Deadly Choices: How the Anti-Vaccine Movement Threatens Us All

by Paul A. Offit M. D.

  Now that herd immunity has broken down, Sears’s position that one should think only of oneself no longer works. Unfortunately, his book contains many examples of this philosophy:

  • “In truth, tetanus is not an infant disease,” he writes. “Also, diphtheria is virtually non-existent in the United States. So you could create a logical argument that a baby could skip the tetanus and diphtheria shots for a few years and be just fine.” These statements are inaccurate. First: tetanus is a disease of infants. A cursory look at any textbook of infectious diseases provides grim pictures of newborns suffering severe muscle spasms and breathing difficulties from tetanus; that’s why it’s called the “disease of the seventh day.” Second: the casual advice that one can simply wait to get a diphtheria vaccine ignores history. Between 1990 and 1993, when public health programs were disrupted in the Russian Federation (states newly independent from the Soviet Union), a hundred and fifty thousand people suffered diphtheria and five thousand died, mostly children. In the absence of vaccination, such an outbreak could happen in the United States just as easily.

  • “[Polio] doesn’t occur in our country,” writes Sears, “so the risk is zero for all age groups.” Although polio has been eliminated from the United States, it hasn’t been eliminated from the world. Four countries—India, Nigeria, Pakistan, and Afghanistan—have never interrupted polio transmission; and children in twenty-three other countries still suffer the disease. Because international travel is common, and because most people who are contagious aren’t sick, it is likely that poliovirus walks into the United States every year. Children whose parents follow Sears’s advice will be particularly vulnerable when an outbreak occurs or when they travel overseas.

  • “Hib is a bad bug,” writes Sears. “Fortunately, it’s also a rare bug, so rare that I haven’t seen a single case in ten years. Since the disease is so rare, Hib isn’t the most critical vaccine.” As Sears knows, Hib is rare because of the Hib vaccine. And if we stop using the vaccine, Hib will be back. Which is exactly what has happened. Sears’s book was published in October 2007. The following year, outbreaks of Hib meningitis occurred in Minnesota and Pennsylvania. All these outbreaks centered on children whose parents had chosen not to vaccinate them; four died from their infections.

  Robert Sears peers out from the back cover of his book with an open, caring expression, exuding a kind of California calm. No doubt he wants to do the right thing; no doubt he is trying to find some middle ground between parental anxiety about getting vaccines and physician anxiety about not giving them; no doubt he believes he is on the side of his fellow physicians. Describing his “alternative schedule,” Sears writes, “I have put together a vaccine schedule that gets children fully vaccinated, but does so in a way that minimizes the theoretical risks of vaccines. It’s the best of both worlds of disease prevention and safe vaccination.” But Sears’s schedule is ill-founded. And rather than calming parents with science that exonerates vaccines, he caters to their fears by offering a schedule that has no chance of making vaccines safer and will only increase the time during which children are susceptible to infections that can kill them. It’s the worst of both worlds.

  Although Sears is probably well meaning, one has to question the hubris of a man who decides to create his own vaccine schedule—someone who claims his schedule is better and safer than that recommended by the CDC and AAP. It’s all the more amazing when one considers that Robert Sears has never published a paper on vaccine science; never reviewed a vaccine license application; never participated in the creation, testing, or monitoring of a vaccine; and never developed an expertise in any field that intersects with vaccines—specifically, virology, immunology, epidemiology, toxicology, microbiology, molecular biology, or statistics. Yet he believes he can sit down at his desk and come up with a better schedule. And parents trust him. Oddly, they trust him because he doesn’t have an expertise in vaccine science—an expertise that would likely have inspired the CDC, AAP, FDA, professional medical organizations, or vaccine makers to seek his advice.

  One final irony. For a new vaccine to be added to the schedule, the FDA requires concomitant-use studies. Pharmaceutical companies must show that a new vaccine doesn’t interfere with the immunity or safety of existing vaccines and that existing vaccines don’t interfere with the new vaccine. Only then can a vaccine become part of the schedule. Dr. Bob’s schedule, on the other hand, is completely untested—never reviewed by the FDA, CDC, or AAP to make sure it’s as safe and effective as the existing schedule. It is remarkable how little Sears thinks of the enormous amount of testing that goes into creating the current schedule.

  Sears isn’t alone.

  On January 12, 2010, Dr. Mehmet Oz, host of the popular The Dr. Oz Show, told interviewer Joy Behar what he thought about the influenza vaccine.

  BEHAR: There’s a rumor that your kids did not get flu shots or swine flu shots. Is that right?

  OZ: That’s true. They did not.

  BEHAR: Do you believe in them for the kids or what?

  OZ: No. I would have vaccinated my kids but you know I—I’m in a happy marriage and my wife makes most of the important decisions as most couples have in their lives.

