Vaccinating Children:
Where Do We Draw the Line?
January 22,1999
Introduction
Since the late nineteenth century, public health officials
have recommended and enforced vaccines for a small number
of highly infectious and communicable diseases. Today,
however, there are more than 200 new vaccines in the
research pipeline, including one for HIV.
Federal health officials (U.S. Centers for Disease
Control) commonly recommend new vaccines as soon as
they receive FDA approval and are placed on the market.
State health departments then routinely add new vaccines
to the list of compulsory vaccines required for school
entry. In most states, this occurs through the regulatory
process without a vote by the legislature, although
most states have religious, philosophical, and medical
exemptions. Currently, the majority of American children
are given 33 doses of 10 different vaccines by the time
they reach age five. But before this trend goes any
farther, lawmakers and parents should question the long-term
effects of these vaccines on children's health and consider
the proper role of government in this area.
Government's Expanding Role
Why the trend toward new mandatory vaccines? For one
thing, Congress placed price controls on routine childhood
vaccines in 1993. But the price controls did not apply
to new vaccines. Thus, manufacturers have had an incentive
to develop and enforce new vaccines for children, since
the new products are exempt from price controls.
Conventional wisdom maintains that children are healthier
and are living longer because of mandatory vaccine policies.
However, a book edited by Philip R. Lee, former Assistant
Secretary of Health and Human Services, explains that
during the early part of the nineteenth century, mortality
for the childhood diseases whooping cough, measles,
and scarlet fever had fallen to a low level before effective
immunization became available. The figure below shows
that the rate of death attributed to measles in Massachusetts
between 1860 and 1970 had dropped long before the measles
vaccine was introduced in 1963, according to government
data. Decreased mortality in the nineteenth century
is primarily attributed to improved basic hygienic measures,
including purification of water, efficient sewage disposal,
and improved food hygiene.
Massachusetts
Deaths Caused by Measles: 1860 to 1970
Figure 1
Vaccine manufacturers, health-care providers, and
public health officials are correct to point out that
since the introduction of the measles vaccine, the rate
of disease has declined. But they neglect to mention
that the number of deaths caused by measles was declining
long before the vaccine was mandated. Given this lack
of historical information, parents and state legislators
rarely question whether or not a new vaccine should
be mandatory.
Instead, they routinely endorse federal recommendations
based on the scientific evidence that shows a vaccine
is associated with decreased childhood mortality. It
is not until a child suffers a serious side-effect or
death before most parents examine historical data and
begin questioning government vaccine policies.
Is Your Child Worth More Than $250,000?
Although states have police power to mandate new vaccines,
the federal government is in charge of compensating
children and their families for any serious vaccine-related
injuries or death. Scientists agree that all medical
products, including vaccines, have risks. For many years,
vaccine risks went unnoticed and unreported. However,
during the 1980s, a national television program publicized
the serious side-effects caused by the mandatory DPT
vaccine (diphtheria, pertussis, and tetanus).
Consequently, a national grassroots movement was established
and parents began questioning the benefits and risks
of vaccines. Parents of injured children also began
suing vaccine manufacturers. Not surprisingly, vaccine
manufacturers began threatening to stop producing vaccines
because their liability insurance premiums skyrocketed.
In an attempt to improve vaccine safety and minimize
manufacturers' liability, Congress enacted the 'National
Childhood Vaccine Injury Act of 1986' (PL 99-660). This
law created a Vaccine Injury Compensation Program (VICP)
which is administered jointly by the U.S. Federal Claims
Court, the Department of Health and Human Services (HHS),
and the Department of Justice (DOJ). The compensation
program serves as a no-fault alternative to the tort
system for resolving claims resulting from adverse reactions
to mandatory childhood vaccines, whether administered
in the private or public sector.
As a result, all parents must first apply to the federal
government for compensation if they feel their child
has suffered from a mandatory vaccine. If a claim for
compensation is rejected by the federal government,
or if parents believe the compensation offered is too
inadequate to provide for their child's lifelong care,
then parents can then file a vaccine injury lawsuit
against the vaccine manufacturer.
The federal government caps the amount it pays for
vaccine damages. The maximum amount a parent may receive
for a vaccine-related death of a child is $250,000 plus
expenses. By 1997, the federal government had awarded
nearly $1 billion dollars to more than 1,000 families
whose children suffered catastrophic reactions to mandated
vaccines. Yet, according to the National Vaccine Information
Center (NVIC), it is extremely difficult to get an award
from the federal compensation program and few parents
have the emotional energy to pursue a lawsuit after
battling the federal legal establishment.
