Reasonable People Can Disagree: The rationale for allowing
philosophical exemptions to vaccinations - POSITION PAPER ON
MANDATORY VACCINATIONS - 1989/1991
by Sandy Gottstein (aka Mintz) 1989/1991
Note: Due to
conversion from DOS to Windows, some formatting errors occur throughout
the paper, which I hope to correct at a later date. Also note
that the references were never reformatted to be in consecutive
numerical order when some of the references were removed. That,
too, will be corrected at a later date. -
In order to attend both public and private
school in Alaska, the State of Alaska currently requires the following
vaccinations of its children: DPT, polio, measles and
rubella.* Exemptions or waivers from these vaccinations are only
allowed on medical or religious grounds at this time. In spite of
appearances, however, there is no consensus about the degree of
efficacy of all vaccines for all children. The arguments which
follow support the contention that reasonable people can disagree about
vaccines and that loving, conscientious, informed parents might choose
to refuse one or more vaccinations for their children.
I am hoping to engage your support to change the law to allow an
additional waiver for personal or philosophical convictions.
Similar laws are currently in effect in 22 states.**(Click
for the for more up-to-date exemption information)
The proposed law, presently before the State
Senate, is a copy of current California law. In addition, an
effort will be made to include in the bill an as yet formally
unidentified action or actions to be required of those seeking a
philosophical exemption. The inclusion of such an action will be for
the purpose of discouraging an otherwise uninformed or negligent parent
from choosing the exemption as the path of least resistance. (One
idea is to require an essay of undetermined length stating the parent's
position on the issue, another that well-child visits, to the health
practitioner of the parent's choice, be required and timed for the same
intervals were the child to be immunized.)
I. THE VACCINES ARE RISKY,
AND PROBABLY MUCH RISKIER THAN IS CURRENTLY KNOWN OR EVEN
A. Reported and Theorized Adverse Effects Are Vast and Varied
There have been numerous reports about adverse
effects. Reported adverse reactions are varied and include
moderate to severe brain damage and death
97,105,43,84,109,136,143b,146,149,156,163a,163b,165). These reactions
appear to be the result of toxins in the vaccines themselves
(65,106,109,110,152), as well as poor quality control of the product
(106,135,166). Also included in the many adverse reactions
reported is contracting the very disease the vaccine was supposed to
offer protection against (29,30,54,57,81,68,150), sometimes in a more
virulent form than occurs naturally (45).
It is easy to dismiss fears about long-term
unknown effects as paranoia. But legitimate concern is being
raised about long-term autoimmune diseases, abnormalities of the immune
system, and even cancer resulting from the use of vaccines
(166,171,97,109). The difficulties in proving long-term effects are
well known. Clinical evidence is slowly mounting, however, as was
the case with smoking and lung-cancer initially. There is
concern, for instance according to The London Times, 1987(177), that
AIDS may have been triggered by smallpox vaccine. To quote "The
Times": "Dr. Robert Gallo (SIC), who first identified the Aids
virus in the US, told "The Times": 'The link between the WHO programme
and the epidemic in Africa is an important and interesting
hypothesis. I cannot say that it actually happened, but I have
been saying for some years that the use of live vaccines such as that
used for smallpox can activate a dormant infection such as HIV.
No blame can be attached to WHO, but if the hypothesis is correct it is
a tragic situation and a warning that we cannot ignore.'"
It has been long known that a small percentage of
polio cases were "provoked" by the pertussis vaccine
(106). We can all hope that the fears about AIDS are groundless,
that "provocation polio" is an aberration, and that there are not other
equally worrisome ramifications of vaccination lurking around the
corner. But the need to keep an open mind and maintain vigilance
B. Current Vaccination Policy Is A Shotgun Approach To The
Problem of Infectious Diseases
Protecting children against relatively mild
childhood diseases only to leave them vulnerable to these diseases as
adults, when the diseases are frequently more serious (124,125), is an
example of how short-sighted these policies may be. No one knows
for sure how long protection is afforded (32,109,92,131). If
vaccines mimicked real diseases, immunity would be life-long for most
(109,121,124), and boosters would be unnecessary. Thus the price
our children may have to pay as adults, for the privilege of avoiding
these diseases, may be high.
One example of an innocuous childhood disease
for which there is mass vaccination is German measles or rubella
(124,122). Women who conceive and are not immune to rubella are
at risk of developing the disease in pregnancy. Some of these
pregnancies result in severe congenital abnormalities. But the
German measles vaccine is not administered to women of childbearing
age, nor do we know that it confers lifelong immunity (32). The
rubella vaccine also has a reasonably high failure rate (109).
Unless there is 100% eradication of the disease, a pregnant woman who
was vaccinated as a child and did not contract measles is more, not
less, vulnerable than one who was allowed an opportunity to get the
disease as a child (92). As Dr. Hugh Paul stated in "The Control
of Diseases"(124), before formulation of the rubella vaccine, "The
disease (rubella) cannot be prevented, and in view of its very mild
character, and the possibility that it may have catastrophic effects if
contracted by an expectant mother, it is questionable if it should be
prevented in childhood and adolescence even if this were
possible. It has been suggested that female children should be
deliberately exposed to infection in order to achieve a life-long
immunity from the disease and possibly from malformation in
the offspring in later life. This idea is not an
unreasonable one... Rubella does not kill, and even complications are
uncommon." Perhaps it would be more prudent to vaccinate only
pubescent schoolgirls, allowing those who wish to avoid vaccination to
take a blood test to ascertain whether or not they have acquired
natural immunity (35,109) than to require vaccinations of all children,
as is presently
Although it is now known that naturally
acquired immunity to rubella is not always lifelong, according to Dr.
