By Richard Moskowitz, M. D.
1. Specific Effects of Specific Vaccines
DPT and SIDS.
MMR and Autism.
Hepatitis B and Auto-Immune Diseases.
2. Nonspecific Effects of the Vaccination Process in General.
Making the Connection: Childhood Ear Infections.
Making Worse What’s Already There: the Common Diseases of Childhood.
Nonspecific Reactions: any Vaccine Will Do.
3. How Vaccines Work: A Preliminary Hypothesis..
Natural Immunity: Absolute, Qualitative, and Lifelong.
Artificial or Vaccine-Induced Immunity: Relative, Partial, and Temporary.
Clinical and Epidemiological Studies of Vaccine Efficacy.
4. Some Individual Vaccines.
Hæmophilus Influenzæ B (HiB).
Anthrax and Bioterrorism.
5. Implications for Health Policy.
The More, the Merrier.
A Sacrament of Modern Medicine.
Toward a More Comprehensive Model of Biomedical Research.
Vaccine Laws and Exemptions.
Cost-Benefit Analysis and the “Bottom Line.”
Thirty-five years of medical practice have convinced me that all vaccines carry an important risk of chronic disease that is inherent in the vaccination process and indeed central to how they work. Yet the growing concerns of parents and legislators and media reports about them rarely if ever elicit anything beyond automatic denials by medical and public health authorities alike. Reflecting on this glaring discrepancy is the main focus of this essay. Writing these lines has also helped me appreciate how much the invisibility heightens the risk and how intimately these phenomena are connected, like mirror-images of the same reality, which makes it imperative to study them together.
Since I am mainly a clinician, I will begin with a story. It concerns a 12-year-old boy whom I know of solely from his mother’s letter, but her words are so heartfelt and so congruent with the rest of my experience that I cannot doubt their veracity:
My son Adam was healthy until his first MMR at 15 months. Within 2 weeks he had flu and cold symptoms, which persisted for 6 weeks, his eyes became puffy, and he was hospitalized with nephrotic syndrome. A renal biopsy showed “focal sclerosing glomerulonephritis,” but he didn’t respond to steroids. I asked if it could be related to the vaccine, but they told me it couldn’t, and we accepted that. Over the next 4 years he was hospitalized repeatedly but then went into remission, seeming normal and healthy and staying off all medications for 5 years.
When he turned 10, his pediatrician recommended a booster, saying that a rise in measles cases made it dangerous for him not to be protected. I checked the PDR and other sources but found no warning for kidney disease and no listing of it as an adverse reaction, so I agreed to it. In less than 2 weeks he relapsed, with 4+ proteinuria, swelling, and weight gain, signs that we recognized immediately. He was admitted in hypertensive crisis, with blood in the urine, fluid in the lungs, and massive weight gain. On Cytoxan, massive doses of Prednisone, and three other drugs he slowly improved, but missed another 7 months of school.
It’s been 2 years since that horrible episode, and he still needs Captopril for high blood pressure and spills 4+ protein every day. The doctor says he sustained major kidney damage, will always need medication to control his blood pressure, and will worsen as he grows, necessitating a transplant eventually. This time I was convinced that his condition was related to the vaccine, but still the doctors didn’t take me seriously and told me it was a coincidence.
I searched for information and even contacted the manufacturer of the vaccine. Finally they sent me two case reports of nephrotic syndrome following the MMR vaccine. It’s very difficult for lay people to get information or even ask questions, since we don’t use correct medical terms and feel stupid. Please tell me if my ideas are reasonable. I don’t think my son could tolerate another episode, and I think he’d have normal blood pressure and kidney function if not for that second shot.
I also have great concern for other children who develop nephrotic syndrome some weeks after receiving MMR and whose doctors never make the connection. They could all be at great risk if revaccinated. I realize that this letter has taken up a lot of your time, and I’d appreciate any help you can give me. Thank you.1
Like many others who seek my help, this woman honestly believed that her son had been crippled for life by the MMR vaccine, yet had no intention of suing the drug company who manufactured it, the doctors who administered it, or the Government’s Vaccine Injury Compensation program, as she was entitled to do. Whether she didn’t think she could win, a conclusion my experience would certainly justify, or simply was not a litigious person, as seems more relevant in her case, the absence of such motive only lends further credence to her story. She was writing to me simply to find a physician to hear and validate the truth of her experience, which neither the pediatrician who gave the shots, nor the specialists who treated Adam in the hospital, nor any of the other doctors she spoke to were willing to do. Although I had very little else to offer her, it was more than enough to earn her gratitude.
To those inclined to discredit such tales, I reply that the confidences our patients entrust to us represent the truth as they live it. Yet when vaccines are involved, such stories are routinely dismissed out of hand, as if they couldn’t possibly be true or worthy of serious consideration. That was the reaction of every doctor involved in Adam’s care, despite compelling evidence to the contrary, even after case reports were supplied by the drug company itself. Whether a canny strategy to defeat possible litigation or simply the instinctive shielding of a cherished world-view from threat of change, this defensive and hostile stance is so pervasive in the medical profession as to merit careful study in itself.
Richard Horton, Editor of The Lancet, felt the sting of censorship himself after publishing an article linking cases of infantile autism and colitis to the MMR vaccine:
Today vaccines are largely an untouchable subject, their benefits too obvious to be questioned. Any hint of dissent concerning their clinical effectiveness and overall social value is met with bitter rebuttal and resentment. A former President of the UK Academy of Medical Science actually threatened to get me sacked for publishing work that raised questions about the MMR vaccine, while at a dinner party years later, the partner of a government vaccine specialist asked, “Will you ever be forgiven?” Forgiven for what, I wondered?2
Dr. Horton himself neither believed in the research nor endorsed its conclusions. His only “mistake,” if mistake it was, lay in permitting the author, a well-known British gastroenterologist, to publish his findings without regard for their political correctness. Needless to say, the snubs and threats he faced for rocking the boat were less serious than the reprisals exacted against the author, whose work was officially repudiated without testing it, and whose career at a London teaching hospital was abruptly terminated.3
Finally, Adam’s misfortune obliges us to ask how “glomerulonephritis,” “autism,” “encephalopathy,” or any other disease gets to be identified as a bona fide complication of a vaccine, such that the victim becomes eligible to receive damages in court. In spite of two reports of MMR nephritis documented by the manufacturer, renal failure is still not recognized as an adverse effect of the vaccine, an omission that undoubtedly helped Adam’s doctors to frustrate his mother’s inquiries.
Exactly similar editing characterizes the Federal guidelines for compensation of vaccine-injured patients, which would never have been enacted in the first place without the repeated insistence of their parents, and which continue to be pared down even further by the determined opposition of the vaccine manufacturers, the American Academy of Pediatrics, and other authoritative and influential pro-vaccine groups. As reflected in the official compensation guidelines, research studies of vaccine-related injuries are limited to a few extreme reactions to particular vaccines, because these alone occur often enough to attain statistical significance in large populations. Such a policy automatically disquallifies two much larger and partly overlapping classes of phenomena that my own research has uncovered: 1) exacerbation of the ordinary chronic diseases of childhood, according to individual susceptibility, often representing 2) a nonspecific effect of the vaccination process in general, for which any vaccine will do. Restricting the issue of vaccine safety to specific effects of specific vaccines is a major reason why the true extent of vaccine-related illness has always been invisible and will likely remain so until the question is reframed in a more comprehensive way.
An equally troubling problem with the approved list of vaccine-related injuries is their restriction in time to acute events occurring within a few days afterward,4 i. e., soon enough for the vaccine to be regarded as the necessary and sufficient cause of the reaction, as if independently of any prior susceptibility. In Adam’s case as in many others, vague, nondescript symptoms appeared soon after vaccination, but the full picture of nephritis did not emerge and could not be diagnosed until six weeks after the first shot and two weeks after the second, by which time it was no longer an acute or fixed injury, but already a chronic, self-sustaining illness that has continued to develop and worsen over the years, so that a claim on his behalf would undoubtedly have been rejected even if it had been filed.
In what follows I will consider five aspects of the vaccine issue: 1) specific effects of specific vaccines, as described in the literature; 2) nonspecific effects of the vaccination process, based on cases from my own practice; 3) how vaccines actually work; 4) several individual vaccines; and 5) implications for vaccine and health policy.
1. Specific Effects of Specific Vaccines.
The vaccination literature contains no mention of adverse effects of the process itself, but only a few documented effects of specific vaccines, such as encephalopathy, autism, anaphylaxis, and so forth, most still hotly contested by authorities in the field. Even those officially recognized as legitimate grounds for compensation under the Federal guidelines are actually vague, generic terms that are applicable to more than one vaccine. Anaphylaxis, for example, is compensable not only for DPT and its components but also for MMR, and will undoubtedly implicate some or all of the newer vaccines in the future.
This all-purpose diagnostic category was the first adverse reaction to be identified and made compensable under the Vaccine Injury Compensation Act of 1986, which it also helped bring about, and is by far the most extensively documented. Here is the story of a 3-year-old girl whose mother wrote to me for support of her mother’s pending litigation against the child’s doctors and the Canadian government:
Our daughter was damaged by her 18-month vaccination, which consisted of the DPT, HiB, and oral polio vaccines. One week later she had a bizarre screaming episode, and is now labeled “autistic.” An MRI showed brain inflammation and demyelination. She had 25 words at 18 months and was ahead in some developmental milestones as well as being quite social. After her screaming episode she stopped talking, ignored the neighborhood kids, made no eye contact, and developed hand-flapping and other repetitive behaviors. Her pediatrician agreed that she was autistic, and we told the specialist that she changed abruptly after the vaccine, and showed him a video of her as an infant and toddler, in which she seemed totally normal. From photos taken before and after, the damage is obvious: her eyes have lost their gleam, and she looks sad and alone, but the doctors dismissed it as a coincidence, and no mention of any vaccine was ever included in their reports.5
Leaving aside the extremity of her misfortune and the refusal of her doctors to accept any responsibility for it, I call attention to her diagnoses, chiefly “encephalopathy,” a synonym for “brain damage,” and the equally vague term “autism,” which today is linked more commonly with the MMR vaccine. Both her sad tale and the necessity of fixing a label to it indicate that these are merely broad, generic, and often interchangeable categories, referring to conditions that can result from several different vaccines, rather than being characteristic of any particular one.
Here is another case, from the lawyer who represented him, a 3-year-old boy who reacted badly to his first DPT and suffered permanent brain damage after the second:
Our firm represents a child who was born normal and healthy in every way. After the first DPT at 6 weeks, he began falling off growth charts, exhhibited multiple developmental delays, and was diagnosed as “failure to thrive,” but then slowly began to recover. At 5 months he received a second DPT, and his delays became much more extreme. He has never recovered. He is now 3 years old, with the mental capacity of an infant of a year and a half. I am convinced that his problems came about as a result of the DPT. In view of what happened after the first shot, he should not have had the second, or at least the pertussis component of it.6
This tragic pattern of a warning ignored, of a lesser version of the same illness with eventual recovery, followed by death or irreversible brain damage after a repeat vaccination, formed a major subtext of the exposé DPT: A Shot in the Dark, in which medical historian Harris Coulter and Barbara Loe Fisher, the mother of such a child, collected the stories of over 100 little victims.7 The outcry over DPT encouraged Ms. Fisher and a friend to found the National Vaccine Information Center, a support and advocacy group for families and friends of vaccine-injured children.
NVIC still hosts conferences, provides educational materials, and maintains a data-base and network of local chapters all over the country. It has kept vaccine issues in the public eye, lobbied and testified before Congress, and helped to write the Vaccine Injury Compensation Act of 1986, which created a program for no-fault compensation of vaccine injuries as an alternative to litigation. Yet Coulter and Fisher’s book was withdrawn by the publisher soon after its release, while an influential group of pediatricians still refuses to accept even these most egregious cases as having any connection with the vaccine. In 1990, Dr. Edward Mortimer et al. published a review in the Journal of the AMA which claimed that
No child who was previously normal without a prior history of seizures had a seizure in the three days following a DPT vaccine that marked the onset of epilepsy or other neurological or developmental abnormality. Our negative findings reinforce those of previous investigators that serious neurological events are rarely if ever caused by DPT.8
In the lead editorial of the same issue, Dr. James Cherry, another leading advocate, cited these data as conclusive proof that DPT encephalopathy is a “myth,” or coincidence, which should be erased once and for all from the ever-shrinking list of “genuine” adverse reactions providing an acceptable basis for compensation:
In recent months three controlled studies examine the risk of seizures and other acute neurological illnesses after DPT, involving 230,000 children and 713,000 vaccinations, These studies found no evidence of a causal link between the DPT and permanent neurological illness. It is not surprising that physicians tended to blame the vaccine for these events. But these recent studies show that the major problem has been our failure to separate sequences from consequences. It is late in the 20th century, and it’s time for the myth of “DPT encephalopathy” to end.9
His words also tally closely with the official report of the Advisory Committee on Immunization Practices, which acknowledged the opposing claims of parents but then tied them up in a skein of evasions, equivocations, and government bureaucratese:
Rare but serious acute neurological illnesses, including encephalitis, encephalopathy, and convulsions, have been reported following the whole-cell DPT. The National Childhood Encephalopathy Study provides evidence that DPT can cause encephalopathy. This occurs rarely, but detailed follow-up indicates that children who had a serious neurological illness after DPT were significantly more likely than children in the control group to have chronic CNS dysfunction 10 years later and to have been given the DPT within 7 days of its onset.
ACIP proposed 3 possible explanations for this association: 1) the dysfunction could have been caused by DPT; 2) the DPT could trigger events in children with brain or metabolic abnormalities who might also experience them if other stimuli such as fever or infection are present; and 3) the DPT might cause the event in children with underlying abnormalities that would have become dysfunctional even without it. The data do not support any one explanation over the others. The evidence was consistent with a causal relationship, but insufficient to determine whether DPT increases the overall risk 10 years later.10
But even an innate predisposition to develop such complications by no means ex-cludes the possibility of a vaccine reaction, since all illness requires both external morbid influences and an individual receptive to them. This is the ultimate riddle of all medical practice, which the emphasis on specific effects for specific vaccines blithely glosses over.