  Given their relative training, one would have imagined that Oz, not his wife, would have made the decision. Mehmet Oz graduated from Harvard University in 1982 and obtained a joint MD and MBA degree from the University of Pennsylvania School of Medicine and the Wharton School in 1986. Since then, he’s climbed the ranks to become a professor of cardiac surgery at Columbia University. His wife, Lisa, has no background in science or medicine. Rather, Lisa Oz is guided by the beliefs of Mikao Usui, who, after three weeks of fasting and meditation on Mount Kurama in Japan, claimed he had been given the power to heal through his palms—called reiki. Lisa Oz isn’t just a follower of Usui, she’s a reiki master.

  The four Oz children weren’t among the hundreds of thousands hospitalized or the hundreds killed by swine flu in 2009. But they could have been. And the influenza vaccine would have prevented it. No scientific evidence supports palm healing as a method to treat or prevent influenza.

  Oz’s disdain for vaccines didn’t end on The Joy Behar Show. In December 2009, Oz and co-author Michael Roizen published YOU: Having a Baby, a book that promotes Dr. Bob’s Alternative Vaccine Schedule. Oz and Roizen wrote, “One of the most highly charged conflicts revolves around an issue that comes up just moments after your baby is born: to vaccinate or not to vaccinate? That, indeed, is one heck of a question.” Like Sears, Oz and Roizen misinformed their readers on several counts:

  Mehmet Oz, host of The Dr. Oz Show, often dispenses anti-vaccine advice. Shown here with wife Lisa at Time magazine’s 100 Most Influential People Gala, May 8, 2008. (Courtesy of Scott McDermott/Corbis.)

  • Regarding the polio vaccine, they wrote, “There’s no doubt that polio vaccine ... causes polio in 1 in 1 million to 2 million,” failing to mention that the only polio vaccine available today in the United States is inactivated and, therefore, incapable of causing polio.

  • Regarding the influenza vaccine, they wrote, “Pregnant women should avoid getting the influenza vaccine in their first trimester.” Instead of the vaccine, they suggest that “you can boost your immune system during the winter by taking 2,000 IU [International Units] of vitamin D daily.” Pregnant women are much more likely to be hospitalized and killed by influenza than nonpregnant women of the same age. That’s why they’re asked to receive the influenza vaccine if they’re pregnant during influenza season. The vaccine, not vitamin D, induces specific immunity to the virus.

  • Regarding the rotavirus vaccine, they wrote, “A prior version of this vaccine was withdrawn from the market in 1999 because it was linked to a severe condition known as intussusception, a blockage or twisting of the intestine. A new vaccine, released in 2006, has been associated with even more cases of intussusception ... than the first version, prompting an FDA notification in 2007. We recommend that you opt out of this o
ne until more data are available.” Oz and Roizen should have read the FDA notification a little more carefully. If they had, they would have seen that the FDA stated that all cases of intussusception following rotavirus vaccine may have occurred by chance alone. Further, one year before YOU: Having a Baby was published, the CDC found the risk of intussusception was the same in children who did or didn’t receive the rotavirus vaccine; parents no longer have to wait for data.

  Robert Sears and Mehmet Oz have followed in the footsteps of anti-vaccine activists before them, claiming to inform parents about vaccines while in fact misinforming them. Their popularity has only widened the gap between some parents and their pediatricians.

  So how does one solve the problem of the growing rift between parents who are concerned about the safety of vaccines and doctors who are worried about the reemergence of infectious diseases? The solution may not be easy; but it’s there.

  CHAPTER 11

  Trust

  Leave the gun. Take the cannolies.

  —PETER CLEMENZA, THE GODFATHER

  We’ve reached a tipping point. Children are suffering and dying because some parents are more frightened by vaccines than by the diseases they prevent. It’s time to put an end to this. Several solutions have been proposed. The first would be effective but is too awful to imagine; the second, given the history of the American legal system, will never happen; the third, while possible, would require a sea change in our culture.

  In 1998, Robert Chen, then head of immunization safety at the Centers for Disease Control and Prevention, created a graph titled “The Natural History of an Immunization Program.” Chen described what happens when vaccines are used for a long time, partitioning the public’s reaction into distinct phases.

  In the first phase, people are afraid of infections. In the 1940s, parents readily accepted the diphtheria and pertussis vaccines because diphtheria and pertussis commonly killed young children; and the tetanus vaccine because many people died of tetanus, especially during World Wars I and II. In the 1950s, parents rushed to get the polio vaccine because they saw what polio could do; everyone knew someone who had been paralyzed or killed by the virus. In the 1960s, parents gave their children measles, mumps, and rubella vaccines because they had witnessed firsthand the devastation wrought by those diseases: pneumonia and encephalitis from measles, deafness from mumps, and severe birth defects from rubella. During this phase of Chen’s graph, immunization rates rise.

  In the next phase, as vaccines cause a dramatic reduction in disease, a new line appears: “Fear of Vaccines.” Vaccines become a victim of their own success. Now the focus is on vaccine side effects, real or imagined. Immunization rates plateau.