Vincent Fulginiti, life-long immunity occurs far more often among the
naturally immune than the vaccine-immune (90-97.5% lifelong immunity
for naturally acquired vs. 20-97% for the vaccine-induced)(109).
The hard or red measles (rubeola) is an example
of a disease that generally is unpleasant, but not serious in healthy
children (102,121,68,125,124), yet which can be deadly serious for
adults. When this measles first hits a population, the adults
contracting it are hit very hard, with whole populations sometimes
being wiped out (122,124). It then settles into the population,
thereby effecting mostly children, since the adults have already been
exposed. Statistics that cite disturbing incidence rates for
encephalopathy and other adverse effects of measles, do not take into
consideration the general health status of the individual, and
socio-economic factors that have reduced disease severity, nor do they
give much weight to the vast incidence of problem-free
Compounding the problem is the fact that the
population most vulnerable to measles, infants, is least
protected. Vaccinating too early can cause vaccine failure more
often (36,101) and/or later booster shots to be ineffective (36,96).
The Catch-22 is that in the past, most mothers passed on
naturally acquired measles antibodies transplacentally to their
offspring who were protected until 6-9 months (124,99,48a). With
the advent of vaccines, a higher percentage of mothers will be
seronegative (have no antibodies) and will not pass those antibodies on
to their children, at precisely the time that the vaccines are not
effective, and yet the infant is most vulnerable (99,48a). On the
other hand, those who would ordinarily be better off receiving maternal
antibodies might find themselves in the untenable position of having
those very antibodies interfere with vaccine efficacy (36,100), with
the end-result that neither the vaccine nor the antibodies were
The MMR (measles, mumps, rubella) vaccine
probably does not confer lifelong immunity (109). What will
happen to our children when they become adults? The medical
community cannot possibly be confident that 100% eradication will occur
with routine childhood immunization and that our children are not going
to get seriously ill as adults (100). At a minimum, questions
like these require better answers before anyone is forced to be
vaccinated. These issues are barely being addressed in the
C. Unreliable Methods For Collecting and Analyzing Data Are Being
Used To Assess Vaccine Risk
At the current time only minimal information is
available about short-term, known, acute reactions, while no hard data
on long-term health and behavioral effects exists. To most accurately
assess all risk, controlled, human experiments would have to be
conducted. Of course, such experiments would not be considered
The next best approach would be to conduct
20-30+ year studies of matched groups (vaccinated vs. unvaccinated) in
which all problems, including even minor behavioral and learning
problems, would be recorded and compared. These have not been
done, nor are they in progress.
Current reporting methods, unlike the
aforementioned are fraught with bias and inaccuracies. First,
they depend upon accurate reporting. Second, they depend upon the
doctor or parent connecting a symptom with the vaccine. Third,
they usually compare vaccinated groups to each other rather than a
vaccinated group to an unvaccinated
group. In the "Report of the Task Force...(177)" for instance, a
study is cited in which immunization status is supposedly
considered. But upon closer examination, it becomes clear that
immunization status was not used; instead timing of immunization was
the factor. What if a large percentage of vaccine-associated
events occur after it is presumed they do not? The result will
dramatically effect conclusions.
In fact, no one knows the relevance of
time. Dr. Fulginiti, a well-known vaccine-use proponent, who has
edited the book "Immunization in Clinical Practice", says: "A
second confusing factor is the time relationship between vaccine
administration and adverse event. How long an interval is
possible in a vaccine-induced central nervous system infection or other
untoward effect? Strom recorded data on some patients who first
fell ill with neurological symptoms 1 week after receipt of
vaccine. Is that disease relatable to the vaccine?
Most experts accept an interval of 24 hours between vaccine and onset
of encephalopathy; a few suggest 2-3 days as an acceptable delay in
onset. But there is no proof for any interval."(109) Most studies
don't even make a pretense of controlling for immunization, instead
opting to use time or some other equally questionable variable.
It is not possible to predict the potential
intelligence, future health, etc., of a given child. Claims, for
instance, that a child has suffered no residual effects from a vaccine
and is normal based on observation are totally unfounded. The
only way to determine potential, be it intelligence or whatever, is to
study groups. When attempting to determine vaccine effects, those
groups must be unvaccinated vs. vaccinated, with the distribution of
The utter inadequacy of the reporting system,
for even the most obvious and serious effects, is accepted
(42,74,80,106), even by vaccine proponents (105,43,109). In the
U.S. there was no requirement to report adverse effects until recently,
but even making it mandatory cannot change the basic problem with a
reporting system of any kind. Furthermore, much of the analysis of
adverse effect rates uses the number of doses administered
(32,43,68,77,105,106,109,115,121,124,139,140,146,152,160), rather than
the number of children affected. Who cares how many doses it
takes to damage a child? What should be sought is data on how
many CHILDREN are harmed by a given vaccine, no matter how many doses
have been received. Using doses skews results in favor of lower
adverse effect rates for all multi-dose vaccines, and in the case of
pertussis, dramatically so, since 4- 5 doses are usually required.
These dose-related conclusions are made all the more insidious when
they are then compared to disease-related problems among
children. Even worse, in some known cases, reporting, as well as
follow-up, appears to have even been
discouraged (170). To quote P. Isacson (Progress in Medical
Virology, 13,263, 1971, cited in a 1972 "Science" article (166), "There
has been a tendency on the part of certain higher government circles to
play down any open discussion of problems associated with
vaccines...Perhaps this has been overdone. Scientists how
find themselves in the position of balancing the benefits of a vaccine
against the risks, yet are in no position to judge what the long-term
risks are." Thus current analytical and data collection methods
should be seriously questioned.