It is obvious to me and to most parents that a family history of serious adverse reactions, especially in parents or siblings, places children in a much higher risk pool and therefore provides valid grounds for exempting them from vaccinations. Yet even affidavits from Board-certified pediatricians don’t always suffice:
I am writing about our 3-year-old son, for whom we seek medical exemption from the DPT, MMR, and HiB. Two older siblings had severe reactions to these shots, with fever of 105,° sleeplessness, and swelling at the injection site. Until age 6 both kids had recurrent ear infections, for which tonsillectomy was proposed, while our youngest has not been immunized, and has no ear infections. We tried oral polio vaccine as an infant, which was followed by extreme irritability and insomnia that lasted for weeks. 6 months ago we repeated it, with the same result. Our pediatrician has written that he is at high risk for reacting adversely, but the judge ignored her. By State law, a letter from a licensed doctor stating medical reasons why he should not be vaccinated is sufficient. But the city guidelines give the Health Department final say, so we’ve ended up in court.11
Before their hearing, the mother obtained a second letter from another pediatrician, which the City Health Department similarly rejected:
The family history indicates epilepsy in the father and extensive allergies in the mother. The child displays a pattern of nervous system hyperactivity in response to foods, and was also sick for weeks after oral polio both as an infant and again recently. I strongly recommend against any further immunizations for this child, the risks of which outweigh any potential benefits for him or the general public.12
Since my testimony was never required, I surmise that the parents eventually won, but their ordeal attests to the draconian spirit in which vaccination laws are often enforced.
DPT and SIDS.
For decades the leading cause of death in infants less than one year old, Sudden Infant Death Syndrome has always baffled pediatricians. Yet pertinent research on SIDS continues to be ignored in this country because its conclusions are unpalatable to the small coterie of doctors who conduct vaccine research, journal editors who publish it, and manu-facturers who fund it. In 1985, Dr. Viera Scheibner, a research scientist investigating SIDS in Australia, and Leif Karlsson, an engineer, developed an electronic monitor that made it possible to follow breathing patterns of young infants from an adjoining room.13 Designed to sound the alarm if breathing fell below a minimum rate or amplitude, the device immediately produced surprising results:
Soon parents were reporting alarms while their babies were deeply asleep, often in clusters of 5 to 7 within a 15-minute period. These occurred after the babies were exposed to stress, or a day or before they developed a cold or cut a tooth. In most cases, the babies were only breathing shallowly and soon resumed normal patterns Without intending to, we also noted their breathing before and after vaccination, and the results were extremely significant. We didn’t know that its merits were being hotly debated at the time. We saw flare-ups of shallow breathing or apnea for 45-60 days after the DPT. When we showed our findings to pediatricians, they pointed to the arrow when the shot was given, saying “This is the cause!” and to the abnormal breathing pattern, saying “This is the effect!” But when we told them our interpretation of these data, we realized we’d touched on a very sensitive area.14
In Australia the medical community greeted these findings with a stony silence, which continues to this day, while the American literature has never published a single study to try to validate or refute it. An equally wet blanket has been thrown over the few epidemiological studies connecting SIDS to the vaccine. In 1979 the Tennessee Health Department reported 4 cases occurring within 24 hours of the first DPT,15 while in a study of 70 cases prompted by them, Dr. William Torch found that 6.5% occurred in less than 12 hours after a DPT shot, 13% within 24 hours, 26% within 3 days, 37% within 7 days, 61% within 14 days, and 70% within 21 days.16 He concluded,
DPT may be a major unrecognized cause of sudden infant death, and the risks may outweigh the benefits. Re-evaluation and possible modification of current policy is indicated by this study.17
Further confirmation came from Japan, where 57 encephalopathic cases and 37 deaths between 1970 and 1974, followed by two dramatic SIDS deaths in 1975, raised a storm of protest that persuaded the government to postpone all DPT vaccinations until two years of age,18 and to promote the development of a safer acellular vaccine. As Dr. Cherry and his colleagues later conceded, the result of this policy was that “SIDS disappeared when whole-cell and acellular pertussis vaccinations were delayed until 24 months of age.”19 Yet these same experts never contemplated such a strategy for our own country, even when the acellular vaccine failed to lower the risk of brain damage to an appreciable extent.20 Today the United States is the only industrialized country that requires the DPT vaccine for all young infants, despite all the evidence against it and the nearly unanimous opinion of Western European, Japanese, and other foreign medical sources.
MMR and Autism.
First described by the American psychiatrist Leo Kanner in 1943, the neurological condition he called “autism” has never been satisfactorily explained. Just as it could have been mere coincidence that his first case appeared very soon after the DPT vaccine was introduced in 1942, no strong evidence for a vaccine link emerged until the late 1990’s. In 1995 Dr. Andrew Wakefield, a British gastroenterologist, compared 3550 adults vaccinated against the measles as infants with 11,400 peers who had not been, and found that the vaccinated group were three times more likely than their unvaccinated controls to develop Crohn’s disease later in life, and twice more likely to develop ulcerative colitis.21
These oddities led Wakefield to study children who reacted adversely to the MMR, many of whom developed normally during the first year but then regressed to an autistic state following the vaccine, suffered from digestive symptoms and food and environment-al allergies, or both.22 Detailed comparison of these children with age-matched controls revealed inflammatory lesions in the small intestines of autistic children that microscopic-ally resembled those of Crohn’s disease and ulcerative colitis; circulating antibodies in the blood of the autistic children that were specific to measles, but not to mumps and rubella, the other MMR components; measles antigens in the lymphoid aggregations of the small intestine, but none from mumps or rubella; and no antigens of any kind in the intestines of normal children.23
These findings have since been replicated by Japanese investigators,24 and the identical combination of autistic symptoms, enterocolitis, and food and environmental allergies following MMR vaccination has been reported by parents in the US, the UK, Canada, Australia, Western Europe, and parts of Asia.25 Further support for Wakefield’s MMR hypothesis has come from the circumstance that the UK, which uses the same dia-gnostic criteria for autism as we do, experienced a similarly dramatic increase in autism cases at the time when the MMR was introduced in Britain,26 and from the experience of holistic physicians in Europe and America that alleviating the food and environmental allergies is proportionately beneficial for the autistic symptoms as well.27
Yet no proof has ever convinced the pro-vaccination forces, who maintain a seem-ingly unbreakable stranglehold over American health policy. A few years ago, Rep. Dan Burton chaired Congressional hearings on the issue when his grandson became seriously ill after his MMR and was diagnosed with autism. Disregarding the NIH’s own estimate of the incidence of autism at about 1 in 500 in 1996, an increase of over 400% since the 1960’s,28 Dr. Colleen Boyle of the CDC reaffirmed the official line that “current scientific evidence does not support a link between vaccination and autism or any other behavior disorder.”29 Similar denials by Dr. Paul Offit of ACIP led Burton to respond that Offit’s consultations for Merck, the vaccine manufacturer, amounted to a conflict of interest that should have disqualified him from serving on the Committee:
Even if they exclude themselves from voting, people who sit on advisory panels and are paid by pharmaceutical companies, influence other members. Are we letting pharmaceutical companies have too great an influence on decisions that affect the health of our nation?30
Even when it is finally recognized as a bona fide complication of MMR, “autism” as a diagnostic category is as vague as “encephalopathy,” is also applicable to DPT cases, as we saw, and will undoubtedly become so to Hep B, HiB, and other vaccines as well.
Hepatitis B and Auto-Immune Diseases.
The official ACIP verdict on the Hep B vaccine makes it sound like one of the safest currently available:
Hepatitis B vaccines are safe to administer to adults and children. More than 10 million adults and 2 million infants and children have been vaccinated in the US and over 12 million children worldwide. Pain at the injection site and fever have been among the most frequently reported side-effects, but no more so than in the controls receiving placebo or DPT. The incidence of anaphylaxis is low. Large-scale programs in Alaska, New Zealand, and Taiwan have not established an association with other adverse events. Any presumed risk that might be causally associated must be balanced against the expected risk of hepatitis B liver disease.31
In my experience, however, the vaccine carries a major risk of auto-immune dis-eases of every type, including lupus, thyroiditis, and major blood dyscrasias, which is also confirmed by a large volume of anecdotal case reports, and by warnings listed in the PDR by the manufacturers themselves. As we saw, the main value of the ACIP whitewash is to guarantee that nearly all private lawsuits and no-fault claims will fail.
Here is a typical case from my own practice, an 18-year-old college student who became ill soon after his second Hep B vaccination at the age of 10:
He remained in good health and developed normally until the age of 10, when two doses of Hep B vaccine were given, with no ill effects from the first. A week after the second dose, a swollen lymph node appeared in his neck, with fever, malaise, joint pains, and other flu-like symptoms, from which he has never fully recovered. Losing 20% of his body weight, he developed large subcutaneous nodules near major joints, and.a very high sedimentation rate. Diagnosing an auto-immune mixed connective-tissue disease, a rheumatologist kept him on nonsteroidal anti-inflammatory drugs and Prednisone for 6 years, as a result of which his growth and sexual maturation were seriously retarded. When I saw him, he had taken no drugs for 6 months, but his face and eyes were still swollen, his cheeks were covered by a bright-red rash, and his muscular and sexual development were those of a puny 12-year-old. Over the past two years, he has improved a lot under homeopathic treatment, but continues to be chronically ill, seriously handicapped, and likely to remain so. His parents are certain that Hep B vaccine was the main cause of his illness, but his medical records contain no written statement to that effect.32
Here are two claims of Hep B vaccine injury whose medical records I have studied thoroughly enough to write detailed reports to the hearing officer. While quite different in the organs and tissues affected, they resemble each other in their overall flavor and style.
An adolescent girl with type 1 juvenile diabetes was in good health and stable condition before receiving the vaccine. Within a few days of her first dose, she developed fatigue and malaise, itched intensely from hives all over her body, and her skin grew puffy and swollen. In a few weeks she developed joint pains, and the hives made her scratch to the point of bleeding. Medications gave temporary relief. Her high sed rate and anti-nuclear antibody titer indicated an auto-immune illness resembling lupus, but vigorous treatment did not help, and she developed allergic reactions to chemicals and food additives that had not bothered her before, while her diabetes, which had been stable for years, went seriously out of control.
After several months her mother broke off the treatment, saying, “Before the shot she was active, full of life, and not allergic to anything. Now she has to analyze everything she eats, avoids the sun, and has to take EpiPen wherever she goes. She is allergic to preservatives and food colorings, but has no idea what else will trigger hives and rashes.” After 4 years, her claim is still pending.33
A previously healthy 31-year-old lab tech developed auto-immune thyroiditis soon after her second round of Hep B vaccinations. At 24 her doctor gave her two shots two months apart, as required for her training. 3 months after the second dose, she developed a cough that lasted for weeks and cleared up on antibiotics, after which she took the third dose. With no antibody titer 4 years later, she was thought to be still susceptible to the disease, so her new employer insisted that she be receive a second round. Within a few days after the first dose, she developed a sore throat and cold symptoms, followed by weakness, fatigue, hoarseness, and weight gain that persisted for months. She took a second dose and grew much worse, with a more intense version of the cough she had had before, causing palpitations and anxiety at night. Finding her TSH to be twice normal, her doctor gave her thyroid, followed by her third dose of Hep B, and her symptoms and elevated TSH lasted for months with no improvement. Even after thyroid antibodies were found, she continued to worsen, despite ever-higher doses of hormone and normal tests. She has since developed a nodular goiter, difficulty swallowing, and esophageal reflux. In short, this previously healthy young woman will remain chronically ill for the rest of her life, needing regular supervision and strong medication. The most clear-cut of any that I’ve reviewed, her claim was dismissed without a hearing, based on current Federal guidelines.34
These cases are also recognizably similar to other reports of auto-immune diseases from Hep B vaccination in the literature, e. g., cryoglobulinemia,35 lupus and rheumatoid arthritis,36 Guillain-Barré syndrome,37 optic neuritis and MS,38 chronic fatigue syndrome,39 vasculitis,40 and diabetes.41 As with the DPT and MMR, many of the same old diagnoses, such as seizures, autism, and demyelinating diseases, keep popping up after Hep B as well. As I will presently show, the term “auto-immune disease” encompasses the whole gamut of non-specific reactions to the vaccination process per se. As for SIDS, it could follow any vaccine given early enough, especially Hep B, which is given soon after birth, as this father learned too late to save his newborn son:
For 12 days, Nicholas ate and slept well, like any other baby. On the 13th day he was given Hep B. When I got home from work, he was crying a lot more than usual, even screaming at times, but we’d just taken him for a checkup and they told us he was big and healthy. We didn’t know that vaccines can cause problems. Nicholas cried on and off most of the night. When I went to work the next day, he was still crying, and he continued most of the day and evening. The next morning my wife found him dead in his crib, looking as if he’d been dead for several hours. An autopsy showed that Nicholas had died of SIDS. The pediatrician said he was one of the healthiest babies he’d ever seen.42
2. Nonspecific Effects of the Vaccination Process in General.
Having questioned the specificity of four well-documented reactions to particular vaccines, around which all debate has so far been framed, I will now consider the far more prevalent adverse reactions that I have witnessed in my practice. For the most part, these represent simple intensification of underlying tendencies that were already present, and encompass the full range of common ailments encountered in any pediatric practice, like ear infections, eczema, asthma, and behavioral and developmental issues. Although the details of their treatment are irrelevant, it is significant that these children responded to the same homeopathic or conventional medicines that would be given in such cases, whether vaccinated or not. From these strange circumstances, I conclude that the small number of adverse reactions reported in the literature make up no more than the tip of an enormous iceberg, the remainder of which lies hidden, unseen, and invisible, because it blends into the mainstream of clinical medicine, and because vaccines play a major but by no means exclusive rôle in causing them.
