To vaccinate or not?

By CATHERINE SNYDER

Tuesday, November 5, 2002 -- The uncomfortable truth about vaccines is that they protect the many at the expense of a very few. While millions are protected from infectious diseases every year, a small number of infants are injured or even killed by the shots they received as their parents stood by.

And while killers such as smallpox and polio have been all but eradicated thanks to mass immunization, critics question why vaccines, which are in effect mandated by the government, are not uniformly safe.

They also say they wonder if it is not better for children to contract childhood diseases such as mumps, measles and chicken pox rather than be vaccinated against them. And they call it irresponsible to inoculate every baby against Hepatitis B when the virus is spread mainly by sexual contact and shared IV-drug needles.

Of the 4 million children each year who receive multiple vaccines, about 10,000 adverse reactions are reported to the federal Centers for Disease Control and Prevention.

Most of those reactions are minor, but about 15 percent involve incidents of hospitalization, disability, life-threatening illness or death. Those reports do not prove the vaccine caused the problem, however.

Despite all these questions, most parents take their infants to the pediatrician's office for shots every few months as a matter of routine.

My husband and I tried to find a middle ground. Armed with facts culled from books, reports and friends, we tailored a vaccination program for our son, submitting to some vaccines and eschewing or postponing others. Our son Anthony's pediatrician didn't blink when we told him we wanted to hold off on the Hepatitis B shot for half a year, and he even suggested we wait to administer the polio vaccine.

At 6 months, Anthony got his first round of shots: Hib, to protect against Haemophilus influenzae type b, which can cause deadly meningitis; and DTaP, which contains the diphtheria, tetanus and acellular pertussis (or whooping cough) vaccines.

I won't pretend that holding down my son while a nurse thrust four needles, one at a time, into his little chubby legs wasn't a nightmarish experience. Anthony screamed and writhed, and I felt I had betrayed the trust I worked so hard to build in the first months of his life. In the days following the immunizations, Anthony was fussy, weepy and clingy. He rolled around less and didn't grab at things as heartily as he had before. But in a few days, he was back to banging on Daddy's keyboard and Mommy's piano. It took a few weeks before he refrained from crying when I left the room.

Still, Susan Lett, the medical director for the immunization program for the Massachusetts Department of Public Health, told me that by delaying the shots, I had exposed my son to "unnecessary risks."

"I wouldn't urge any parent to defer vaccines," she said. She also said my pediatrician stood in the minority by suggesting we wait to administer the polio vaccine.

"We don't know at any time what risks are being introduced," Lett said. "People travel all the time," possibly from countries where the population is not vaccinated against diseases such as polio.

Lett had convincing answers for all my skeptical questions. The incidence of hepatitis B, and its corresponding liver cancers and liver cirrhosis, would be cut dramatically if every baby got the vaccine. Diseases eradicated in the United States still lurk in other parts of the world. No causal link exists between vaccines and developmental disorders such as autism, according to the scientific literature and a report by the Institute of Medicine. She had a soothing answer for my concerns about overwhelming the immune system of a weeks-old newborn with toxins.

"Babies are exposed to hundreds of millions of antigens," Lett said. "The hundred or so they get in the vaccine is really quite tiny."

New mother Sue Keller of Deerfield said she hadn't given a second thought to vaccinating until her "crunchy granola" friend raised some of these points. Once she started doing research, she decided to ask her physician to fax her a list of ingredients, along with the manufacturer and the lot number of each vaccine scheduled for her daughter. Keller, a dentist, also talked to several pediatricians about vaccines and urges parents to do the same.

"Pediatrician? What's that?" joked a Northfield mother of two. Her son, she said, has gotten nonstop ear infections since getting one round of shots, and she since has taken her kids to holistic healers for their routine aches and pains. She won't vaccinate her daughter and says she plans to use a religious exemption for her child when it's time to enter public school.

In Massachusetts, parents who don't vaccinate their children can seek either a religious or medical exclusion to attend public schools, according to Cindy Dourmashkin, director of health services for the Northampton public schools. She said that in each Northampton school "one or two" children are not vaccinated, and that number has remained steady over the last 10 years.

Lett, of the state public health department, suggests parents visit the immunization Web site for the Centers for Disease Control and Prevention, www.cdc.gov/nip. The Children's Hospital of Philadelphia also maintains an excellent site at www.vaccine.chop.edu. Or check out the National Vaccine Information Center (www.909shot.com), which advocates more and better research to ensure that vaccines' rare serious side effects are curtailed.

In the end, parents have to weigh the risks and benefits of vaccination for themselves. However, they may want to consider the words of Andrew Weil, a noted doctor of alternative medicine and best-selling author. Weil was quoted in Natural Health magazine in 1997 as saying, "The debate about immunization could only be going on in a country where the people are mostly immunized. If people in this country lived with these diseases, you wouldn't hear them questioning immunization."