Where more effort is made to follow adverse
effects, the riskiness of one or more of the vaccines appears to
increase, although the totality of adverse effects is still unknown
II. THERE IS NO PROOF TO
THE CLAIM THAT UNVACCINATED PEOPLE THREATEN THE GENERAL PUBLIC
A major argument in favor of compulsory
vaccination is that the unvaccinated threaten the general public
health. However, if the vaccines work, they protect anyone
choosing to be vaccinated. Some people additionally claim,
nevertheless, that since there are vaccine failures, the unvaccinated
threaten those who try but fail to get protection. Even here,
however, there are mitigating effects: first, in at least one of the
more serious diseases, whooping cough, a vaccinated person who
contracts the disease will usually get a less serious form of the
disease. (105,62,32,43,46,51,68,78,106,121,134,135); second, vaccine
failure rates can be so high
(32,43,46,87,100,105,109,116,131,134,135,152) that one could question
the extent of any additional risk created by the unvaccinated.
Even proponents of achievement of so-called "herd immunity" admit that
nowhere near 100% compliance is necessary to result in protection to
the entire population, although at least 80% is usually advocated
There is virtually no threat posed by states
allowing philosophical exemptions. Five states provided their
rate of philosophical exemptions: California, Vermont, Ohio, Arizona,
and Wisconsin. Less than 1% took the exemption. Other
states provided overall compliance rates: Missouri, Minnesota,
Pennsylvania, and Delaware were all 98% or better, meaning
philosophical exemptions have to be less than 2%. Two other
states, Indiana and Oklahoma, were 97% or better, while none of the
reporting states were less than 91%(172,173,179). We know that
vaccine failure rates have been equal to or greater by far than the
philosophical exemption rates which are occurring. There is no
reason to assume the unvaccinated are totally responsible for disease
outbreaks unless vaccine proponents are unreasonably arguing that
vaccine failures do not contribute to them in any way. Surely no
one is arguing that, while a "vaccine failure" can catch a disease and
spread a disease, it cannot be the first one to get the disease in an
Besides, a disease doesn't START
anywhere. When public health officials cite the unvaccinated as
the source of an outbreak, they are being arbitrary. Where did
the alleged source catch the disease? Everyone gets these diseases from
someone. Outbreaks are not isolated events with some sort of
spontaneous (measles/pertussis/whatever) eruption at their source; they
are part of chains of events. Where one looks for the source will
determine what one finds. Where one stops will determine who is
There are a number of diseases that can be mild
enough that they would go unrecognized, particularly among the
vaccinated. Pertussis is a well-accepted example, as discussed
earlier. Measles has been noted to be milder among the vaccinated
as well (46). A very credible scenario would be to have, for
instance in the case of pertussis, a number of sub-clinical cases among
the vaccinated causing a full-blown recognized case in an unvaccinated
person. The blame could then easily be placed on the unvaccinated
with no concern about where THEY got the disease.
Let's examine the role of vaccine failure more
closely. It is commonly assumed that vaccine failure rates are
low - after all, there are few outbreaks of the diseases in question,
and what outbreaks have occurred are often attributed to the
unvaccinated few. When actual outbreaks have occurred, however, as high
as 80% of those contracting the disease have been reported to have been
vaccinated (174). Upon close inspection, the success rate of the
vaccines themselves must be questioned. Estimates of failure vary
widely (109,46,87,100,152,134,26,32,43,105), but it would appear that
to some extent, success rates are statistical illusions - as long as no
outbreaks occur, the vaccines appear to be working. By the same
token, however, being unvaccinated appears to be working as well.
Given these high failure rates among the vaccinated during disease
outbreaks, it is hardly reasonable to conclude that the unvaccinated
add any appreciable risk, especially in the small numbers seen in the
"philosophical exemption states".
Another concern raised by vaccine proponents is
fear that formerly vaccinated adults, whose immunity has waned, will
then be threatened by disease outbreaks. Those same adults can,
however, choose to be revaccinated in most cases. One exception
to that case is pertussis, which is not a safe vaccine for adults
(105,108,175). Pertussis is also not usually serious for adults,
however (106). In fact, the practical effect of waning vaccines
is to make formerly vaccinated adults contributors to disease outbreaks
(108,68,135). Had they acquired natural immunity, this would be
But what about pertussis and infants?
Isn't it true that pertussis is mostly a problem for them?
Shouldn't everyone be vaccinated to protect them? It is true that
most fatalities occur among infants under 1 year of age
(178,106). The vaccines are not recommended for use before 2
months of age, with protection sometimes not being conferred before the
third administration at 6 months. But a number of factors make
this a more complicated issue than would appear on the surface.
First, improvements in medical management,
especially the use of antibiotics, have enhanced our arsenal against
this disease. Antibiotics can, as stated in the "Task Force
Report"(178) and elsewhere, prevent further contagion, prevent serious
disease, particularly if timed right, and combat secondary infections
like pneumonia, which are the major cause of death in infants
contracting whooping cough.