Making the Connection: Childhood Ear Infections.
As we saw, causal connections between vaccines and chronic illness are obscured by the usual time lag of two weeks before their symptoms become diagnosable. Parents and doctors are equally unlikely to suspect a vaccine if the illness is an aggravated version of what the child already has or what friends and classmates are also coming down with.
My first definite cases were specific reactions that I managed to identify from characteristic signs of a particular vaccine or component, and at times to confirm by the curative effect of homeopathic medicines prepared from the natural disease. In one such case, I noticed that in addition to its specific action on the parotid gland and the posterior auricular lymph nodes, the MMR also had a nonspecific effect on the immune system as a whole, making the boy more susceptible to other ailments going around the neighborhood:
I saw a 4-year-old boy for bilateral soreness and enlargement of the posterior auricular nodes for the previous year, when he also became more prone to upper-respiratory infections. Over the same period, his mother also noticed recurrent swelling of the parotids, beginning soon after his MMR vaccine at the age of three. Because she was pregnant, I decided not to treat him until after the birth. A year later, he developed acute bronchitis, and again the nodes were swollen and tender, so I gave him the homeopathic rubella vaccine. The cough soon subsided, and the nodes regressed in size. Two weeks later he returned with a hard, tender swelling in the cheek and pain on chewing or opening the mouth. After one dose of homeo-pathic mumps vaccine, these symptoms also subsided, and he remained well.43
As in other cases, the specific reaction to a vaccine helped me recognize it, but the reaction as a whole was vague and nondescript, suggesting an underlying tendency that most children do not have. The rapidly increasing prevalence of childhood ear infections during those years soon taught me that such nonspecific reactions are the rule rather than the exception, and provided a large body of evidence that was ready to hand. Here is a typical example, a 19-month-old girl whose MMR vaccination was soon followed by ear infections and a flare-up of allergies and eczema, which she had had only mildly before:
At 19 months of age she had already suffered 5 ear infections and 5 rounds of antibiotics since her MMR 4 months earlier, with eczema and allergic rhinitis as well. Although her allergies began soon after birth, they were mild, while the eczema was confined to a few small patches on the face. With no obvious reaction to her DPT’s, she did fine until her MMR, after which her ears flared up repeatedly, often with high fever, earache, and listless, clingy behavior, and never cleared up despite 5 rounds of antibiotics, while her allergies became intense and unrelenting, and the eczema spread over her entire body. Advising them not to use antibiotics if she got sick and not to vaccinate for a while, I gave her homeopathic medicine, and the ears healed promptly, but her eczema and nasal congestion took a bit longer. Now 12, she has had no more shots, and enjoys excellent health and normal hearing.44
Occasioned by the MMR more than the DPT or other vaccines, and not included on any official list, this girl’s reaction consisted of ear infections, one of the commonest illnesses of her age group, as well as a recurrence and intensification of the same allergies and eczema she had had in the past. Here is another typical variant, a girl of 15 months who had had 11 ear infections and 11 full courses of antibiotics by the time I first saw her:
Otherwise in good health, a chubby girl of 15 months was brought in for recurrent ear infections, which had never cleared up despite 11 rounds of antibiotics. After a healthy pregnancy and labor, her mother didn’t nurse, and her first ear infection came with a fever of 103° at 2 months of age, soon after her first DPT, HiB, and polio. All later episodes were afebrile, with fretting, screaming, and pulling the ear, and were relieved by being carried about. Twice she seemed fine, but her doctor found some fluid, and the drugs caused persistent diarrhea both times.
Asking the parents to stop vaccinating her, I gave homeopathic medicines, and in 2 weeks she developed a replica of her first episode, with fever of 102° and intense screaming. She came through it in a day or so and has been entirely well since, once catching a cold without ear involvement for the first time. By then she was thriving, growing, and gaining weight, with good appetite, sleep, and energy. That was 3 years ago. Since then she’s had no ear infections and no vaccines.45
In spite of the clear link between her first episode and the combined vaccines, this girl’s condition became so chronic that later shots made no difference, except for her last episode, which presented with fever, just like her first. From such cases I have learned to regard acute illness as a good prognostic sign, indicating strong vitality and an immune system that is developing normally, and to worry about children who are unable to mount a fever or acute response to infection, as the immune system is programmed to do. My sense is that all vaccines, whatever their specific effects, tend to reprogram the organism to react more chronically in general, whatever the illness, as shown by my next case, a girl with recurrent ear infections of the same type following several different vaccines:
A baby girl of 10 months was brought in for otitis media with high fever, intense earache, and loud screaming, her 5th episode since two months of age, each beginning soon after finishing the antibiotic from the one before. The cycle began when her mother weaned her to go back to work, she became fussy, and she developed a rash on milk-based formula. All symptoms were intensified after her first DPT, HiB, and polio, culminating two weeks later with high fever and violent earache, as with all later episodes. After that, she was given the DT, which she didn’t react to in any way, except that her ear infections continued as before.
With homeopathic medicines, they stopped soon enough, but came back with a vengeance when her parents separated 6 months later, and her father insisted on taking her for the MMR. 3 acute ear infections and 3 rounds of antibiotics followed in rapid succession. Again she responded well to homeopathic treatment, and remained in very good health overall, despite a tendency to relapse whenever she visited her father, who indulged her with dairy and took her to the doctor for her quota of vaccines and antibiotics. Now a freshman in college, she still gets sick at times, but her ear infections are gone, and her robust immune system has helped her respond acutely and vigorously and recover quickly.46
This girl’s almost identical reaction to two different vaccines indicated a definite predisposition to fall ill in a certain way that was recognizably her own and already in place when the vaccines were given, the important and obvious contribution of vaccines being simply to reactivate and intensify it.
Making Worse What’s Already There: the Common Diseases of Childhood.
From this viewpoint, I began to notice a similar causal link between childhood vaccines and the usual chronic illnesses, such as asthma, eczema, sinusitis, behavioral problems, and the like. As with ear infections, if the condition was already symptomatic prior to vaccination, a dramatic intensification was observed not long afterward, while if quiescent it was often reactivated. As before, many children reacted in a similar way to two or more different vaccines, indicating a peculiar characteristic of the individual rather than a specific effect of the vaccine, and often linked with a family history or past history of the same kind. At times the reaction occurred too long afterward for anyone to suspect a vaccine until the same pattern was observed from a later dose or a different vaccine. Moreover, these reactions likewise encompassed the usual range of ailments seen in any pediatric practice, vaccinated or not, and were curable by the same group of medicines, homeopathic or not. Unlike the specific effects of specific vaccines, which are narrowly defined to be as serious and as rare as possible, these nonspecific reactions are common enough to be the rule, not the exception, though by no means necessarily minor or trivial:
A 15-month-old boy was brought in for croup, recurrent colds, swollen glands, and developmental issues. Born to a diabetic mother, he weighed 8 pounds at birth and spent weeks on a respirator in the Newborn ICU because of “undeveloped lungs,” with cyanosis and unstable blood sugars. In the early months he was colicky and had a severe diarrhea that stopped when his mother eliminated wheat from her diet. At 3 months, soon after his first DPT, HiB, and polio, he became very restless, with swollen glands and a sickly pallor that lasted for months and culminated in a prolonged attack of croup, high fever, and sunken chest that required hospitalization and IV corticosteroids for relief. When the cough persisted, his mother put off the second round of shots for months, but even so the croupy cough came right back, as did the swollen glands and exactly the same symptoms as before. With a marked fear of strangers, the boy appeared subnormal, drooling profusely with his mouth hanging open, and hiding behind his mother. Once I found a good homeopathic medicine that fit his symptom-picture, the illness cleared up in a few days and never came back. A month later, his mother was ecstatic. For the first time, in the dead of winter he had no croup or swollen glands, slept well, and seemed more alert, more interested in his surroundings, and less fearful around strangers. That was 6 years ago, and I’ve not seen him since, but his mother recently called to say that he is still thriving and developing normally, “like other children his age.”47
In another case, a boy with severe asthma accomplished a sustained remission with homeopathic treatment, but relapsed almost immediately after a DPT booster:
Asthmatic since age two and testing positive for a broad spectrum of allergens, a 4-year-old boy was brought in because a regimen of bronchodilators and inhaled steroids all year round had not prevented major flare-ups the previous fall and winter, several requiring oral prednisone and antibiotics as well. During the first 6 weeks of homeopathic treatment, he cut his inhaled steroids by half, maintained higher peak flows of 150 or more, and got through a cold for the first time without developing asthma or requiring drugs. Emotionally, too, he was calmer and less wild, even expressing remorse after a fit of rage, which he had never done before.
The following summer, at the peak of his allergy season, he was still doing well on half-doses of inhaler, and remained healthy and energetic all spring and summer, with peak flows at record levels of 160-175. That fall he got a DPT booster before entering kindergarten and quickly came down with bronchitis, for which he was given antibiotics, and his allergies also returned in full force. Again he responded to the same homeopathic medicine as before, and has continued to improve over the past 2 years, without needing to come back or take it again.48
His mother’s narrative leaves little doubt that the DPT reactivated and intensified his pre-existing condition, which had been in almost total remission for many months. Although it is certainly possible that the DPT and other vaccines may have played a rôle in the origin of his asthma as well, an underlying predisposition would have been an important contributing factor in any case. What matters is that he was well on his way to being cured of his asthma until a DPT booster set him back a lot and for a long time.
Nonspecific Reactions: any Vaccine Will Do.
As with ear infections, additional evidence of nonspecific reactions was provided by children who responded in the same way to two or more different vaccinations. The following case of environmental sensitivity was so severe and its exacerbation by each vaccine so obvious that the allergist recognized it and agreed to withhold further doses:
A 2-year-old boy came in for asthma and allergies. Severely allergic herself, his mother reluctantly agreed to the Hep B at birth and a second dose at two weeks. After his first DPT, HiB, and polio at two months he erupted with eczema all over his body, which she knew had been caused by the vaccines, but the pediatrician ridiculed the idea. After the second round, his stools became green and watery for 6 weeks, and she weaned him, but Similac led to apnea, cyanosis, vomiting, and giant hives everywhere. Finding him highly sensitive to dairy, eggs, peanuts, and animals, the allergist agreed he should not be vaccinated again, but the familydoctor insisted on an HiB booster at 18 months, and in two weeks his asthma was back for real. When I saw him he needed Albuterol daily, all year round. He too has responded well to homeopathic medicines and is now rarely asthmatic, although still avoiding vaccines and careful with animals and foods.49
3. How Vaccines Work: A Preliminary Hypothesis..
In spite of their importance in medicine and public health and an abundance of detailed knowledge about how the immune system works, a vaccine still need satisfy only two minimal criteria to be considered effective: 1) that the incidence of the corresponding natural disease decline significantly after administering it, and 2) that measurable titers of specific antibodies be found in the serum of vaccinated individuals for extended periods of time. These standards are analogous to those of the of the drug industry as a whole, which expects vaccines and drugs to act mainly as they are intended to, in that everything else they do is relegated to the fine print as “side” effects, and often simply forgotten. In short, the medical system does not seek or even seem to want any broader conception of how medicines affect the organism as a whole. In search of a more comprehensive view, I will reflect on how we come down with and recover from an acute disease such as the measles, and contrast it with what happens after the corresponding vaccine is administered.
Natural Immunity: Absolute, Qualitative, and Lifelong.
With its affinity for the respiratory mucosa, the measles virus is dispersed through the air by sneezing and coughing infected droplets and inhaled by susceptible persons on contact with them. For 10 to 14 days, the virus multiplies first in the tonsils, adenoids, and accessory lymphoid tissues of the pharynx, then in the regional lymph nodes of the head and neck, and finally in the blood, spleen, liver, thymus, and bone marrow, the major organs of the immune system. Throughout this prolonged “incubation” period the patient usually feels quite well and experiences few or no symptoms of any kind.50
With the first signs of illness, circulating antibodies are already detectable in the blood, in concentrations roughly proportional to the severity of the disease.51 In other words, the illness we know as the measles is simply the concerted effort of the immune system to clear the virus from the blood, largely via sneezing and coughing, the same routes through which it entered in the first place. This mighty exploit involves a general mobilization that includes inflammation of already sensitized tissues at the portal of entry, activation of B- and T-lymphocytes, macrophages, and the serum complement system, and a host of other mechanisms, of which the production of specific antibodies is only one, which depends for its effectiveness upon its collaboration with the system as a whole.
Such a magnificent effort leaves no doubt that coming down with and recovering from acute illnesses of this kind are the defining experiences in the healthy maturation of the immune system. The immunity resulting from it is specific, to be sure, in that those who recover from the measles will never again be susceptible to it, no matter how many times they are re-exposed in the future. But it is also nonspecific, in the equally important sense of priming the system to respond rapidly and effectively to other infections it may encounter in the future.
The natural immunity acquired through recovering from acute diseases represents an enormous net gain for the health of individuals and their descendants, and thereby also of the community and the race as a whole. The measles virus kills 20% of populations exposed to it for the first time, and many centuries of adaptation were required for our own ancestors to convert it into a routine disease of childhood, such that when I caught it at the age of six, nonspecific mechanisms were already in place to help me recover from it with no complications or sequelæ, an achievement that I credit in no small part for the good health I enjoy today. The ability to respond acutely and vigorously to infection ranks among the most fundamental requirements of general health and well-being, a truth so elementary that merely having to reaffirm it will attest to how far we have strayed from a saner and more wholesome conception of life.
Artificial or Vaccine-Induced Immunity: Relative, Partial, and Temporary.
When the live, attenuated vaccine virus is injected into the blood, at most a brief inflammatory reaction may be noted at the injection site, with no local sensitization at the portal of entry, no incubation period, no acute illness, and no massive outpouring. Like a conjuror’s trick, vaccination yields measurable titers of specific antibodies in the blood, but without any overt illness or inflammatory response, and without any significant improvement in the general health of the recipients, apart from reducing their statistical risk of developing the acute disease as we know it.
