August 2003

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The Vaccine controversies

By Ruth SoRelle, MPH

I am not sure how old I was, but I know I had not entered high school the day my mother came home from a visit to our family physician with a little vial and a box of sugar cubes.

She had managed to procure some of the new Sabin polio vaccine, and she was not willing to wait until it would be given at the local school. Even though all of us had had our Salk vaccine by that time, she wanted her children protected against polio as soon as possible. Carefully, she dotted the vaccine onto the sugar cubes and gave one to each of her children.

What a difference four decades makes. The Sabin vaccine became available in 1963, and millions around the nation lined up to receive it. Protecting children against the devastating disease was a priority then.

This year, the Texas Legislature passed a law that enables parents to reject immunizations for their school-age children while still enrolling those children in school. They did not have to have a religious objection, just a “conscientious” objection to the shots.

In most cases, parents who object to vaccines are reacting to misinformation or reports of rare reactions to vaccination. Perhaps they never saw the effects of infectious disease. Those of us who grew up with children who had had polio and carried with them the resulting disabilities know the importance of preventing diseases if at all possible.

The measles epidemics of the late 1980s and 1990s resulted in a rash of deaths and serious illnesses requiring hospitalization – a reminder of the dangers that such diseases can still pose. The rise of whooping cough in this country and the British Isles again reminds us that preventing disease is always better than attempting to treat it.

In the decade between 1991 and 2001, 128,717 reports of adverse events were reported to the Vaccine Adverse Event Reporting System operated by the federal government. During that period, 1.9 billion doses of human vaccines were given. In other words, there were 11.4 reports of adverse events for every 100,000 doses of 27 types of vaccine given. Of these, 25.8 percent of the adverse events were fever and 15.8 percent were some kind of visible reaction at the site of the injection. A total of 14.2 percent of all reports were serious, including death, life-threatening illness, hospitalization or prolonged hospitalization or permanent disability.

That means that for every 10,000 doses of vaccine, there is one adverse event, and that is most likely to be a minor problem like fever, swelling or rash. Only 14 percent of those events were serious. In other words, the rate of serious problems resulting from vaccines is minuscule. That is not to dismiss the tragedy that occurs when a child does become ill as a result of a vaccine. It is devastating.

The greatest risk, however, is that children who are not immunized will get a devastating life-threatening disease that will either kill them or leave them with a permanent disability. Parents who do not protect their children by immunizing them are left with the knowledge that they “could” and “should have.”

Children who are not immunized also pose a risk to their fellow students – even those who have received their vaccines. No immunization is completely protective. Only when all children in a group are immunized is the protection sufficient to prevent an outbreak or epidemic. Parents who elect not to immunize their children are putting others at risk.

I am a member of the generation that attempted to wrap our children in cotton wool. My children received all the available immunizations. They were placed in infant safety seats for the ride home from the hospital, and today they are still uncomfortable without seatbelts. The outlets in my home were covered, and the kitchen cabinets were almost impossible to open. Medications were stored in a box with a combination lock, and there were no guns or ammunition in the house.

I know, however, that life is fraught with risk. Everything we do with our children is a risk-benefit ratio. It is ironic that parents who are loath to immunize their children think nothing of packing them into a car for a ride down the Southwest Freeway. Yet, each year, approximately 2,500 children under the age of 15 die from auto accidents. Riding in an automobile is probably the most dangerous thing a child can do.

Immunizing children is, in the end, more than a decision by one parent about a child’s safety. Certainly, parents should check with their physicians about vaccines and their children’s reactions to them. In some instances, vaccines are not indicated. In the vast majority of cases, immunization is the healthy thing to do – healthy for individual children and healthy for the community of children. It is not only a decision. It is a responsibility.

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