Second, even if everyone under 6 were
vaccinated, infants would still be at risk. It is widely
acknowledged (108,175,105) that booster shots given to anyone 6-7 years
of age or older are not recommended because of the risks
involved. Because of the known seriousness pertussis can pose to
infants under 1 year of age, vaccinations are then given, but only to
children up to 6-7 years old. It is also widely accepted that
pertussis vaccine significantly loses its effectiveness over time
(135,109,108,131). With widespread waning immunity from pertussis
vaccine a fact of life, however, large reservoirs of susceptibles exist
in the older groups capable of infecting infants (108). Yet we do
not vaccinate these older groups because of the risks associated
with doing so. I have shown that the medical community has
no hard, reliable data to back up claims of low risk from the vaccine
to younger children. The most that can legitimately be said is
that although some short-term risks have been established, both
short-term and long-term risks are virtually unknown. It should
not be acceptable to force young children to face risks that are
unacceptable for older children and adults. The practical effect of not
revaccinating either group is to put infants at risk. But because
of unsubstantiated claims that the risks are low for children 6 and
children 6 and under are being asked to
shoulder the burden of protecting infants even though they cannot do it
alone. I am not suggesting that older children and adults now be
compromised. I submit, on the other hand, that the addition of
small numbers of unvaccinated young children to the already significant
pool of vaccine failures and larger pool of immunity-waned older
children and adults adds marginal increased risk.
III. MUCH OF THE CREDIT
FOR THE DECLINE IN DANGEROUS CONTAGIOUS DISEASES SHOULD GO TO
FACTORS OTHER THAN THE VACCINES
The benefits of vaccination are
over-rated since much of the decline in morbidity and mortality of the
diseases targeted by the vaccines occurred before the vaccines were
introduced (26,27,30,34,91a, 91b, 105,124,126,90,106,108).
Pro-vaccine reports will often begin around 1950 or later
(34,68,98,178), after declines were already in effect, thereby giving
unsubstantiated weight to the role of vaccines. As implied by the
declining death rate, severity of the illnesses also has diminished for
the unvaccinated (89,90,124).
Socioeconomic factors, including improved
health care and living conditions, have contributed dramatically to
both disease incidence and severity decreases
(26,55,58,90,121,126,85,51,98,108,113b, 119,121,124,135). Even
our previous inability to treat whooping cough has been aided in
particular by antibiotic therapy aimed at secondary infections like
pneumonia (105,118,78,91a, 121,134,135), which is a primary factor in
pertussis mortality if left untreated (107,106,152,124), and
improvements in hospital care for the seriously ill (105,106,25).
Perhaps even more important, it would appear
that a well-organized effort to control the spread of whooping cough
could be effective since certain antibiotics like erythromycin given to
an identified whooping cough victim will prevent the spread of disease
to others (107,108,120,121,117,134), and
erythromycin given to an exposed person before the paroxysmal stage can
actually prevent the disease in the treated individual
(120,117,118). The "Task Force"(178) reports that erythromycin
even given during the paroxysmal stage has been shown to reduce
symptoms, contrary to popular belief. Hence widespread,
uncontrolled spread of whooping cough could be a thing of the past
without the risks associated with the vaccine and moral dilemmas posed
by making it compulsory.
Two prominent examples of diseases, which have
decreased dramatically without the aid of vaccines, are scarlet fever
and TB. Scarlet fever is no longer the scourge it once was
(103,122,126). There is no vaccine for it, but if there were, the
vaccine probably would be given credit for a decline it had nothing to
do with. In most places, where the general health of the
population is good, TB is no longer a problem either
(122,123,124,126,59,129). What would have happened had there been
a TB vaccine? Sometimes the conditions the world used to face are
forgotten - no toilets, unclean water, lack of refrigeration, crowding,
lack of heat, poor nutrition, etc. Where those conditions and/or
others still exist, for instance in parts of rural Alaska vis à
vis TB, disease morbidity and mortality increase. But those
conditions in Alaska, for instance, have existed for a long time, and
yet do not pose a threat to the general population, because the general
population does not face those conditions.
IV. MUCH IS UNKNOWN ABOUT
THE MECHANISMS UNDERLYING VACCINE PROTECTION
How vaccines work is not truly understood
(109). When a human being contracts most of the diseases for
which there are vaccines, lifelong immunity occurs. With the
vaccines, boosters are needed and adults may go
How well vaccines work is also not clear since,
as discussed in section II, varying percentages of the vaccinated can
contract the disease, and varying percentages of the ill have been
vaccinated (3,46,85,86,87,98,101,169,95,108,147). Nowhere near
100% of the vaccinated are protected. For example, Dr. Stephen A.
Hoffman, an expert on infectious diseases at Harvard University, and a
proponent of vaccines writes (130), "In the majority of recent
(measles) cases , the administered vaccine apparently never took hold
in the first place. This suggests that our ability to wipe out
measles may, after all, be limited by a built-in failure rate of the
vaccine itself." In the first 26 weeks of 1985, according to the
Centers for Disease Control (174), 80% of those between the ages of 16
months and 28 years who contracted measles were vaccinated; in
1986(147), 57% from 16 months on up had been vaccinated.
V. POLICY THAT MAKES
VACCINATIONS COMPULSORY IS UNJUST AND UNWISE
Since anyone who wishes to be vaccinated
has the right to do so, and built-in vaccine failures insure that the
diseases remain in the population, no one can unequivocally argue that
the unvaccinated appreciably affect the vaccinated. I would like
to include some of the testimony made to Congress in 1962 by Clinton R.
Miller of the National Health Federation because he so eloquently
framed this issue in the context of history.