But where the virus goes, how it persuades the immune system to continue producing antibodies against it for years at a time, and what price we have to pay for the counterfeit immunity that they represent, are the questions that are seldom if ever asked. Vaccines seem tailor-made to accomplish through deception what the immune system seems to have evolved to prevent, giving viruses, bacteria, and other foreign antigens free and immediate access to the organs of the immune system without any obvious or easy way of getting rid of them. No mere side effect, the continuing production of specific antibodies over the long term requires the physical presence of live viruses and other highly antigenic substances inside the cells of the immune system on a more or less permanent basis.
In the case of measles and the other live-virus vaccines, excellent models already exist for imagining how this chronicity might occur, and for predicting the pathologies that are likely to follow from it. Many viruses are known for their capacity to survive in latent form indefinitely within the cells of the immune system without provoking acute disease, by attaching their own DNA or RNA as extra particles or “episomes” to the genome of the host cell and replicating along with it, allowing the cell to perform its normal functions but adding instructions for the synthesis of viral proteins as well.52
Residing as foreign elements within the cells of the host, latent viruses of this type would automatically pose a major threat to the immune mechanism as a whole, which is programmed to destroy and remove them by every available means. Once viral elements are incorporated into the genetic material of the host, such attacks have no possible target but the infected cells themselves. Chronic intracellular parasitism by latent viruses would appear to insure a rich harvest of auto-immune diseases, which must also be regarded as “healthy” in that removing the transformed cells becomes the only way to eliminate the foreign material.
In short, my fear is that vaccinating children against measles and other live viruses simply reprograms their immune systems to respond chronically and weakly rather than acutely and vigorously to other infections, and indeed to antigenic challenges of any kind, a conclusion amply borne out by the clinical evidence already presented of alarming and as yet unexplained increases in the chronicity of ear infections, asthma, eczema, autism, and other common diseases of childhood. It is dangerously misleading and indeed the exact opposite of the truth to claim that measles vaccine “protects” us against the disease by obliging us to harbor the virus chronically instead, so that our immune systems are less capable of responding acutely, not only to the measles but to everything else as well.
If that is true, then the most major achievement of mandatory vaccination could be to exchange a few epidemic diseases of the past for the vastly more prevalent and less curable chronic diseases of the present, with their suffering and disability amortized at a high rate of interest over the patient’s lifetime. It is difficult to imagine that most parents would accept such a devil’s bargain if they were told the truth about it, let alone open a real Pandora’s box of new diseases and mutations for the future, through in vivo genetic recombination within the cells of the race.
Made from killed bacteria, inactivated toxoids, tissue extracts, and recombinant viruses, the non-living vaccines are also designed to remain inside the cells of the host and continue to provoke antibody responses over long periods of time. Though how they do it is also poorly understood, something in their method of preparation and preservation must promote similar long-term carrier states within the antibody-producing cells, presumably by conjugation with host-cell proteins, which would allow these non-living vaccines to remain highly antigenic for as long as possible. At least three kinds of chemical additives are implicated in and indeed deliberately used for such purposes.
First, vaccines prepared from toxoids and cellular extracts are precipitated onto adsorbents, usually aluminum hydroxide, both to preserve them and to enhance their anti-genicity.53 There is reliable evidence that vaccines prepared without them are much less toxic, as in recent studies of an aluminum-free pertussis vaccine.54 Also used in cookware and other products, metallic aluminum and its salts have been implicated in a broad array of auto-immune, allergic, and neuropathologic states, including Alzheimer’s disease and encephalopathy.55
Second, some vaccines prepared from live microörganisms or their toxins are first killed or inactivated with formaldehyde, which also fixes and preserves them in that form, much as in embalming the dead. An efficient and well-known carcinogen,56 even in tiny amounts,57 formaldehyde is the last thing we would want injected into the bloodstream of our children, let alone to trap already dangerous vaccines inside them.
Third, several vaccines are sterilized, denatured, and preserved with Thimerosal, an inorganic sulphur-mercury salt which prevents bacterial overgrowth. Already linked to a broad ramge of toxic and auto-immune reactions, from allergies to renal failure and dementia,58 mercury salts and Thimerosal in particular have been studied and publicized so widely in recent years that the vaccine manufacturers themselves have been scrambling to develop or discover alternatives to it.
Clinical and Epidemiological Studies of Vaccine Efficacy.
The best evidence that vaccines really work dates from the introduction of the Salk polio vaccine in the 1940’s and the measles vaccine in the 1960’s, after which the dreaded polio epidemics disappeared from the developed world, while the annual incidence of measles plummeted from over 400,000 to less than 10,000 cases in the United States.59 Yet the disturbing possibility that vaccines act in some other way than by producing a genuine immunity is implicit in the circumstance that measles, like other such diseases, has continued to break out even in heavily vaccinated populations, while in such cases the observed differences in incidence and severity between the vaccinated and unvaccinated children have been much less dramatic than expected.
In 1985, 157 cases of measles were reported in Corpus Christi and nearby Nueces County, Texas, over a 3-month period, notwithstanding a vaccination rate of over 99% and supposedly “immune” antibody titers in more than 95%.60 In 1989, one Illinois high school similarly reported 69 cases in 3 weeks despite verified records of vaccination for 99.7% of the students.61 Although both reports oddly omitted the actual numbers of vaccinated and unvaccinated cases, they effectively discredited the common prejudice that unvaccinated children, assumed to be the main reservoir of the disease, pose a threat to their vaccinated classmates, a fear widely exploited by health departments to shame reluctant parents into compliance. In fact these outbreaks suggested the opposite, that the immunity conferred by the vaccine can’t be genuine, or the unvaccinated kids would only be a threat to themselves.
These inconvenient facts were dismissed easily enough by the official explanation that artificial or vaccine-mediated immunity is only partial and temporary, and wears off with increasing age, leaving the child presumably unaffected and just as susceptible as before. Indeed, this assumption is the main rationale for revaccinating with “booster” doses at a later date. But other studies indicate that this assumption is false. In 1980, when the disease seemed to have been all but eradicated in the United States, Dr. James Cherry, whom we’ve met before, found that children previously vaccinated against the measles whose specific antibody titers had fallen below supposedly immune levels responded to a booster dose only minimally and for an unacceptably short time:
In the booster vaccinees, there was only a modest initial rise in titer, and after a year the level was almost back to where it had been before the booster. In addition, we noted a lack of “take” in 14 other children, most of whom had probably been immunologically stimulated before. In short, the data suggested that another booster dose might not have any lasting effect on waning immunity.62
Both the outbreaks of measles in supposedly highly immune populations and the failure of Cherry’s simple booster shot to remain effective for a prolonged period of time cast doubt on the conventional wisdom that immunity is a purely quantitative variable, that the specific antibody titer accurately measures it, and that by applying sufficient force it can be ratcheted up more or less at will. Within a few years, when major outbreaks like those just cited generated intense pressure to do something about them, Cherry’s suddenly inconvenient research was discreetly forgotten, and the MMR booster was duly mandated for all children and remains in force to this day.63
Another suggestive finding emerged from a sustained outbreak of 235 measles cases reported in Dane County, Wisconsin, over a nine-month period in 1986.64 In add-ition to the usual cases, only 6% of whom were unvaccinated,65 the authors identified a subset with so-called “mild measles,” consisting of a paler rash, no fever, and minimal discomfort or systemic involvement.66 To their surprise, they also discovered that this syndrome was much commoner in previously vaccinated kids without specific antibodies than in either unvaccinated kids or those with high levels of antibody, both of whom were more likely to develop the full-blown disease:
36 of the 37 unvaccinated patients, or 97%, had rash illnesses that met the CDC clinical definition of measles, but 29 of the 198 vaccinated patients, or 15%, did not, primarily because of low-grade or absent fever. Of 122 patients with sero-confirmed measles, 10 patients, all previously vaccinated, had no detectable measles-specific IgM antibodies and significantly milder illness than either vaccinated or unvaccinated patients with IgM-positive serum.67
This paradoxical result suggested a kind of latent viral activity that was undetected and indeed belied by routine serological testing, echoing Dr. Wakefield’s original finding that children receiving the MMR vaccine were much more likely to develop inflammatory bowel disease later in life than their unvaccinated controls. The inescapable inference is that artificial, vaccine-mediated immunity is both counterfeit and dangerous, culminating in a broad range of auto-immune diseases, as we have seen.
4. Some Individual Vaccines.
With this as background, I will re-examine a number of individual vaccines, all of which illustrate the basic issues that have already been discussed, yet differ significantly in the seriousness and impact of the corresponding natural diseases. Since I have already written about DPT, MMR, and polio in the past,68, 69 I will focus on vaccines of more recent vintage.
Hæmophilus Influenzæ B (HiB).
Originally developed against outbreaks of bacterial meningitis in infants and pre-school children in large day-care centers, the HiB vaccine has been adapted to a broader and more ambitious agenda in a sequence that has become typical in the industry and raises pertinent economic and political issues that I have referred to only in passing.
The first vaccine to be prepared against an organism that resides in the healthy throat, HiB was directed against the B strain of Hæmophilus influenzæ, which has at times been associated with serious invasive diseases, such as otitis media, sinusitis, meningitis, pneumonia, laryngitis, epiglottitis, and endocarditis. Since bacterial meningitis can be fatal or leave permanent brain damage in spite of the most vigorous antibiotic treatment, the vaccine establishment saw no downside in attempting to prevent these outbreaks by vaccinating children of two years and older who were being cared for in crowded public facilities. After a small pilot project of this kind, the vaccine was eventually mandated for all children at 18 months, and is now administered with the DPT at 2, 4, 6, and 18 months, often in the same preparation.
Since it began in the late 1980’s, the campaign to promote HiB was accepted by nearly all pediatricians without a murmur, and has in fact produced moderate reductions in the incidence and severity of all systemic diseases involving this organism,70 including ear infections,71 which by then had become an intractable problem in its own right. Yet this seemingly glorious triumph for the vaccination concept has upstaged the obvious risk of new, less friendly species occupying the vacancy it left behind, or otherwise altering the normal ecological balance of the pharynx as a whole, possibilities that do not seem to bother or even have occurred to these experts. In addition to its documented side effects, such as Guillain-Barré syndrome,72 thrombocytopenic purpura,73 and invasive HiB disease in the first two weeks after vaccination, associated with very low levels of specific anti-body,74 this reckless tampering with complex, well-established homeostatic mechanisms to achieve limited, short-term goals gives ample grounds for advocating a moratorium on HiB vaccination until more comprehensive studies are carried out.
Introduced in the early 1990’s, the Hep B vaccine raises a different set of issues. Widespread but only infrequently fatal, Hepatitis B presents acutely, chronically, or both, and occasionally leads to irreversible liver damage and cirrhosis, which carry high risks of liver cancer and death. Transmitted primarily through contaminated blood and to a lesser extent by sexual contact, the disease has long been an important source of ill health among IV drug users. In the 1980’s, the medical system belatedly took notice when Hepatitis B and C, AIDS, and other blood-borne diseases began to appear as contaminants in donated blood, a scandal that pressured the blood banks into more rigorous screening procedures.75
Because the clandestine subculture of IV drug use has always remained beyond the reach of the medical system, campaigns of selective Hep B vaccination aimed at these high-risk groups have never been effective. In 1991 mandatory vaccination was finally introduced as a last resort for exerting some degree of leverage over this more and more intractable problem. The desperate and improbable strategy adopted was to vaccinate all newborns in the hospital, so that even those who become drug addicts in their teens and twenties would be a little less likely to get the disease, while the blood supply would also be protected to that extent at least. Sound far-fetched? Most pediatricians thought so, at least in the beginning:
“I don’t see what the rush is,” said one pediatrician at a UCSF conference, and neither did his audience. Only about a third of the 400 attendees said they were giving the vaccine routinely to infants. “We’re trying to prevent a disease 25-30 years from now,” he added. Others felt that children receive too many vaccines in the first year, that each injection is a disagreeable experience which may adversely affect compliance.76
Letters of protest began pouring in, many of them dubious that the vaccine would last long enough to do any good, and predicting that boosters would also be needed later:
The patient handout falsely assures parents that that the protective effects will last throughout the child’s life, while the article admits that antibody levels decline over time, and booster shots may be needed. Since adolescence begins the period of greatest exposure, immunizing them might be more effective, and compliance would be higher.77
Nevertheless, most pediatricians remained strongly committed to vaccination as a general strategy for fighting disease, and by the mid-1990’s the majority were actively on board with the Hep B campaign just as reports of adverse auto-immune reactions began to appear in large numbers, and as usual it became their task to launder and sanitize them.
Among the first of its kind, the Hep B vaccine is a product of bio-engineering, a genetically recombinant form of the virus that is allegedly no longer capable of replicating itself and to that extent no longer “alive.” Ignoring the ultramicroscopic realm of epi-somes and intracellular viral fragments, this purely semantic rationale is widely invoked to defeat compensation claims for Hep B-related auto-immune diseases, as I have said. While such facile word games may have postponed another major scandal for a little while longer, even the polite objections of ten years ago are more than enough to predict a noisy failure for this hare-brained scheme of vaccinating all newborns against a disease of young adults that very few of them will ever come into contact with.