  In the next phase, as fear of vaccines continues to rise, immunization rates fall. And preventable diseases increase. It’s in this phase that America now finds itself. When Chen showed this graph to colleagues at the CDC, he used statistics to support his argument. And, like most thoughtful scientists, he remained dispassionate, referring to children as numbers on a graph. But there was emotion in those numbers. (“Statistics are people with their eyes wiped dry,” said former Surgeon General Julius Richmond.)

  The last and most disturbing phase of Chen’s graph offers a solution to the problem posed by unvaccinated children. In this phase, the incidence of preventable deaths becomes so high that parents again seek solace in vaccines. Immunization rates rise. In a more perfect world, we would never get to this part of Robert Chen’s graph. We would learn from history—learn from the smallpox deaths in England in the late 1800s following widespread anti-vaccine activity, learn from pertussis deaths in England and Japan in the mid-1970s following unfounded fears that the vaccine caused brain damage, learn from measles deaths in England and Ireland in the late 1990s caused by the false notion that MMR caused autism, and learn from bacterial meningitis deaths in Minnesota and Pennsylvania in 2009 caused by the fear that children were getting too many vaccines.

  Although renewed fears of fatal infections caused by the reemergence of these diseases would undoubtedly increase vaccination rates, the price is far too great.

  Another solution to the problem of unvaccinated children would be to eliminate religious and philosophical exemptions.

  Religious exemptions would be impossible to eliminate. That’s because parents have been letting their children die in the name of religion for decades, without consequence. And these children have been denied treatments that would have saved their lives, not vaccines that might have saved their lives. For example:

  • In the late 1890s and early 1900s, many children of Christian Scientists died from diphtheria, even though diphtheria antitoxin was widely available. Christian Science healers were unrepentant, one stating, “We do not feel bound to the laws of hygiene, but to the laws of God.” Several parents were charged with manslaughter, none successfully.

  • In 1937, Edward Whitney, a widowed insurance salesman, left his ten-year-old daughter, Aubrey, in the care of her aunt in Chicago. Aubrey was a diabetic. The aunt, a Christian Scientist, took Aubrey to her practitioner, William Rubert, who immediately took her off insulin. On December 10, 1937, Aubrey Whitney died in a diabetic coma; Rubert wasn’t held accountable for her death. Twenty-two years later, Edward Whitney walked into Rubert’s office, pulled out a 32-caliber handgun, and shot him at point-blank range.

  • In 1951, Cora Sutherland, a fifty-year-old Christian Scientist who taught shorthand at Van Nuys High School in Los Angeles, argued successfully that she should be exempt from the periodic X-rays required by her school to detect tuberculosis. Three years later, in March 1954, she died of tuberculosis, but not before exposing thousands of students. The health department petitioned the board of education to eliminate religious exemptions, without success.

  • In 1955, seven-year-old David Cornelius became ill; his parents, Edward and Anne Cornelius, took him to a doctor who diagnosed diabetes and started insulin. Later, a Christian Science clinician stopped the insulin, causing David to die in a diabetic coma. The district attorney indicted Edward and Anne Cornelius for involuntary manslaughter, but dropped the charges when a senior church official persuaded him that the Corneliuses “had sincerely believed that they could save their son through prayer.”

  • In 1967, Lisa Sheridan, the five-year-old daughter of Dorothy Sheridan, contracted strep throat. For the next three weeks Lisa found it harder and harder to breathe. Dorothy, a Christian Scientist, prayed but to no avail; Lisa Sheridan died of pneumonia on March 18, 1967. At autopsy, the pathologist found a quart of pus in Lisa’s chest that had collapsed her lung—pus that could have been removed easily had Dorothy sought medical attention. Sheridan was convicted of manslaughter and sentenced to five years in jail. The church, frightened by the verdict, issued a scathing rebuke: “We must not yield to the mesmeric claims of medicine by calling a doctor and being forced to worship a false God.” Christian Science officials successfully lobbied the Department of Health and Human Services to exempt faith healers from prosecution. In 1974, when the federal exemption was made, eleven states already had a religious exemption statute; ten years later, all fifty states and the District of Columbia had it.

  • In 1977, Matthew Swan, the second child of Rita and Douglas Swan, had a high fever. The Swans asked their Christian Science practitioner, Jeanne Laitner, to treat him. Laitner complied; sitting next to Matthew’s crib she said, “Matthew, God is your life. God didn’t make disease, and disease is unreal.” Matthew continued to scream in pain. On July 7, Matthew Swan was pronounced dead from bacterial meningitis. Unlike other Christian Science parents, Rita Swan saw the death of her son as a wake-up call. She founded Children’s Health Care Is a Legal Duty (CHILD), an organization devoted to changing religious exemption laws.

  But the neglect continued:

  • On March 9, 1984, Shauntay Walker died of bacterial meningitis. Her mother, Laurie, a Christian Scientist, had kept her home for seventeen days. At the time of death, Shauntay, who was five years
old, weighed only twenty-nine pounds. In 1990, Walker was convicted of manslaughter, but the conviction was overturned with the help of her lawyer, Warren Christopher, who would later become Bill Clinton’s secretary of state.