"The only time (NHF) would feel justified in
violating an American's exercise of choice in matters of health would
be when such exercise of freedom violated the equal right of
another. Clearly at the present time no one is denied vaccination
for themselves or their children if they desire it. Therefore,
citizens who exercise their freedom of choice by choosing not to be
vaccinated are not denying an equal right to another by the exercise of
This principle of freedom is a superior and more fundamental
consideration than that of vaccination. There are those people
who so stoutly believe in the principle of vaccination that their
enthusiasm leads them to an intolerance of anyone who just as stoutly
does not believe in
Those who believe in freedom of choice in matters of politics,
religion, and health, emphasize that minority views of one generation
become majority views of another. History has a wonderful lesson
to teach us here if we will learn it. History will record a man
of one age as a wise man, even though subsequent research might prove
his theories to be in error, if he refrained from force of any kind in
sharing of his beliefs with his disciples and contemporaries. But
it will record the same man with the same theories as a fool or a
tyrant, who uses, or allows to be used, force of any kind- not the
least of which is governmental force - to gain acceptance for his
Humility about the extent of one's knowledge, or of the
collective knowledge of any age is always the
mark of greatness, progress, and understanding....
Dr. Benjamin Rush, a signer of the Declaration of Independence,
and Congressman is quoted as saying 'The
Constitution of the Republic should make provision for medical freedom
as well as for religious freedom.... All such laws’ (which restrict
health choices)'are un-American and despotic. They are fragments
of monarchy and have no place in a Republic'.
.... We maintain that this right was implied, if not written.... But
the fact is that it was not written, and we are left to argue that it
was certainly implied.
At the time Benjamin Rush made this plea, it was argued that this
'right' was assumed by the guaranteed freedom of religion and didn't
need to be codified…Incidentally, Dr. Rush was a strong believer in
vaccination theories of Jenner, but emphasized the greater need for
freedom in all health matters (104)”.
VI. MOST OF THE FREE WORLD HONORS THESE PARENTAL RIGHTS
As of August 1987, 22 states allowed for
personal or philosophical exemptions. Indeed, but for the former
communist-bloc countries, most of the world does not deny this basic
right. The following countries compulsory vaccination laws:
the Eastern block nations (Albania, Bulgaria, Hungary, East Germany,
Czechoslovakia, Poland, Romania, U.S.S.R., and Yugoslavia) as well as
the Bahamas, Bolivia, Brazil, Costa Rica, Ecuador, Granada, Mexico,
Peru (93), and about 28 states in the U.S. Obviously, allowing
for this exemption is not a radical notion. I would like Alaska to join
the many U.S. states and free world,
which currently allows for a choice.
VII. IN A FREE SOCIETY IT
IS PARENTS, AND NOT THE GOVERNMENT, WHO SHOULD DECIDE
AMONG REASONABLE RISKS FOR THEIR CHILDREN
The state should not have the right to force a
child to have a potentially harmful vaccine, no matter how
statistically remote the possibility. Reasonable people can argue
which is riskier for an individual child, the vaccines, or the diseases
they are designed to prevent. In places where the standard of
living is high and adverse effects conscientiously reported, arguments
have been made to support the contention that the risks from the
vaccines approach that of the disease (80,90). But even if the
vaccines in general are safer, for a particular child they may not
be. No one, not even public health proponents of compulsory
vaccination, is arguing that vaccines do not harm individual children,
only that the general public good is served by vaccination. The
argument regarding general public good has been addressed and I think
shown to be weak. There is incontrovertible evidence that
vaccines harm individual children. It is the parent, not the
state, who should be allowed to choose risk for an individual
VIII. HISTORY MUST NOT BE
If government is going to force people to
put known toxins into their bodies, they have a tremendous
responsibility to be absolutely right. Of course that is not
possible. History is filled with examples of medical procedures
which were touted at one time, with nary a dissenting voice, which were
later totally discredited. Examples are routine tonsillectomies,
appendectomies, hysterectomies, X-rays and Cesarean sections.
X-ray pelvimetry during pregnancy, DES, the original Salk vaccine, the
killed-cell virus measles vaccine and swine flu shots are additional
examples of now defunct or largely discredited medical
approaches. Actual dangers of procedures have often been utterly
denied, radiation being a most glaring example, only much later to be
admitted, leaving many damaged health-care consumers. Where is
our sense of humility and history? While there is nothing wrong
with a medical professional informing a person about all sides of an
issue, giving his or her opinion based on personal evaluation of
current knowledge, and getting consent to proceed according to a
certain plan, there is something terribly wrong about forcing
individuals to comply.
If physicians and government saw themselves as
providers of information and respectfully deferred the decision-making
to willing patients, I submit that fewer malpractice suits would be
brought. One cannot insist upon taking responsibility for a
decision and reasonably deny responsibility for the outcome.
Obviously, the point of all this is not that
anything has been proved here or elsewhere on the scientific level, but
that reasonable people can disagree on this issue. In a free
society, reasonable disagreement on matters of conscience and health
should be honored.
*Interestingly enough, although mumps is not
required, neither the schools nor pediatricians are forthcoming with
information to that effect: school health forms which must be
submitted to the state and which indicate student vaccination histories
list measles-mumps-rubella (MMR) only and pediatricians do not inform
parents that the mumps vaccine is optional.
**The following states allowed the exemption as
of August 1987: Arizona, California, Colorado, Delaware, Idaho,
Indiana, Louisiana, Maine, Michigan, Minnesota, Missouri, Montana,
Nebraska, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island,
Utah, Vermont, Washington and Wisconsin. (Click
here for the for more up-to-date exemption information)
Note: There are approximately 115
references in all. The reason they are not numbered consecutively
is that many of the articles were removed prior to finalization of the
paper, but the corrections to the numbering were never made. The
references in the paper, insofar as they refer to articles below,
however, are correct. Links to PubMed or other links will be made
where they exist.