While quickly smoothed over and all too easily forgotten, this mini-disaster and the peculiar mentality that engendered it should both be kept under glass as a specimen of what undoubtedly lies ahead. In 1996, the AMA Journal published a CDC report which advocated mass vaccination against rotavirus, a major source of infectious diarrhea:
Rotavirus is the most common cause of severe diarrhea among young children in the US. Of children up to five years old, approximately 70% will become ill with rotavirus, of whom 1 in 8 will see a physician and 1 in 80 will be hospitalized. Though it causes few deaths in this country, it causes 50,000 hospitalizations and $550 million in direct medical costs annually. Safe live oral vaccines have been developed that will prevent 50-60% of the diarrhea and 70-100% of the severest cases. The decision to implement a national vaccination program will be based on the expected reduction in severe outcomes and its cost-effectiveness. A previous study found it would yield net savings of $80 million in health care costs and $465 million in social costs, based on a price of $20 per dose.78
By their own math, however, the authors calculated a saving of only $300 million in social costs and a net loss of $100 million in health care costs that could only be offset by lowering the price of the vaccine to the break-even point of $9 per dose.79 Entitled “When Is Too Much Too Much?” an editorial in the New England Journal of Medicine took up the same issue and concluded that the program would be extremely effective in the developing world, where rotavirus and other infectious diarrheas pose an enormous and urgent public health problem, but affordable and profitable only in affluent countries like our own:
Diarrhea is no longer a serious threat in the United States. It remains common, but its severity has diminished to about 300 deaths per year. On the other hand, the vaccine is safe and can prevent nearly half of all infections, 80% of the severe episodes, and virtually all of the dehydration. An effective program of vaccination would significantly reduce mortality, hospitalization, and other medical costs, estimated at $500-600 million annually, as well as the indirect costs, including lost wages for parents and the cost of child care. When is too much too much? One hundred preventable deaths per year are too many, and $500 million in direct health care costs is too high. Hence a safe and effective vaccine, even at $30 per dose, can be recommended for routine use in the US and developed countries.80
Recommended by ACIP, the vaccine was mandated in 1998 for all infants, even though 5 cases of intussusception, a life-threatening form of intestinal obstruction, had already been reported in the trial population of 10,000 children, a risk of about 0.05 per cent.81 In the first eight months of the program, many new cases were discovered, and the vaccine was quietly withdrawn pending further investigation, which did establish “a strong, temporal, and specific causal association” between the vaccine and this dangerous complication that was much more prevalent than the trials had indicated.82 The vaccine was then hastily recalled and the whole affair hushed up as if it had never happened.
For the moment I will leave aside the narrowness of the cost-benefit calculation, which ignores the possibility of chronic, non-specific effects like those I’ve described, and the fascinating process by which vaccines are rubber-stamped for general use with at most nominal regulation and oversight. The rotavirus vaccine fiasco could not have happened without the zealous, crusading attitude, usually left unstated but here made explicit, that even the tiniest number of preventable deaths are unacceptable, and that mass vaccination is always an appropriate strategy to consider for eliminating them.
In a land so notoriously ruled by dollars and cents, these supremely un-economical ideas both assume 1) that vaccination is inherently safe, and indeed an unmixed blessing for the health of individuals and nations alike, and 2) that whatever adverse effects an individual vaccine or batch may have, there is never anything cumulative about them, so that it is perfectly OK and indeed of great benefit to pile on as many as we wish. Even in the absence of other reasons, the enormous bulk of nonspecific reactions I have described would be quite sufficent to prove both assumptions false. With the new biotechnology companies now capable of manufacturing vaccines against viruses and bacteria almost as fast as they can identify them, the obvious unwisdom of giving away our public health and welfare to private, for-profit enterprises is an issue that is already ubiquitous and becomes ever more threatening with each new campaign.
Many of the same issues are illustrated even more pointedly in the history of the chickenpox or varicella vaccine, which although first developed by Merck in the 1960’s, was never used on a large scale until the Clinton years, when official enthusiasm for all vaccination programs attained such dizzying heights that a plausible rationale could at last be invented for marketing it. Even then it was not an easy sell, since the chickenpox is an illness so innocuous that the AMA Encyclopedia of Medicine described it as “a common, mild infectious disease” to which “all healthy children should be exposed at an age when it is no more than an inconvenience.83 Even the American Academy of Pediatrics, which yields to no one in its righteous enthusiasm for vaccines, affirmed in a 1996 brochure that
Most children who get chickenpox and are otherwise healthy experience no complications from it. When adults get it, the disease usually lasts longer and is more severe, often developing into pneumonia. Adults are almost 10 times more likely than children under 14 to need hospitalization for the disease and more than 20 times more likely to die from it.84
Bucking these traditional, common-sense attitudes, the manufacturers’ successful campaign to win a government mandate for universal vaccination represents a brilliant coup for them and the industry, clinched by exclusive “sweetheart” contracts with state health departments and Federal agencies guaranteeing millions of doses at their own chosen price. How did they pull it off?
Although nobody claimed that the disease was serious or even required medical attention in most cases, the Clinton Administration’s oft-repeated boasts about the cost-effectiveness of vaccination as a favored health strategy enabled manufacturers to argue that the huge savings in social costs, chiefly in lost wages and extra day care, would make the vaccine a bargain for parents, as alleged in this handout from the American Academy of Family Physicians, designed to be distributed to parents as their kids were offered up:
Why is a vaccine needed? Chickenpox is usually a mild illness, but can cause problems like brain swelling, pneumonia, and skin infections. It may be very serious in infants and adults. Because it is so contagious, children shouldn’t go to school or day care until all the sores have dried or crusted. Many parents miss work during the illness, because of which the lost pay can be a significant cost to them.85
As with Hep B, many physicians were lukewarm to the program in the beginning, and compliance was very low. Here is a letter from 1997, expressing the worries that have actually materialized in the case of MMR, the waning immunity in adolescents and young adults, associated with more severe illness and a higher risk of complications:
Chickenpox has been a benign disease of preschool- and school-aged children. Although immunization is supposedly axiomatic for public health, vaccinating all kids against chickenpox is a bad idea. It is unknown whether long-term immunity arises from an attack of the disease, or from the virus repeatedly boosting it in our communities, or how long immunity will last after vaccination. Over time, mass vaccination will eradicate most naturally occurring varicella and its booster effect. If the immunity of vaccinated kids wanes with age, and unvaccinated kids escape disease because contagion is rarer, life-threatening outbreaks may occur as these kids grow older. Since morbidity and mortality are increased in fetuses and after childhood, an ever-expanding population of adults with unboosted or waning immunity, including pregnant women, may be created.86
As expected, these hesitations and warnings were drowned out by special pleading from the vaccination establishment. In a JAMA editorial entitled “Just Do It!” two Yale pediatricians concluded their pep talk with the following exhortation:
Do the benefits of universal immunization outweigh the risks? Many studies show the risk of complications from varicella in normal children, and there is evidence that they have been underestimated. Others show that the vaccine is cost-effective. Why would we deny children protection from this unpleasant rite of passage when the evidence is so favorable? It’s time to stop procrastinating, and JUST DO IT!87
Similar in many ways to HiB, the Pneumococcus vaccine raises many of the same issues. A sometimes pathogenic strain of Streptococci, the “pneumococcus,” or Strepto-cccus pneumoniæ, shares capsular polysaccharide antigens with Hæmophilus influenzæ, which are also the basis of its virulence and the source of the vaccine. The organism also occupies a similar niche in the normal flora of the pharynx and has been implicated in the same diseases: otitis, sinusitis, pneumonia, meningitis, and endocarditis.
Long before HiB, the pneumococcal vaccine was introduced during the 1970’s to prevent bacterial pneumonia in the elderly, especially in overcrowded nursing homes and residential facilities, where pneumococci were the species most frequently isolated. But the vaccine proved only marginally effective in this already debilitated population, as in this study of ambulatory but high-risk middle-aged and elderly patients in the VA system:
We conducted a randomized, double-blind, placebo-controlled trial to test the efficacy of a pneumococcal polysaccharide vaccine in 2295 high-risk patients with one or more of the following: age over 55, diabetes, alcoholism, chronic cardiac, pulmonary, hepatic, or renal disease. We were unable to prove any efficacy of the vaccine in preventing either pneumonia or bronchitis in this population.88
As a result of such studies, the vaccine was not very popular with either the target population or their doctors, who continued to use it without much enthusiasm. So matters stood until the Clinton years, when the war on childhood ear infections reached its climax and the conventional strategy of aggressive antibiotic treatment was exposed as a dismal failure. In the late 1990’s, the vaccine was recycled for pediatric use when it was found to be moderately effective in preventing otitis media, in which the pneumococcus plays a major rôle.89 Here at last was the marketing strategy that everyone had been waiting for, and the vaccine is now being promoted aggressively, not only for young children, but also for adolescents, young adults, mature adults, and even middle-aged fifty-somethings of the AARP set,90 as if it might eventually be refashioned into a panacea for everyone and hopefully need to be repeated throughout life.
Yet a sizeable number of pediatricians and other critics have continued to resist this steamroller. In 2001 the Finnish Otitis Media Study reported that a new vaccine was effective in preventing ear infection, but several letters quickly punched gaping holes in it:
The vaccine manufacturer concludes that the new vaccine is effective for prevention. But the data do not support this conclusion. As the authors admit, the treated group could have had more episodes than the controls. In 1999 these same data were presented to the FDA, which rejected the use of this vaccine in otitis media. But the most interesting results are ecological. In a short time the predicted sero-type replacement, as observed with other bacterial vaccines, was realized. With this clear warning sign, it is ecologically perilous to push this vaccine.91
The most telling criticism came from a pediatrician in Holland, where ear infect-ions are common but rarely medicated or even considered a major public health problem:
According to the protocol, all infants received 4 vaccinations, which led to the prevention of only 6% of cases. More could be gained by changing our attitude toward acute otitis media, which in the Netherlands is seen as a self-limiting disease. Often parents do not take their children to the doctor for it, and antibiotics are only moderately effective anyway. As has been shown, educating parents and doctors will lead to a decrease in antibiotic prescriptions.92
Despite considerable evidence that it is ineffective and unsafe, the pneumococcus vaccine continues to be promoted aggressively, and I have no doubt that it will eventually be mandated, at least for children, once these technical scruples are swept aside.
Prepared from live influenza viruses that are attenuated in a medium of chick embryo cells, the influenza vaccine is inactivated by formalin, split with hydrocarbon ethers into antigenic fractions, and preserved with Thimerosal. Its unique challenge and profitability lie in the fact that annual flu epidemics involve different subtypes of the virus, which cannot be known with certainty in advance, so that it has to be recreated and marketed anew every year, before the epidemic, based on extrapolation from possible animal reservoirs, i. e., on guesswork, and is apt to be only partially effective, despite some degree of cross-reactivity between various strains.
Like the pneumococcus, influenza vaccines were originally designed to prevent pneumonia in the elderly, especially debilitated patients in nursing homes and assisted living facilities. But careful studies of this high-risk population yielded at best mixed results and at times no results at all,93 while serious adverse reactions, like the dreaded Guillain-Barré polyneuritis, were also reported with some frequency. In the 1978-79 season, the highly-touted “swine flu” epidemic never materialized, but over 40,000,000 people were given the vaccine, and several hundred cases of severe polyneuritis were officially confirmed within 10 weeks of receiving it, representing a five- or six-fold increase over its baseline prevalence in the unvaccinated,94 while unofficial reports suggested a rate much higher than that. As ever, authoritative studies quickly appeared to discredit any causal link, but a large volume of legal claims were settled on the quiet by the manufacturer.
The annual flu shot nevertheless remained a popular ritual with many doctors and their elderly patients and continues to be heavily promoted, but as with the pneumococcus, the “hard sell” for mandating it had to wait until the Clinton years, when vaccination came to be seen as the strategy of last resort against health problems that seemed intractable and unresponsive to other solutions, like otitis media, influenza epidemics, and AIDS.
Building on the example of the chickenpox vaccine and its narrowly economic rationale, the respected and influential American Academy of Family Practice took the lead by recommending that annual flu shots be offered to all adults aged 50 or older.95 In an interview with Family Practice News, Dr. H. F. Young, AAFP Director of Scientific Affairs, emphasized the major economic benefit of preventing absenteeism from work,96 while Dr. Gregory Poland of the National Coalition for Adult Immunization cited the increased probability of complicating risk factors like heart disease, asthma, emphysema, cancer, and diabetes in this age group.97
The economic argument was soon recycled for vaccinating all schoolchildren on a yearly basis, which a 1999 study claimed would save hundreds of millions of dollars in lost wages and eliminate the major reservoir of the disease.98 Facing no real opposition, the same program was eventually extended to healthy young adults in the work force,99 and even to pregnant women, in order to protect their newborns from the risk of RSV and bronchiolitis, according to one imaginative CDC scientist.100 As with pneumococcus, the influenza vaccine is clearly being groomed for mandatory use on a yearly basis, with no recognition of even the possibility of a serious downside to the idea.
Anthrax and Bioterrorism.
Mandated for all U. S. military personnel serving in the Middle East from the time of the first Gulf War in 1991, the anthrax vaccine has been controversial from the start. First, there was speculation about its possible rôle in “Gulf War syndrome,” an assortment of still unexplained diseases reported by many veterans and downplayed or covered up by officials of both Clinton and Bush Administrations. As reported in the Boston Globe, this account of one such veteran was typical of many:
Sgt. Frank Landry’s chest has been hurting a lot. He can’t ride a bike, climb stairs, or play with his children. He wheezes even with medication, sleeps propped up on three pillows, and suffers from diarrhea and stomach pain. The worst of it is, he doesn’t know what’s wrong. He left in perfect health two years ago, to serve in the Gulf War as a specialist in nuclear, chemical, and biological weapons, and he returned coughing up phlegm and too short of breath to resume his job, as well as dropping from 150 to 128 pounds,. Landry is one of many Gulf War veterans who report a variety of mysterious ailments, such as joint pain, hair loss, skin lesions, bleeding gums, asthma, and digestive disturbances. They don’t know what causes them, but Landry’s best guess is a reaction to the anthrax vaccine. He’d never had lung problems before, and within an hour of receiving it he began to wheeze, and felt as if his chest were filled with water. He’s never been well since.
