "I don't think the increase in autism is related to vaccines," she says. "The time in your life when you're getting vaccinations is the time when you're going to develop autism. There's no causality between vaccines and autism."
David Kirby is the author of "Evidence of Harm: Mercury in Vaccines and the Autism Epidemic: A Medical Controversy." Kirby spoke at the Defeat Autism Now! conference in Charlotte that was held in July. "I think vaccinations are extremely important," Kirby said in an interview with Charlotte Parent. "You want the vaccines that you give to your children to be as safe as possible." In his interview and in his book, Kirby emphasized that he is not anti-vaccination; rather, he sees the potential connection between thimerosal and neurological conditions — including autism — as worthy of serious debate. Thimerosal was removed from most standard childhood vaccinations, but is still present in the flu shot and in other over-the-counter and prescription products.
"Why would a trusted health agency (the CDC) allow a known neurotoxin (mercury) to be injected into the bloodstream of small babies — in amounts that exceed federal safety exposure levels for adults by up to 50 times per shot?" Kirby wonders in the preface to his book. He notes a curious rider attached to the Homeland Security Bill that would have exempted pharmaceutical company Eli Lilly — the main supplier of thimerosal — from litigation.
Others do not see a need for speculation. "Many have blamed thimerosal for causing autism in children. Since removing thimerosal from the standard childhood immunizations in 2001, the U.S. has seen no change in autism rates," says Dr. Adams.
"I'm not even sure there is a possible risk (of autism)," says Dr. Ahmed about vaccinations. "The lack of proof (of harm) is outweighed by the benefits. No component in vaccine that we know causes autism." She also doubts that testing the number of children necessary to conclusively determine a link or conclusively disprove linkage would be ethical or possible. "We'll never know," she says.
Jillani believes powerful interests with a lot to lose are overriding public health concerns. "The precise selection and small size of studies have saved the pharma industry from many problems that manifest only in very large groups," she says. "Actually, environmental mercury exposure is being well studied in the U.S. It's just that the CDC knows the mindboggling liability of damaging a billion brains globally with bad vaccines."
Adams sees greater harm in refusing vaccinations. "Diseases such as measles and polio are rampant overseas. I expect to see more cases of these diseases imported to the U.S. in the future. By not immunizing their children, parents put them at risk for contracting these devastating diseases," says Adams. "Fortunately, the overwhelming majority of children in the U.S. have been properly immunized, making disease epidemics unlikely. However, if more parents decide to withhold immunizations in the future, all of our children will be at a higher risk."
Kirby cautions parents who believe there is a sensitivity to heavy metals in their family history to be careful about vaccines that contain mercury. "It would appear the general predisposition that shows an inability to excrete mercury is also related to autoimmune diseases," Kirby said in the interview.
Jillani sees other culprits in the high number of worldwide deaths due to preventable disease. "Malaria, malnutrition and diarrheal diseases are the main killers in third world countries. Starving children will have complications from even a common cold. What is the CDC and Bill Gates doing about good food and clean water?" (Bill Gates, founder of Microsoft, has a foundation that helps to provide childhood immunization rates in poor countries.)
Two local moms shared their thoughts about having their babies vaccinated.
Katrina Wilson, of Concord, says that the vaccine debate was on her mind. "It was a thought, and I did look up some information," Wilson says, "but all of the negative information I found did not sway my decision to get her vaccinated." Wilson, who is expecting again, intends to have the new baby vaccinated as well. "I don't think there's enough evidence to the contrary," she says.
Kristen Basilice of Charlotte also says the debate "definitely was" on her mind, especially since one of her four boys has some learning delays. "It has crossed my mind," she says of the debate. "You try to do what you think is best." Still, she had full immunizations for all of her children. Basilice says she talked with parents whose children had bad reactions to shots, and says she wonders about the delays her son has experienced, which showed up at the same age he received immunizations. "We sometimes question (a possible link) because we were aware of the arguments," she says.
Kirby emphasizes that his reservations about some components in vaccines should encourage dialogue on how to create safer vaccines, not scare parents off from vaccinating. "Some parents, fearing harmful effects, have been tempted not to vaccinate their children," he says in the introduction to his book. "Most would agree this is foolhardy and dangerous. . . . These diseases, all of them preventable, can kill children. When vaccination rates fall, disease rates rise." Kirby notes that in an age of new diseases and bioterrorism, vaccines play a "crucial" role. "Childhood immunization was perhaps one of the greatest public health achievements of the 20th Century," he says.
"Parents must weigh the benefit against the costs of any intervention involving their children," says Adams. "The benefits of childhood immunizations clearly outweigh the costs. I urge parents to consider that much of the information they encounter regarding links between vaccines and autism is untrue and not based on any sound evidence. Parents should rely on their children's pediatrician and reputable organizations like the AAP (American Academy of Pediatrics) and CDC for accurate vaccine information."
Kristen Basilice had her own yardstick. "We've leaned toward the immunizations," Basilice concludes. "I'm more worried about them catching something and dying from it."
|Gail Martin is a local freelance writer.|