1/24/01 11:10 a.m.
Protecting Parents’ Rights
To protect their children.

By Linda Gorman, senior fellow at the Independence Institute

ast December, the Journal of the American Medical Association published a paper on how well measles and pertussis vaccines protect Colorado children from disease. Unsurprisingly, it concluded that unvaccinated children were more likely to contract measles and whooping cough than vaccinated ones. It also reported that schools with more unvaccinated children are more likely to have outbreaks of these diseases.

What was different about this paper, and what should make every parent in the United States sit up and take notice, is that its authors concluded that since many vaccine preventable diseases are spread from person to person "the health of any individual in the community is intricately dependent on the health of the rest of that community" and that "policymakers might consider requiring some evidence of parental strength of conviction when claiming personal exemptions for their children. In Colorado, the ease of claiming personal exemptions could encourage exemptions of convenience by parents who have not really considered the issue…" Among the authors was Dr. Richard E. Hoffman, Colorado's chief medical officer and epidemiologist.

This is intricate nonsense. Immunizations are recommended precisely because they make the health of immunized individuals independent of the health of others in their communities. What public-health officials don't like is that Colorado's vaccine-exemption statute lets parents have the final say over the amount of risk that public-health officials can force a child to bear.

Until recently, immunizations were required only for diseases posing a clear and deadly risk. Public-health officials had no qualms about vaccine exemptions because parents had no qualms about vaccinating their children. In fact, the JAMA paper estimated that almost 98% of Colorado children aged 3-18 were immunized in 1998. Immunization remains important — polio virus has recently been found in India, Haiti, the Dominican Republic, and the Middle East, tetanus germs live in the dirt, and diphtheria was epidemic as recently as 1995 in the newly independent states of the former Soviet Union.

For some of the newer vaccines, the risk-reward ratio is not as clear. U.S. residents who avoid promiscuous sex, are not on dialysis, and are not needle-using drug addicts have about a 4 in 100,000 chance of catching hepatitis B, a virus that can cause chronic liver disease. Children under age 14 catch it at the rate of 2 to 6 cases per million people — their risk is virtually nonexistent. But public-health officials who had no success in vaccinating people in the major risk groups, decided to attack the virus by vaccinating infants and children. Fragile newborns receive their first hepatitis B vaccination before leaving the hospital.

Data from the Vaccine Adverse Event Reporting System (VAERS) suggest that there are about 4 serious reported reactions for every 10,000 hepatitis B vaccinations, including 48 deaths. Passive systems such as VAERS are generally assumed to catch about 1/10 of all adverse events, and Congress has heard testimony from people who say they were pressured not to report bad reactions. Given these statistics, an informed and conscientious physician or parent might reasonably advise against hepatitis B vaccination in newborns and certain adolescents unless other risk factors, like an infected mother or contact with a hepatitis B carrier, are present.

In states where personal exemptions are not allowed, public officials brush such considerations aside. Parents who resist have been threatened with charges of child abuse. In Utica, New York, a school district threatened with a loss of state aid for failing to meet immunization quotas suspended children without hepatitis B vaccinations. It then announced that parents refusing to vaccinate their children within two weeks would be reported to child protective services for educational neglect.

This ignores the fact that parents have a duty to protect their children from danger, including that posed by overzealous public officials. The RotaShield vaccine was designed to protect against a virus that infects almost all children by age 5. It usually causes mild diarrhea. More severe cases cause roughly 20 to 40 deaths a year and 55,000 hospitalizations in the United States. The vaccine was licensed in August, 1998 and recommended for all infants in June, 1999. On July 15, 1999, CDC officials advised "suspending" its use. Vaccinated infants in post-licensure trials had rates of intussusception, a potentially fatal intestinal blockage often requiring surgery to correct, that were 6 times the expected rate. Critics say that pre-licensure trials, reportedly limited to 10,000 infants, were too small to detect such relatively rare events.

CDC officials debating the vaccine's safety worried that taking it off the American market would make it unavailable in India, where infant diarrhea can be deadly. "Western thinking," one opined, "seems to suggest that part of what makes an activity ethical is having the people involved appropriately informed." Western thinking also holds that doctors should first do no harm, a precept enforced only when parents have the power to exempt their children from such public health experiments.