He can’t work, and accepts $1000 a month in food stamps and Aid to Dependent Children, because he has two kids, his wife has a bad back, and they’ve sold most of their possessions. Meanwhile, the Government denies that his problems are service-related and has reclassified him as fit for duty. Despite what happened, he’s not bitter about the Army. He volunteered knowing the risks: “they gave me a life and education. I was illiterate and got my GED because I couldn’t be promoted without it.” No diagnosis has been made. All he knows is that he can’t breathe, can’t work, and can’t support his family. And he’s only 29 years old.101
A recent survey reported that more than 230,000 of the 600,000 troops serving in the Gulf War have sought medical care, and that 185,000 have filed disability claims as a result of their ailments, a shockingly high percentage, while almost 10,000 of them have died, and no official explanation of their illnesses has ever been offered.102
So matters stood until the late 1990’s, when in its enthusiasm for vaccines the Clinton Administration required that all military personnel receive the anthrax vaccine, whether on active duty or not, and the vaunted discipline of the Armed Forces began to crack. By 1999 several hundred officers and enlisted men from all branches had accepted dishonorable discharges rather than submit to the shots, as the Army reluctantly admitted in a Boston Globe cover story:
In Maine, where he grew up, Zack Johnson didn’t have a reputation for civil disobedience. He was so law-abiding and laid back that his parents called him “Mr. Light ‘n’ Easy.” But the 22-year-old Naval airman faces a court-martial because no threat of biological weapons, or a jail sentence, or even of the loss of the GI Bill he planned to use for college could persuade him to take the anthrax vaccine. Ten Marines were court-martialed in California last month for the same reason. An Army spokesperson says that over 300,000 military personnel have had at least one shot, and 175 to 200 people have refused, too few to affect battle-readiness. But Mark Zaid, an attorney representing the 10 Marines, said, “Some Air National Guard units have lost a third of their flight crews and can’t be deployed any more.” He estimates the number of refusals at 300 to 500.103
In a related story from the New York Times, the Surgeon-General of the Army acknowledged the seriousness of the problem:
The happy military career of Jeffrey Bettendorf ended abruptly Wednesday. A senior airman with an untarnished record, Bettendorf was dishonorably discharged for refusing to take the anthrax vaccine, because he believed that the Pentagon had never proved its safety or effectiveness. Facing rebellion from a growing number of cases, the Pentagon dismissed them as insignificant, but stopped counting how many had refused. “It speaks to an undercurrent of distrust of the Government and the military,” said Lt. General Ronald Blanck, Surgeon-General of the Army, which oversees the anthrax program. “We have a credibility problem.”
The Marine Corps in particular has been hit hard. Resisters note that there is no way to test the vaccine against the anthrax used in weapons, and they criticize the lack of follow-up research on those who did receive it during the Gulf War. They also point to two FDA reports critical of the manufacturer, Michigan Biologic, a state agency which was sold last year to Bioport, a private company. One month later, Bioport was awarded a $29 million contract to produce the vaccine for the Pentagon, which insists that the program is safe and effective.
But reassurances are not enough for Marine Lance Cpl. Jason Austin, who read that the vaccine can cause sterility and refused to take it with four others in his antitank missile platoon and now faces a court-martial. While their numbers are small, they can upset the readiness of their units, notably in the Reserve and National Guard, whose members can resign more easily than those on active duty. In January, nine A-10 pilots with the Connecticut Air National Guard, a quarter of the squadron, quit rather than be vaccinated. At Travis AFB in California, where Airman Bettendorf served, 11 of 40 reserve pilots in his Squadron refused to take the vaccine, leaving them short-handed just before heading to the Persian Gulf.104
As news of these refusals and disciplinary actions spread, high-ranking officers began hearing the concerns of the men and women under their command. Appointed Commander of an F-16 Fighter Squadron, Lt. Colonel Thomas Heemstra, a decorated combat veteran of 20 years’ experience, decided to investigate the vaccine independently, and was outraged by what many personnel had endured, including disrespect, ridicule, and inadequate medical care. As told in his book, Col. Heemstra invited Dr. Meryl Nass, a government consultant who had raised serious doubts about the vaccine, to address his pilots.105 Including firsthand accounts by three Michigan National Guardsmen who were disabled by the vaccine and treated harshly by their superiors, her lecture persuaded all twenty pilots who attended to refuse the vaccine, as a result of which they were cashiered, including the Colonel himself.106 The same fate befell Major Sonnie Bates, another highly decorated combat pilot of long experience who later testified before Congress on a wide variety of auto-immune complaints observed in military personnel after taking the shot.107
As the scandal spread through the ranks, investigators discovered that many Gulf War syndrome patients who developed auto-immune diseases after the anthrax vaccine showed antibodies to squalene, a fat-soluble substance that was still being used by BioPort as an experimental adjuvant in the vaccine, despite strong FDA warnings in the past and solemn assurances by the Pentagon that they had abandoned the practice.108 In part to counter the bad press, Admiral William Crowe, ex-Chairman of the Joint Chiefs of Staff, was named to BioPort’s Board of Directors and given a 13% stake in the company in return for blessing the anthrax venture.109 Ironically, he had previously brokered the sale of weapons-grade anthrax to Saddam Hussein by Donald Rumsfeld, President Reagan’s special emissary, for later use against the Iranians and Kurds.110
Only a few weeks after the attacks of September 11, 2001, and the official Bush Administration “Declaration of War” against Terrorism worldwide, spores of weapons-grade anthrax made their way through the Postal Service to the offices of Democratic Congressional leaders and CBS Television News, resulting in 22 cases of cutaneous and pulmonary anthrax and five deaths. Although the perpetrators of these crimes have not been identified and the results of an extensive Federal investigation have never been made public, it leaked out that the material had been manufactured in the U. S. Army Biological Warfare Laboratories, as the country trembled with the realization that even such minute amounts were enough to infect and kill people, and that the Government is essentially powerless to stop a large-scale biological attack by a determined enemy. These fears were assiduously cultivated by the Administration to win support for the public health agenda of the Patriot Act and the vast Homeland Security bureaucracy created to administer it, but fantasies of vaccinating the general population brought back the aftertaste of the military’s incestuous relationship with BioPort and the ominous signs of its complicity in the Gulf War syndrome, and the plan never got off the ground.
After September 11, the abortive campaign to vaccinate everyone against smallpox was even more revealing. Amid the tragedy, confusion, and heroism displayed at Ground Zero, the whole country began taking seriously the possibility and indeed the likelihood of nuclear, chemical, and biological attacks in the future. Because anthrax cannot be transmitted from person to person, each intended victim must be targeted individually and be brought into direct physical contact with the spores, whose range is therefore limited to the environs of a large city. Smallpox, on the other hand, evokes deep mythic and historic fears of plague and pestilence, because it is highly contagious and capable of propagating itself to populations far beyond the target area, so that many authorities entertained the idea of reintroducing vaccinia, or cowpox, the original vaccine that had been used for 200 years and had in fact eliminated smallpox from the world. Yet when the Administration attempted to obtain large quantities of it, and President Bush made a photo-op of rolling up his own sleeve to receive it, the public remained surprisingly cool to the idea. Even when a scaled-down plan was made optional and offered to doctors, nurses, firemen, and other emergency personnel, very few of them actually took it,111 and the predicted adverse reactions were widely publicized.112
Given the almost universal propensity to ignore or overlook the adverse effects of vaccinating not only our children but indeed everyone else against a host of other diseases both great and small, this sudden show of solicitude and cold feet regarding a vaccine that had seemed so familiar and effective is utterly fascinating to me. How these same people can then resume taking their annual flu shots and bringing in their babies for one disease after another without a murmur has to rank with the great unsolved mysteries of our time.
In any case, there is plenty of good sense in it, for it means either that the actual threat of the vaccine is perceived to be greater than the hypothetical threat of the disease, or that the public simply does not believe that any vaccine can reliably stop a determined enemy from doing us harm. In my view, both reservations are well taken. Larry Brilliant, M. D., a veteran epidemiologist formerly with WHO, said it better than anyone:
If Saddam has smallpox, he might use it if he were about to be killed, but he also has the capacity to alter the virus to make it vaccine-proof. Why would he use a virus that we have a vaccine against? It makes no sense. If Al Qaeda has it, I don’t believe they’d use it either. They want victory for a people, a culture, a religion. Smallpox is the ultimate boomerang. If released at Chicago-O’Hare, it’s only a matter of days before it hits Mecca and Medina. It’s not a weapon for war unless one seeks the destruction of both civilizations.113
Prof. David Rosner of Columbia gives another argument for the same conclusion:
Smallpox is the only disease to have been eradicated through human intervention. Yet we saw in it the chance to create a new and better weapon of mass destruction. Both the U. S. and Russia kept the virus in storage awaiting the opportunity to terrorize the world. Both made it immune to the vaccine that had eradicated it by genetically altering the virus. Even if smallpox could be used as a weapon, the fear of it is being used to make fundamental changes in public health. Mundane but indispensable activities like making sure our water is safe to drink, our air isn’t too polluted to breathe, and our food isn’t too spoiled to eat are being sacrificed for fear of smallpox, which plays into Bush’s strategy of militarizing public health.114
5. Implications for Health Policy.
In conclusion, I will apply the broader, more comprehensive viewpoint I have sketched out to identify some underlying themes of our present vaccine policy, correct some of the inadequacies, and resolve some of the contradictions and that follow from them.
The More, the Merrier.
The sequence whereby vaccines originally intended for a limited purpose or target population are awarded a larger and larger market share logically culminates in the prized government mandate enforcing them on everyone. As we saw, such universalization pre-supposes a deep, abiding faith that vaccines are inherently beneficial and in no sense a major public health risk, which makes it look acceptable to promote all vaccines to the fullest extent possible and achieve maximum compliance with each new mandate.
Writing in medical journals and news magazines, prominent advocates routinely exhort physicians to improve their vaccination rates, offer practical tips for overcoming patient resistance, and downplay the risks and contraindications that parents continually worry about, and that still crop up in the literature. Part pep talk and part sales pitch, such motivational efforts have long since reached out beyond any narrowly defined pediatric constituency to target other age groups as well.
In “Adult Immunizations: How Are We Doing,” a typical example of the genre, a leading infectious disease specialist calculated the number of lives that could be saved by vaccinating adults with the same zeal and thoroughness that we bestow on our children:
30,000 lives could be saved yearly if adult immunization recommendations were implemented. Between 50,000 and 70,000 adults die each year from influenza, pneumococcal infection, and hepatitis B. This exceeds the number of automobile deaths, and far outweighs mortality from these diseases in children. Those for whom vaccines are contraindicated are fewer than those who fail to be immunized because of the following, which are not contraindications but often thought to be:
1) local reactions to past vaccines, with fever less than 104º; 2) mild acute illness, with or without fever; 3) antibiotic treatment or convalescence from recent illness; 4) household contact with a pregnant woman; 5) recent exposure to infectious disease; 6) breastfeeding; 7) history of allergies, including to penicillin or most other antibiotics; and 8) family history of allergies, adverse reactions, or seizures.115
In other articles, similar concern is expressed for adolescents and young adults, who have been equally neglected by our narrow preference for infants and small children:
Vaccination programs focusing on infants and children have decreased the occurrence of many vaccine-preventable diseases. But many adolescents and young adults are still being attacked by hep B, chickenpox, measles, and rubella, because our vaccination programs have not focused on these age groups. All not previously or adequately vaccinated should be updated with Hep B, MMR, DT, varicella, and pneumococcus. Influenza and Hep A should be offered to all at high risk.116
The most convincing proof for the universality of the concept is its extension to pregnant women, who have always been considered exempt and inviolate, out of concern for the safety of their unborn that the new imperative bids fair to render obsolete:
Adult immunization rates have fallen short of goals because of misconceptions about the safety and benefits of vaccines. This danger is magnified during pregnancy, when physicians are hesitant to give vaccines and patients to accept them. Routine vaccines that are safe to give during pregnancy include DT, flu, and Hep B. Meningococcus and rabies may be considered. Contraindicated are MMR, varicella, and BCG. Others have not been adequately studied.and must be weighed individually. But inadvertent use of any of these is not grounds for termination.117
Ironically, it is widely agreed that mandated childhood vaccination programs have not only achieved but often outstripped their stated goals. According to the CDC National Immunization Survey, all recommended vaccine targets were met or exceeded by 1995:
95% of children aged 19 to 35 months received at least 3 doses of DPT; 92% received at least 3 doses of HiB; 90% received the MMR; 88% received polio; and 68% the Hep B. In fact, the 1996 goals were reached in 1995.118
Even in California, where alternative medicine is widely popular and a thriving subculture openly questions traditional medical practices, vaccination rates have reached extremely high levels, as shown in a 2001 study by the state Health Department:
The California Department of Health examined school immunization records for all children in the state. In the fall of 2000, personal belief exemptions were listed for 0.77%, or 4000 of the 526,000 attending kindergarten. Seventh-graders have higher exemption rates, probably because of the Hep B requirement. Of 500,000 seventh-grade students, 1.3% recorded personal belief exemptions.119
In fact these levels are far in excess of what is necessary to prevent sustained out-breaks of even the most highly contagious diseases, like chickenpox and measles, both of which attack nearly 100% of the people exposed to them for the first time. A study of 1000 Milwaukee-area children with measles found that
Modest improvements in low levels of immunization among 2-year-olds confer substantial protection against measles outbreaks. Coverage of 80% or less may be sufficient to prevent sustained outbreaks in an urban community.120
While these campaigns all tacitly assume that it is permissible and even desirable to add on as many different vaccines in as many doses as we think fit, the preponderance of evidence points to exactly the opposite conclusion, as we saw. If all vaccines tend to promote, intensify, activate, or reactivate whatever chronic disease tendencies already exist, then the risk of adverse reactions is not rare or incidental, but inseparable from the process, and indeed, I fear, in direct proportion to the total number of vaccinations given.