20. Toomey, James A. Reactions to
pertussis vaccine. JAMA (Feb 12)1949,:448-450.
22. Anderson, Roy M. & May, Robert
and herd immunity to infectious diseases. Nature
25. Harris, F., Bush, G. & Lewis,
Margo. (letter) The Lancet (Sept 1)1979, 472-473.
26. Bassili, W.R. & Stewart,
evaluation of immunisation and other factors in the control of whooping
cough. The Lancet (Feb 28)1976,471-474.
27. Miller,C.L., Pollock, T.M.&
vaccination: an assessment. The Lancet (Aug 31)1974,510-513.
29. Terry, Luther L., Goddard, James L.,
et al. Oral poliomyelitis vaccines: report of special advisory
committee on oral poliomyelitis vaccines to the Surgeon General of the
Public Health Service. JAMA 190:1 (Oct 5)
30. Henderson, Donald A., Witte, John J.,
Morris, Leo & Langmuir, Alexander D.
Paralytic disease associated with oral polio vaccines. JAMA
32. Burgess, Margaret A.
on immunisation for measles, mumps, rubella and pertussis.
Austr Fam Phys 15:4(April)1986,449-453.
34. Bloch, Alan B., Orenstein, Walter
impact of measles vaccination in the United States.
35. Edmond, Elizabeth & Zealley,
impact of a rubella prevention policy on the outcome of rubella in
pregnancy. Br J Obst Gyn 93(June) 1986,563-567.
36. Wilkins, Jeanette & Wehrle, Paul
against measles vaccine administration to infants less than 12 months
of age: altered immune response following active/passive
42. Kulenkampff, M., Schwartzman, J.S.,
& Wilson, J.
complications of pertussis inoculation. Arch Dis Child
surveillance, 1979-1981. MMWR,31:25(July 2)1982,333-336.
44. Byers, Randolph K. & Moll,
following prophylactic pertussis vaccine. Pediatrics,1:4(April)1948,437-457.
45. Fulginiti, Vincent A. & Helfer,
measles in adolescent sibling 16 years after killed measles virus
vaccine. JAMA 244:8 (Aug 22/29)1980,804-806.
46. Bell, T.M.,Tukei, P.M., et al.
Investigation of the
effectiveness of measles vaccination in children in Kenya.
Journal of Hygiene, 95,1985, 695-702.
47. Anderson, R.M. & Grenfell, B.T.
of congenital rubella by mass vaccination. The Lancet
48a. Narod, S. (letter)
in Haiti. New Engl J Med 314:9(Feb 27)1986,581-582.
49. Ehrengut, W. (letter) Central nervous
system sequelae of vaccination. The Lancet (May 31)1986,1275-1276.
51. Nicoll, Angus.
to measles and whooping cough vaccination: reality and mythology.
The Practitioner 230(June) 1986,593-597.
53. Amsel, S.G., Hanakoglu, A., Fried,
D., & Wolyvovics, M.
after triple immunisation. Arch Dis Child
54. Leake, J.P. Poliomyelitis
following vaccination against this disease. JAMA (Dec 28)1935,2152.
55. Halsey, Neal A., Modlin, John F., et
Risk factors in
subacute sclerosing panencephalitis: a case-control study. Am
J Epidem 111:4, 1980,415-424.
57. Boffey, Philip M.
challenges safety of Sabin's live-virus vaccine. Science,
58. Cassel, John M. Potentialities
and limitations of epidemiology. Health and the Community:
Readings in the Philosophy and Sciences of Public Health. Katz,
Alfred H. & Felton, Jean Spencer. The Free Press, 432-445.
59. Basch, Paul F. International
Health. New York, Oxford University Press, 1978, 241.
60. Chin, James, Werner, S.B., Kusumoto,
Howard H., & Lennette, Edwin H.
of rubella immunization in children. Cal Med
62. Committee on Infectious
Diseases. Pertussis vaccine. Pediatrics,74:2
63. Kilroy, Anthony W., Schaffner,
William, et al.
following rubella immunization: clinical observations and
epidemiological studies. JAMA 214:13(Dec 28)1970,2287-2292.
64. Cho, Cheng T., Lansky, Lester J.,
& D'Souza, Bernard J. (letter)
following measles vaccination. JAMA 224:9(May 28)1973,1299.
65. Blumstein, George I. & Kreithen,
neuropathy following tetanus toxoid administration. JAMA
66. Reinstein, Leon, Pargament, Jeffrey
M. & Goodman, Jay S.
neuropathy after multiple tetanus toxoid injections. Arch
Phys Med Rehabil 63(July)1982,332-334.
67. Marshall, Gary S., Wright, Peter F.,
Fenichel, Gerald M., & Karzon, David T.
following measles, mumps and rubella vaccination. Pediatrics
68. Rutledge, S. Lane & Snead III, O.
complications of immunizations. J Pediatr
69. Globus, Joseph H. & Kohn, Jerome
L. Encephalopathy following pertussis vaccine prophylaxis.
JAMA 141(Oct 22)1949,507-509.
70. Cody, Christopher L., Baraff, Larry
J. et al.
Nature and rates of
adverse reactions associated with DTP and DT immunizations in infants
and children. Pediatrics 68:5(Nov)1981,650-660.
71. Holliday, Patti & Bauer, Raymond
B. Polyradiculoneuritis secondary to immunization with tetanus
and diphteria toxoids. Arch Neur 40(Jan)1983,56-57.