The NVIC also notes that: "Since the National Childhood
Vaccine Injury Act was passed in 1986, HHS officials
and Justice Department lawyers have systematically gutted
the law by passing federal regulations that narrow the
criteria that special masters employed by the U.S. Claims
Court may use to make awards to vaccine-injured children."
New Mandatory Vaccine for Hepatitis B
In addition to routine childhood vaccines, federal
health officials have recommended that all infants and
children ages 11-12 get vaccinated for Hepatitis B.
But unlike other communicable diseases that are easily
transmitted via air and casual contact, Hepatitis B
is transmitted by direct contact with blood and body
fluids. Those at risk for contracting the disease include
intravenous drug users, sexually active individuals,
blood transfusion recipients, health care workers, and
babies born to high-risk mothers.
Why then, if those are the groups most at risk, is
the government pushing for all children to be
vaccinated against Hepatitis B? Why are parents' children
being kicked out of public school for refusing the Hepatitis
B vaccine? Why are newborns of healthy mothers being
injected before leaving the hospital; and why don't
hospitals screen expectant mothers to find out if they
are carrying the Hepatitis B virus, instead of vaccinating
all newborns? Currently, only 15 states have laws requiring
screening of pregnant women for Hepatitis B infection.
As recently reported in a Regulation article,
the government's public health officials could not effectively
vaccinate intravenous drug users and prostitutes. Therefore
they are forcing all children -- even those not
at risk -- to be vaccinated against Hepatitis B. The
CDC's web site explains: "While most HBV [Hepatitis
B virus] infections occur among older adolescents and
young adults, vaccination of persons in high-risk groups
has generally not been a successful public health strategy."
In other words, the government could not force adults
in the high-risk behavior groups to accept the Hepatitis
B vaccine, so they are going after newborns and young
children - the groups least likely to contract or transmit
the disease.
Currently, Hepatitis B vaccine is required for children
in 35
states, with medical exemptions in all states,
religious exemptions in all but two states, and philosophical
exemptions in 16 states. Public health advocates argue
the benefits outweigh the risks, so parents should vaccinate
their children. However, civil libertarians and those
in favor of a free market raise an important question.
Who should be making this decision in the first place?
Why should Johnny be vaccinated against his will if
he is not at risk for contracting or transmitting Hepatitis
B? And why should Johnny's parents be forced (by state
law) to vaccinate their child for Hepatitis B, if Johnny
poses no threat to himself or to other students?
Some parents have refused to have their children vaccinated
for fear of unknown long-term side effects. The CDC's
web site assures Americans that the Hepatitis B vaccine
has been shown to be very safe when given to infants,
children, and adults. Yet, the Physicians Desk Reference
(PDR) tells another story. The PDR lists a host of serious
side effects that occur with less than one percent of
injections. This number sounds small, but when one considers
there are more than 70 million American children, that
means nearly 700 thousand children could suffer serious
adverse reactions. That is more than the approximately
30 thousand infants and children the CDC claims were
infected each year before routine Hepatitis B immunization
began.
Individuals worldwide are challenging the Hepatitis
B vaccine policy. In March 1998, an Illinois student
testified before a Springfield Board of Health public
hearing on vaccinations. He explained he was kicked
out of college during the middle of the semester because
he refused the vaccine.
In France, the Ministry of Health suspended Hepatitis
B vaccinations in French schools because of the public's
concern about long-term side effects. Meanwhile, concerned
parents in Canada recently went to court asking the
government to stop Hepatitis B vaccinations for up to
18 thousand fourth-grade students across Manitoba.
Despite public resistance to the Hepatitis B vaccine,
the World Health Organization (WHO) strongly encourages
all countries already using the Hepatitis B vaccine
as a routine vaccine to continue its usage. WHO also
urges countries not yet using the vaccine to begin as
soon as possible.
Conclusion
Americans in general and legislators in particular
need to remember that the role of our government is
to protect individual rights; not to run individual
lives. Our country was founded on the principle of individual
liberty, not state control. Times change, technologies
change, and we see new health care advances every day.
But one thing remains the same: Americans have an inherent
desire for freedom of choice.
The United States should set the world standard for
liberty by giving parents the freedom to decide whether
or not to vaccinate their children for Hepatitis B.
If parents are not even allowed to reject questionable
vaccines for preventable diseases, such as Hepatitis
B, then what will be forced upon their children in the
future? Where do we draw the line for vaccinating children?
Government certainly has a legitimate role in making
sure all parents understand the risks and benefits of
vaccines. But in the end, parents should be the ones
making important health care decisions for their children.
Note: This information is not intended as medical
advice. Consult a physician for medical advice.
By Sue Blevins. This article was originally published
as a book chapter in the Legislator's Guide to Children's
Issues: 1999, published by the Pacific Research Institute
in San Francisco, CA.
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