Whether unaware of or simply untroubled by this possibility, in January 2004 the ACIP updated its Recommended Childhood and Adolescent Immunization Schedule:
3 Hep B shots in the first 24 months, beginning at birth;
3 DPT at 2, 4, and 6 months, and a 4th 5-24 months;
3 HiB at 2, 4, and 6 months, and a 4th at 12-18 months;
2 injectable polio at 2 and 4 months, and a 3rd at 6-24 months;
One MMR at 12-18 months;
One chickenpox at 12-24 months;
3 pneumococcus at 2, 4, and 6 months, and a 4th at 12-18 months; and
One influenza yearly, beginning at 6 months.121
This means 22 different vaccinations for each child in the first 2 years, many with two or more components, and that’s only the beginning. For ages two through 18,
Influenza vaccine annually [another 16 from 2-18 years of age];
3-4 Hep A shots recommended, from 2-18 years;
DPT booster at 4-6 years, followed by DT at 11-12 years;
Injectable polio booster at 4-6 years;
MMR booster at 4-6 years; and
Chickenpox booster at 4-6 years.122
This makes 25 more mandatory or recommended vaccinations between 2 and 18, a total of close to 50 by the time they enter college, not to mention whatever new vaccines lie in store for them in the future. Moreover, as young adults they will become eligible for yet another series of boosters to carry them into old age. Thus slowly, incrementally, and inexorably, purely as a matter of policy and without any real public health emergency, vaccination has become the normal, acceptable means for reducing the incidence of any identifiable acute infectious disease whatsoever, often simply to save money or time lost from productive work, a strategy which now involves every individual in every age group and necessitates repeated doses throughout life.
To stop this juggernaut, I would assign top priority to reducing the total vaccine burden borne by our population, especially infants and young children. In my view, this should be done, first of all, by postponing vaccination as long as possible, at least until two or ideally three years of age, to give young immune systems ample opportunity to develop in a wholesome and natural way, by learning how to mount fevers and other vigorous, acute responses to infection, before reprogramming them more chronically.
Second, we should preserve the clear distinction between diseases that represent a clear and present threat to life and limb, such as DT and polio, and others that originate from organisms in our normal flora, like HiB and pneumococcus, or are nuisances that we elect to vaccinate against for economic or other policy reasons, such as influenza, MMR, and chickenpox, or problem diseases that we feel helpless to influence in any other way, like Hep B and undoubtedly AIDS on the horizon.
With no urgent medical need for it, the MMR was brilliantly successful as a public relations stunt, proving that vaccination could work as a general strategy by nearly erasing three ubiquitous acute diseases as a simple demonstration of its validity. Yet it is wholly counterproductive to impose the MMR on populations like ours, which through centuries of adaptation had already tamed these viruses into routine diseases of childhood that most kids in reasonably good health would benefit substantially from coming down with and recovering from.
In industrialized countries like the United States, recommending vaccination for all children could make a little bit of sense for DT and polio, while the other vaccines could still be made available to those who request them. As for pertussis, I cannot support large-scale use unless a vaccine is developed with a much better safety record than any we have now. Since the pressure to vaccinate early derives mainly from the risk of pertussis in young infants, dispensing with that vaccine will also encourage waiting longer before giving DT and polio. In my opinion, the MMR, chickenpox, and Hep B vaccines have no legitimate use on a mass scale and should not be recommended. Vaccinating the whole population in advance of bioterrorist threats like anthrax and smallpox is useless, since weaponization renders these organisms impervious to vaccines, and also unnecessary, since the likelihood of their use remains vanishingly small.
A Sacrament of Modern Medicine.
Just as vaccinating everybody against everything at every possible opportunity satisfies the ideal requirements of an enormously profitable venture for manufacturers, the aggressive marketing strategies I have described are not so different from what successful businesses often do to maximize their bottom line. As we saw, their sweetheart deals with state health departments, foreign governments, and federal and international agencies, involving millions of doses guaranteed at their chosen price, along with the famous “hard sell” of doctors and patients that accompanies them, entail nothing more mysterious or unfamiliar than old-fashioned crony capitalism getting a free ride.
The rotavirus debâcle was all about greed. Luckily, the vaccine was never made available to the poor countries that might have benefited from it, because its $30 unit price was far beyond their reach, while the U. S. government, which never tried to persuade the manufacturers to lower it, gladly provided easy access into the domestic market. In like manner, the anthrax vaccine controversy ended in scandal because the government policy of requiring it of all military personnel resulted in too many high-profile casualties and defections for the company’s shoddy practices and the Pentagon’s condoning of them to be kept hidden any longer.
Thus unrestrained even by market forces, abetted by corporate welfare at the tax-payers’ expense, and rubber-stamped by their allies in government, the thriving biotech industry has amplified these problems exponentially by creating new vaccines against any desired viruses or bacteria as fast as they can identify, isolate, and propagate them, often for no better reason than their technical capacity to do so. In short, we can expect a rich harvest of new vaccines in the future, some on the drawing board, others already in stock and awaiting only a convenient opportunity and marketing strategy to launch them:
While its incidence has declined in the past decade, hepatitis A is still responsible for nearly 60% of acute viral hepatitis in the United States. It seems unfortunate that outbreaks continue to occur in one of the most affluent countries in the world, given that a highly immunogenic, safe, and effective vaccine is available. Routine vaccination in early childhood would lead to a dramatic reduction in the infection within a decade. The failure to begin such a program is a missed opportunity.123
However ubiquitous they may be, corporate greed and worldly ambition are only the most familiar and obvious side of the story, the motives that many industries share. In degree if not in kind, vaccines are uniquely blessed and indeed sanctified above all other industrial products by their extraordinary triumph at the mythic or unconscious level, as a veritable panacea for a health care system that seems embattled and in deep trouble almost everywhere else.
No purely financial or commercial motive can account for the sincere and nearly universal veneration accorded to the idea of vaccination by doctors and patients alike, which not only exempts vaccines from the ordeal of criticism that every new scientific discovery must rightly endure, but also makes the mere hint of disapproval seem disloyal or sacrilegious, and even inspires the physicians who administer them to volunteer their own children for the latest experiments.
Quasi-religious sentiments of this kind are evident in the writings of Dr. Paul Offit, the aforementioned Merck consultant who recently claimed that young infants are capable of generating protective humoral and cellular responses to many vaccines simultaneously, perhaps as many as 10,000 at a time, by what he calls a “conservative estimate.”124 In this sense, the vaccination project must also be understood in mythic and spiritual terms, as a kind of baptismal initiation into the religion of modern medicine.125 Whichever of these motives seem uppermost in any given case, the result is the same: compulsory vaccination has promoted a kind of self-righteous fanaticism that is often invoked to justify various abuses and infringements of the rights of parents, children, and the public at large.
From the 1940’s through the Reagan years, compliance with vaccination laws was achieved mainly by intense social pressure to conform that doctors, school boards, friends, neighbors, and relatives brought to bear against deviant parents, whose unvaccinated kids were regarded as the chief reservoir of the few diseases at issue and therefore a substantial threat to the vaccinated kids and everyone else as well. In the mid-1980’s, as we saw, this simplistic rationale was demolished by the large measles outbreaks in highly vaccinated populations, where most of the cases had been vaccinated, and parents wondered how, if the vaccine were any good, unvaccinated kids could threaten anybody but themselves.126
During the Clinton years, as both the number of required vaccinations and the public resistance to them began to multiply, the government and public health authorities began implementing a tracking system for identification and surveillance of noncompliant parents, based on computerized government databases that raised widespread alarm and fears of “Big Brother” overriding personal privacy, notwithstanding official denials and reassurances to the contrary:
Community- and state-based immunization registries are computerized systems that contain data about children’s vaccines, a tool to maintain high vaccination coverage. Such registries consolidate records from different providers, provide generate reminder notices, and produce an official record. Remaining challenges include balancing the need to protect privacy with gathering and sharing information to benefit the public and individuals. $178 million in Federal funds has so far been awarded to state and local health departments to develop such registries.127
With the added impetus of President Bush’s “War on Terrorism” and the Home-land Security bureaucracy created in its name, the threat to civil rights began to frighten eminent legal experts and health activists all over the country, as in the following “News Release” that was sent to me over the Internet and gave only a phone number as its source:
Attorneys for the CDC have advanced legislation that suspends civil rights in case of a declared biological emergency. The Emergency Health Powers Act gives governors and public health officials the power to arrest, transport, quarantine, drug, and vaccinate anyone suspected of carrying a potentially infectious disease. An article by Prof. Lawrence Gostin of Georgetown that tried to balance the need to control disease with protecting individual rights was removed from the Boston Globe website. The law gives state public health authorities dictatorial powers with scant legal recourse for internees. Its definition of a public health emergency is highly subjective. Once it is declared, most civil liberties are suspended, with states declaring ownership of private property. Persons refusing to submit to medical exams and tests are subject to misdemeanor charges and forced isolation. If authorities suspect that they have been exposed to infectious diseases or pose a risk to public health, detention may be ordered for them. If an attack is carried out or even suspected, thousands could be held in camps, and physicians assisted by police be required to perform medical tests and exams. Individuals may be forcibly vaccinated or medicated, and those refusing would be guilty of a crime and subject to arrest, isolation, or quarantine, while the state and public health authorities are exempt from liability associated with the death or injury of detainees or damage to their property.128
In a sizeable number of divorce and/or child custody hearings and lawsuits that have come to my attention, the plaintiff, almost always the husband or ex-husband, seeks to win or regain physical custody of his children on grounds that his wife or ex-wife was negligent or unfit as a parent by failing to comply with vaccination laws, even if he had acquiesced in her position and failed to challenge it for all the time they were together.129
Even in Canada, where vaccinations remain optional but are held in comparable esteem by the medical establishment, the Québec College of Physicians revoked the medical license of Dr. Guylaine Lanctôt, a physician who strongly opposed routine vaccination,, simply for espousing ideas that they found “derogatory to the honor and dignity of the medical profession,” and for disseminating information to the public that they proclaimed to be “inaccurate, deceptive, inappropriate, and contrary to accepted medical science.” 130
Vaccination has also lurked behind the scenes in the criminal prosecution of some parents for “shaken-baby syndrome,” a form of encephalopathy secondary to traumatic brain injury. In an infamous case from Florida, the father served 8 years of a life term for murder in the state penitentiary, and recently won his release only when the Medical Examiner’s testimony that convicted him proved to have been falsified in several key respects,131 while my own review of the baby’s medical records, corroborated by several other physicians, found them consistent with the possibility of an encephalopathic reaction to the DPT vaccine, which he had received only a few days before.
But my favorite illustration of the sacramental power of the vaccination concept lies in the voluntary and largely instinctive self-censorship practiced in its favor by the news media, which almost never make statements or issue opinions of their own that vaccines actually hurt anybody, apart from those attributed to interested parties such as parents or medical experts. The only exception to that rule that I know of was this article from the Boston Globe that let the cat out of the bag just this once:
INOCULATIONS PUT ASPIN IN D. C. HOSPITAL. Defense Secretary Les Aspin was in “clearly improved” condition but remained in the Intensive Care Unit of Georgetown University Hospital yesterday after suffering breathing difficulties triggered by routine inoculations. “He’s definitely on the road to recovery,” the spokesman said, but would remain in the ICU to be monitored, because he has a history of heart problems, and fluid collected in his lungs. He entered the hospital because of shortness of breath aggravated by a “mild, pre-existing heart condition,” the Pentagon said. He became ill the day before, after receiving a number of immunization shots in preparation for overseas travel.132
Although Aspin’s hospitalization remained newsworthy for several days, there was no further mention of his vaccinations, and readers who had missed the original story were given the impression that he merely suffered a flare-up of his pre-existing heart condition, which was true enough, thus superbly illustrating the theme of invisibility that furnished the basic subtext and starting point of this inquiry.
To dispel the aura of sanctity that hallows the vaccination concept and protects it from closer scrutiny, it is enough to show that vaccines are no panacea for the health care system, to see them for what they are, instruments of medical science with power to do harm as well as good, like any other drug or procedure, and to hold them to the same standards of safety and efficacy, by obliging them to run the same gauntlet of lively criticism and open debate.
I have always wondered who decides that a particular disease represents such a grave or urgent threat to the public health that everyone has to be vaccinated against it, whether they want to be or not. Yet simply asking the question is enough to remind us of what on some level we already know, that these important deliberations invariably take place behind closed doors without any public input or oversight. The fantasy scenario that immediately springs to mind cannot be far from the truth: a government conference room where officials of the CDC, the FDA, and the American Academy of Pediatrics meet the vaccine manufacturers themselves, to decide which vaccine to recommend or mandate next, and to devise a suitable marketing strategy for promoting it. Whatever the out-come, this “good ol’ boy network” rarely seems to meet a vaccine that it doesn’t like.
I can easily imagine a real emergency where swift actions need to be taken for the public good that people of conscience might disagree with. But that is not the issue here. Whether because or in spite of the vaccinations that have been mandated in the past, or perhaps for other totally unrelated reasons, no vaccine-preventable disease now poses any urgent threat to the health of the nation, and most of the vaccines now in use are marketed largely from motives of policy, as we saw, whether to save lost wages, to gain access to a group that would otherwise be elusive, to eradicate a disease that has been a problem in the past, or simply to make a lot of money for the manufacturer.
Like many other physicians, I believe it is neither wise nor legitimate to privatize our health system to the extent of surrendering decisions in the public domain that clearly affect the health and welfare of everyone to private corporations that are devoted mainly to turning a profit. In conformity with the laws of all other civilized countries, I consider health to be a basic human right of everyone, not merely a privilege of the few who can afford to pay whatever the providers feel entitled to charge for it, as our own President and Congress still adamantly insist. The issue of vaccination is too important to be decided in backroom deals behind closed doors, and must be opened to public discussion and debate at every level and at every stage.