73. Kazarian, Edward l. & Gager,
complicating measles, mumps and rubella vaccination. Am J
74. Gaebler, John W., Kleiman, Martin G.,
complications in oral polio vaccine recipients. J Pediatr
75. Spruance, S.L., Klock Jr., L.E., et
symptoms in children vaccinated with HPV-77DK12 rubella vaccine.
J Pediatrics 80:3(March)1972,413-417.
76. Gilmartin, Jr., Richard C., Jabbour,
J.T., & Duenas, D.A. Rubella vaccine
myeloradiculoneuritis. J Pediatr 80:3(March)1972,406-412.
77. Miller, D.L., Ross, E.M., et
immunisation and serious acute neurological illness in children.
Br Med J 282(May 16)1981, 1595-1599.
78. Miller, Christine L. & Fletcher,
of notified whooping cough. Br Med J (Jan 17)1976,117-120.
79. Thursby-Pelham, D.C. & Giles,
C. Neurological complications of pertussis immunization.
(letter) Br Med J (July 26)1958,246.
80. Strom, Justus.
experience of reactions, especially of a cerebral nature, in conjuction
with triple vaccination: a study based on vaccinations in Sweden
1959-1965. Br Med J (Nov.11)1967,320-323.
81. Ogra, Pearay L. & Faden,
vaccines: live or dead. J Pediatr
84. Landrigan, Philip J. & Witte,
disorders following live measles-virus vaccination. JAMA
85. Stewart, Gordon T.
cough and pertussis vaccine. Br Med J 287(July 23)1983,287-289.
86. Pachman, Daniel J. (letter)
occurring in previously vaccinated adolescents. AJDC
87. Gustafson, Tracy L., Lievens, Alan W.
Measles outbreak in
a fully immunized secondary-school population. New Engl J Med
89. Taranger, John. (letter)
Mild clinical course
of pertussis in Swedish infants today. The Lancet
90. Strom, Justus. Is universal
vaccination against pertussis always justified? Br Med J (Oct
91a. Barrie, Herbert. (letter)
of terror. Am J Dis Child 137(Sept) 1983,922-923.
91b. Fulginiti, Vincent A. (letter)
Letter from the editor. Am J Dis Child 137(Sept)1983,923.
92. Proudfoot, Alex. (letter)
Med J Austr 146(Jan 19)1987,119.
93. Noah, Norman D.
before school entry: should there be a law? Br Med J 294(May
94. Chaiken, Barry P., Williams, Neil M.,
The effect of a
school entry law on mumps activity in a school district. JAMA
257:18(May 8)1987, 2455-2458.
96. Linnemann, Calvin C., Dine, Mark S.,
after revaccination: results in children vaccinated before 10 months of
age. Pediatrics 69:3(March)1982,332-335.
97. Eibl, Martha M., Mannhalter, Josef
W., & Zlabinger, Gerhard. (letter) Abnormal t-lymphocyte
subpopulations in healthy subjects after tetanus booster immunization.
New Engl J Med 310:3(Jan.19)1984,198-199.
98. Hardy, Jr., George E., Kassanoff,
Hyman G., et al.
The failure of
a school immunization campaign to terminate an urban epidemic of
measles. Am J Epidem 91:3,1970,286-293
99. Dickson, Nigel. (letter)
Measles. New Zeal Med J (July 8)1987,424.
100. Tobias, Martin.
Measles immunity in
children: the 1985 national immunisation survey. New Zeal Med
J (May 27)1987,315-317.
101. Addiss, David G., Berg, Jeffrey L., &
Davis, Jeffrey P. Revaccination of
previously vaccinated siblings of children with measles during an
outbreak. J Infect Dis 157:3(March)1988,610-611.
102. Top, Sr., Franklin H. et al Communicable
and Infectious Diseases: Diagnosis, Prevention and Treatment. Saint
Louis, The C.V.Mosby Company,1968,20.
103. Shaw, Edward B.
happened to the "old-time" infections. (letter) JAMA
104. Hearings before the Committee on
Interstate and Foreign Commerce, House of Representatives, 87th
Congress, Second Session on H.R. 10541. Conducted May 15&16, 1962.
105. Cherry, James D.
epidemiology of pertussis and pertussis immunization in the United
Kingdom and the United States: a comparative study. Curr Prob
106. Miller, D.L., Alderslade, R., & Ross,
cough and whooping cough vaccine: the risks and benefits debate.
Epidem Rev 4,1982,1-24.
107. Nelson, John D.
treatment of pertussis. Pediatrics 44:4(Oct)1969,474-476.
108. Nelson, John D.
changing epidemiology of pertussis in young infants. The role of adults
as reservoirs of infection. Am J Dis Child 132(April)1978,371-373.
109. Fulginiti, Vincent A.
in current immunization policy and practices: one physician's viewpoint.
Curr Prob Pediatr 6:6(April)1976,1-35.
110. Fulginiti, Vincent A.
disease, vaccine, and controversy. JAMA 251:2(Jan 13)1984,251.
113b.Hull, Harry. (letter) The Lancet
115. Gonzalez, Elizabeth Rasche.
TV report on DPT
galvanizes US pediatricians. JAMA 248:1(July 2)1982,12-22.
116. Hinman, Alan R. & Koplan, Jeffrey P.
pertussis vaccine: reanalysis of benefits, risks, and costs.
JAMA 251:23(June 15)1984, 3109-3113.
117. Baraff, Larry J., Wilkins, Jeanette, and
Wehrle, Paul F. The role of
antibiotics, immunizations, and adenoviruses in pertussis.
118. Ames, Rose G., Cohen, Sophia M., et
of the therapeutic efficacy of four agents in pertussis.
119. Modlin, John F., Jabbour, J.T., Witte,
John J., & Halsey, Neal A.
studies of measles, measles vaccine, and subacute sclerosing
panencephalitis. Pediatrics 59:4(April)1977,505-512.
120. Altemeier,III, W.A. & Ayoub,
prophylaxis for pertussis. Pediatrics 59:4(April)1977,623-625.
121. Krugman, Saul, Katz, Samuel L., Gershon,
Anne A., & Wilfert, Catherine M. Infectious Diseases of
Children. The C.V.Mosby Company, 1985.
122. Ackerknecht, Erwin H. History and
Geography of the Most Important Diseases. Hafner Publishing
123. Winslow, Charles-Edward Amory. The
Conquest of Epidemic Disease, A Chapter in the History of Ideas.
Hafner Publishing Company, 1967.
124. Paul, Hugh. The Control of Diseases
(Social and Communicable) The Williams and Wilkins Company, 1964.
125. Moffet, Hugh L. Pediatric Infectious
Diseases, a Problem-Oriented Approach. J.B.Lippincott Company,
126. Illich, Ivan. Medical Nemesis.
Pantheon Books, 1976.
127. Chaitow, Leon. Vaccination and
Immunization: Dangers, Delusions and Alternatives (What Every Parent
Should Know). The C.W.Daniel Company Limited, 1988.
128. Coulter, Harris L. & Fisher, Barbara
Loe. DPT*A Shot in the Dark.Warner Books,1985.
129. Lerner, Monroe & Anderson, Odin
W. Health Progress in the United States: 1900-1960. The
University of Chicago Press, 1967.
130. Hoffman, Stephen A. Comeback
diseases: why cholera, TB, syphilis and a host of "vanquished" bugs are
creeping back. Am Health (Dec)1988, 51-55.
131. Jenkinson, Douglas.
of effectiveness of pertussis vaccine: evidence from a 10 year
community study. Br Med J 296(Feb 27)1988, 612-614.
133. Dyer, Clare.
vaccine on trial again. Br Med J 295(Oct 24) 1987,1053-1054.
134. Fulginiti, Vincent A. & Ray, C.
pertussis - still with us. AJDC 139(July)1985,656.
135. Fine, Paul E. & Clarkson, Jacqueline
on the efficacy of pertussis vaccines. Rev Infect Dis
136. Illingworth, Ronald. (letter)
Skin rashes after
triple vaccine. Arch Dis Child 62(Sept)1987,979.
139. Committee on Infectious Diseases,
Family history of
convulsions in candidates for immunization with pertussis-containing
vaccines (diptheria, tetanus, pertussis). Pediatrics
140. Walker, Alexander M., Jick, Hershel, et
events following diptheria-tetanus-pertussis immunization.
143b.Wilkins, Jeanette. (letter) What is
'significant' and DTP reactions. Pediatrics
146. Church, Joseph A. & Richards,
formation following DTP immunizations: association with
hypersensitivity to tetanus toxoid. Pediatrics
States, first 26 weeks, 1986. MMWR 35:33(Aug 22)1986,525-533.
149. Hanebert, Bjorn, Matre, Roald, et
hemolytic anemia related to diphtheria-pertussis-tetanus vaccination.
Acta Paediatr Scand 67, 1978,345-350.
Trends Paralytic Poliomyelitis - United States, 1982 and 1983. MMWR
152. McAuliffe, Janet & Wadland, William
156. Lewis, Karen, Jordan, Stanley C., et
urticaria after DTP vaccination: detection of circulating immune
complexes containing vaccine-specific antigens. J
160. Mortimer, Jr. Edward A. (editorial)
DTP and SIDS: when
data differ. AJPH 77:8(Aug)1987,925-926.
163a.Rasch, Deborah K., Wells, Oralia, &
Fowles, John. (letter) Fatal disseminated
infection due to poliovirus type 2 vaccine. AJDC
163b.Chonmaitree, Tasnee & Lucia,
vaccine-strain poliovirus in cerebrospinal fluid of patient with
near-miss sudden infant death syndrome. AJDC
165. Denning, D.W., Peet, L., & Poole,
Skin rash after
triple vaccine. Arch Dis Child 62,1987,519-511.
166. Wade, Nicholas.
biologics standards: the boat that never rocked. Science
169. Stewart, Gordon T. (letter)
cough in Hertfordshire. The Lancet (Sept 1)1979,473-474.
170. see 128
171. see 127
172. Pels, Ivan. Dept. of Health,
Immunization Program, Epidemiology Division, State of Vermont.
Letter indicating exemption rate in Vermont.
173. State of California. Statistics
showing rate of personal exemption for 1989.
Trends Measles - United States, First 26 weeks, 1985. MMWR
35:1,(Jan 10)1986, 1-4.
175. Linnemann, C.C., Jr., Ramundo, N.,
Perlstein, P.H., et al. Use of pertussis
vaccine in an epidemic involving hospital staff. Lancet (Sept
176. Mortimer, Edward A., Jr.
immunization: problems, perspectives, prospects. Hosp Pract
177. Wright, Pearce. Smallpox vaccine
'triggered Aids virus'. London Times (May 11)1987.
178. Cherry, James D., Brunell, Philip A., et
of the task force on pertussis and pertussis immunization - 1988.
American Academy of Pediatrics 81:6:2(June)1988, 939-984.
179. Letters from the other 15 states allowing