I do not believe and have never maintained that all vaccines are wholly bad or evil and to be avoided under all circumstances. In all my writings, I have simply tried to show that there is a major downside to their use that needs to be acknowledged frankly, studied carefully, and factored into all future deliberations about them. To that end I advocate a basic pro-choice position, that under most circumstances, and in the absence of any public health emergency, it should be left to the free and informed decision of the parents about which vaccines, if any, are given to their children.
Toward a More Comprehensive Model of Biomedical Research.
Devising adequate vaccine policies will also require more comprehensive studies of their adverse effects and actual mechanisms of action than any previously undertaken, and to succeed they will have to be designed in a new and radically different way. In the first place, they will need to look well beyond the narrow focus of our present studies on the reduced incidence of the typical acute disease and the titers of specific antibodies, our only available standards of vaccine “efficacy,” both of which correlate very imperfectly with true immunity, as we have seen.
Secondly, estimating the safety of vaccines and identifying adverse reactions to them must include learning to recognize their non-specific effects, as we have seen. To render these phenomena more visible, three major changes in research methodology will suffice. First, it will be necessary to investigate the full range of adverse effects of each vaccine and vaccine combination, involving every organ and tissue of the body, as well as more global measures of health and functioning, such as neurological development, school performance, sensory-motor integration, mental and emotional maturity, and suffering and disability from other diseases. These investigations must also be carried out for enough time to reveal significant chronic patterns, i. e., for years or decades at least.
Finally, the overall health status of the children receiving vaccines has to be com-pared with that of those who do not receive them, an obvious requirement which assigns special priority to finding the unvaccinated children. Far from being “spoilers,” as they are often regarded, this control group, along with the parents who choose not to vaccinate them, must be sought out and protected as our last, best hope for enabling such studies to be carried out, to whom society as a whole and even the parents who choose to vaccinate ironically owe a major debt of gratitude.
Owing to the profusion of different vaccines and combinations, it is impossible at present to study each individual vaccine one by one. Therefore, I propose the simplest kind of survey to begin with, to compare the overall health picture of those vaccinated according to the official schedule with those minimally vaccinated at age three with tetanus and polio alone, and with those not vaccinated at all. If what I have said proves to be true, as I fear it will, then the lightly vaccinated and unvaccinated children should turn out to be substantially healthier, freer from chronic disease, more alert mentally, and more stable emotionally than the fully vaccinated ones, and to outperform them in school, with fewer absences, higher test scores, and the like. That is my prediction and my deepest concern. If any can prove me wrong, let them come forward, and I will thank them from the bottom of my heart.
Vaccine Laws and Exemptions.
Achieving even these modest reforms also involves rethinking our present vaccine laws and the allowable exemptions from them. Under our federal Constitution, which leaves to the states all residual powers not explicitly assigned to the central government, vaccination and the practice of medicine generally fall within the authority of each state, with some important local and regional differences. Regarding mandatory vaccination, all states recognize a medical exemption, based on recommendations from Board-certified pediatricians or other licensed physicians, but these are only valid for one vaccine at a time, and for one of its approved effects, and has to be renewed regularly or even yearly. Because of these limitations, medical exemptions rarely do justice to the feelings of my patients, and even when they do, are by no means uniformly successful, as we saw.
Almost half the states also recognize a so-called “religious” or “philosophical” exemption, based on membership in some Church or denomination which is on record as being opposed to vaccination, such as Christian Scientist or Jehovah’s Witnesses, or in the most liberal interpretation, simply a deeply-held“philosophical” conviction that opposes the practice. In Massachusetts, where I practice, the law as written includes the narrower word “religious,” but the courts have interpreted it very liberally to extend into the purely personal realm of the individual conscience.
Much closer to the actual beliefs, attitudes, and special circumstances I typically encounter in my practice, the religious exemption has generally been honored whenever my patients have claimed it, but serious difficulties remain that it does not address. Even in this most liberal interpretation, the religious or philosophical exemption is an absolute, across-the-board rejection of the concept of vaccination per se, designed to accommodate a dogmatic belief system in the “abolitionist” or “conscientious objector” mold. In other words, the law protects the right of any citizen to dissent from established beliefs by being equally rigid and inflexible on the other side. It doesn’t allow parents to make intelligent medical decisions for their children, such as choosing some vaccines but not others. While this “pro-choice” position is respected by open-minded physicians, nurses, and school boards in some areas, such wording has yet to be written into the laws of any state, and draft laws proposing such changes have so far been rejected by every state legislature which has considered them, although by smaller and smaller margins each year.
As the biotech industry continues to crank out new vaccines at without limit or restraint, and new and ever-broader applications are being found for the old ones, the widespread belief that the total number of vaccinations does indeed matter provides the best guarantee that the optional or pro-choice position will eventually prevail. As their ultimate strategy for circumventing even this modest ceiling on their profits, the vaccine manufacturers are busy at work developing a single vaccine containing a dozen or more individual components and administered in a single dose, whether injected, ingested, or perhaps even inhaled, to be repeated at rare intervals, and thus presumably arousing less public outcry.
Cost-Benefit Analysis and the “Bottom Line.”
With that in mind, I want to consider the ultimate claim of the advocates of compulsory vaccination, which its critics have so far ignored, its alleged effect on reducing the bottom-line costs of health care. As we saw, this viewpoint attained its peak of inflence during the Clinton era. Borrowing the newly popular “cost-benefit analysis” from the economists who used it to analyze the Federal budget into a list of allegedly dis-crete “line items,” vaccination advocates 1) estimated the number of additional cases of any acute disease to be expected in an unvaccinated population; 2) multiplied it by the cost of caring for each case, including doctor and hospital fees and time lost from work, to obtain the total cost saved by the health care system; and then 3) divided it by the cost of vaccinating, i.e., the unit cost per vaccination times the number of doses given, to compute the “benefit-cost ratio.”
In 1992, before President Clinton took office, Dr. Georges Peter of Brown made the economic case for mandatory vaccination, based on its high benefit-cost ratio:
One of the most important medical developments in the 20th century has been the control of once-common childhood infectious diseases by the administration of highly effective vaccines. With the exception of safe water, no other modality, not even antibiotics, has had such a major effect on mortality reduction and population growth. Of particular importance in the current era of escalating health care costs is the fact that effective childhood vaccines are highly economical and thus represent an efficient use of society’s resources. A highly favorable benefit-cost ratio -- the ratio of the reduction in the cost of disease to the cost of the vaccination program -- has been substantiated by many studies in the United States. For example, the MMR program led to savings of nearly $1.4 billion in disease costs in 1983, with a benefit-cost ratio of 14.4:1. By a similar analysis, for each dollar spent on pertussis vaccine, $2.10 is saved in health care costs.133
While these soon became the favored calculations for arguing on behalf of child-hood vaccinations and for silencing effective opposition to them, they uniformly ignore the rampant but still largely unseen epidemic of nonspecific effects that I have described, including ear infections, asthma, eczema, allergies, ADD, autism, auto-immune diseases, and the whoe spectrum of common diseases of childhood, each of which contributes its own enormous chunk to those same exorbitant costs that vaccinations are supposed to be keeping down. To give one familiar example, this study of childhood ear infections was published in 1982, fully ten years earlier:
Otitis media is the most frequent diagnosis made by physicians who care for children. It has been estimated that approximately $2 billion is spent annually on medical and surgical treatment of this disease in the United States. This figure includes expenses for the estimated 1 million children who receive tympanostomy tubes and over 600,000 who yearly undergo tonsillectomies and adenoidectomies, which are mainly for the prevention of such infections.134
These figures would of course have been much higher had they been calculated at the time of Professor Peter’s study, not to mention comparable figures for asthma, autism, allergies, and the other ailments we have been discussing, all of which have attained truly epidemic proportions in the twelve years since 1992. I have never claimed that vaccines are solely responsible for creating these diseases, and cannot estimate with any degree of accuracy the percentage of their total medical and social costs that are attributable to the adverse reactions I have described. But merely to recognize that such reactions occur with the kind of frequency that I see in my practice, coupled with the fact that vaccines are required of every child, is sufficient to establish that this hidden factor is enormous in size, and that the benefit-cost ratio will look shockingly different once we factor it in.
I therefore propose the appointment of a bipartisan government Commission to investigate the medical and social costs of the leading childhood diseases, with the help of a panel of medical economists whom they would select, and with the understanding that its deliberations be conducted in a public forum and its final report include a wide range of testimony from the medical and public health community and all sectors of the general public. In particular, the Commission should be directed 1) to calculate the total medical and social costs of the common problems that all pediatricians commonly deal with, such as asthma, autism, allergies, eczema, ear infections, pneumonia, sinusitis, ADD, learning disabilities, behavior problems, and the like; 2) to try to measure the fraction of them that should be ascribed to vaccine-related causes; and 3) to multiply the first by the second to obtain the real cost of giving children all recommended vaccines on the approved list.
If we estimate the vaccine contribution at 20% of the total cost of each of these diseases, which I fear is much smaller than the true figure, it is evident that these hidden factors exceed by several orders of magnitude any conceivable savings that even the most rabid vaccine advocates have ever claimed for them. Far from being a bargain, I would argue that vaccines are in fact exorbitantly expensive on every level, and must bear an important share of responsibility for the skyrocketing costs of the present health care crisis as a whole, over which representatives of the government, the insurance industry, and the medical profession merely shake their heads in confusion and disbelief. In short, they provide a splendid example of what CFOs refer to as a “hidden cost center.”
Finally, even if vaccination programs could be proven effective in achieving their stated goals, the goals themselves may be of dubious value. As René Dubos once aptly warned, in words sounding even more prophetic today,
The faith in the magical power of drugs often blunts the critical senses, and comes close at times to a mass hysteria involving scientists and laymen alike. Men want miracles as much today as in the past. If they do not join one of the newer cults, they satisfy this need by worshipping at the altar of modern science. This faith in the magical power of drugs is not new. It helped give medicine the authority of a priesthood, and to recreate the glamour of ancient mysteries.135
The idea of eradicating measles, polio, and the rest has come to seem attractive to us because the power of medical science makes it seem technically possible: we worship each victory of biotechnology over Nature as a bullfight celebrates the triumph of human intelligence over brute beast. Yet it is absurd to suppose that, even if we managed to eliminate measles, polio, and all other acute diseases of mankind, we would be any the healthier for it, or that other even more serious ailments would not quickly rise up to fill their place. From a medical no less than an economic viewpoint, trading off the epidemic diseases of the past for the ubiquitous chronic diseases of today hardly seems like a good bargain, at least in the industrialized world, where major infectious diseases were already in rapid decline owing to basic improvements in hygiene, sanitation, air and water quality, and so forth.
In that sense, the quasi-religious fervor of the vaccine establishment offers an appropriate metaphor for the privatization and commercialism of the American medical enterprise as a whole, with its uncritical and idolatrous worship of biomedical science and technology, its identification, expropriation, and commodification of every available life function for the sacrosanct twin purposes of mastery and profit. The deeply irreligious and infinitely hazardous myth that technical solutions can be found for illness and all other authentic human problems seems seductively attractive because it bypasses the problem of healing, which is a genuine miracle in the sense that it requires art and caring and individualized attention and therefore can always fail to occur.
1. Unpublished letter.
2. Horton, R., “Vaccine Myths,” in Health Wars, New York Review Books, 2003, pp. 207-208.
3. Ibid., p. 206.
4. Morbidity and Mortality Weekly Report in Journal of the AMA 260:198, April 8, 1988.
5. Unpublished letter.
6. Unpublished letter.
7. Coulter, H., and Fisher, B., DPT: a Shot in the Dark, Harcourt Brace Jovanovich, 1985.
8. Mortimer, E., et al., “The Risk of Seizures and Encephalopathy after Immunization with the DTP Vaccine,” JAMA 263:1641, March 23, 1990.
9. Cherry, J., “Pertussis Vaccine Encephalopathy: It’s Time to Recognize It as the Myth That It Is,” JAMA 263:1679, March 23, 1990.
10. “Update: Vaccine Side Effects, Adverse Reactions, Contraindications, and Precautions,” Advisory Committee on Immunization Practices, MMWR 45:22, September 1996.
11. Unpublished letter.
12. Unpublished letter.
13. Scheibner, V., Vaccination: a Medical Assault on the Immune System, New Atlantean Press, 1993, pp. xiii-xv, passim.
15. Bernier, R., et al., “DTP Vaccination and Sudden Infant Deaths in Tennessee,” Journal of Pediatrics 101:419, 1982.
16. Torch, W., “DPT Immunization: a Potential Cause of SIDS,” Neurology 32:169, 1982.
18. Noble, G., et al., “Acellular and Whole-Cell Pertussis Vaccines in Japan,” JAMA 257:1351, 1987.
19. Cherry, et al., Report of Task Force on Pertussis ands Pertussis Immunization, Pediatrics 81:939, Supplement, 1988.
20. Noble, op. cit.
21. Wakefield, A., et al., “Measles Vaccine: a Risk Factor for Inflammatory Bowel Disease?” Lancet 345:1071, 1995.
22. Wakefield, et al., “Ileal-Lymphoid Nodular Hyperplasia, Nonspecific Colitis, and Pervasive Developmental Disorder in Children,” Lancet 351:637, 1998.
24. Wakefield, “MMR, Enterocolitis, and Autism,” Lecture, NVIC International Conference on Vaccination, November 2002.
27. Megson, M., “Genetics, Vaccine Injury, and Getting Well,” and Cave, S., “Vaccine Injury Therapy,” NVIC Conference Presentations, November 2002.
28. Family Practice News, May 15, 2000, p. 49.
31. ACIP Update, 1996, op. cit., pp. 7-8 passim.
32. Unpublished case.
33. L. K. vs. Secretary of HHS, No. 99-624V.
34. T. O. vs. Secretary of HHS, No. 99-635V.
35. Mathieu, E., et al., “Cryoglobulinemia after Hep B Vaccination,” Letter, New England Journal of Medicine 335:356, August 1, 1996.
36. “Hepatitis B Vaccine,” The Vaccine Reaction, NVIC Special Report, September 1998, p. 7.