• On April 8, 1986, Robyn Twitchell—the two-year-old son of David and Ginger Twitchell—died of a bowel obstruction. David and Ginger had graduated from a Christian Science college in Missouri. After the bowel obstruction ruptured, Robyn vomited stool and portions of his bowel. He died in his father’s arms. At trial, Dr. Burton Harris, chief of surgery at Boston’s Floating Hospital for Infants and Children, testified, “It’s beyond comprehension that the parents of a child who’s vomiting stool wouldn’t seek medical help.” The Twitchells were found guilty; the verdict was overturned on appeal.
• On June 5, 1988, twelve-year-old Ashley King died of bone cancer. The only child of John and Catherine King, Ashley lay at home for months without medical care. At the time of her death, the tumor was the size of a watermelon; her hemoglobin level was incompatible with life, and she was covered with bedsores. John and Catherine King each pleaded no contest to one charge of reckless endangerment: a misdemeanor. They were sentenced to three years’ probation.
• On May 9, 1989, eleven-year-old Ian McKown—the son of Kathleen McKown—died in a diabetic coma. Doctors testified that insulin given even two hours before his death could have saved his life. The police officer called to the house said that the child was so emaciated that “he didn’t even look human.” Kathleen McKown was protected from prosecution by Minnesota’s religious exemption law.
Despite deaths at the hands of faith healers, religious exemptions have remained intact, causing prosecutors either to decline to file criminal charges or to lose in court. Only three states—Massachusetts, Hawaii, and Maryland—have repealed their religious exemption health laws; the rest continue to offer protection to parents who medically neglect their children in the name of God.
The notion that U.S. courts would eliminate religious exemptions to vaccination, when they haven’t eliminated religious exemptions to lifesaving medicines, is fanciful.
Philosophical exemptions, which have become increasingly more popular, would also be difficult to eliminate.
In the 1990s, philosophical exemptions were available in only a handful of states; now, they’re available in twenty-one. Alan Hinman, the CDC official interviewed for Vaccine Roulette who actively promoted state mandates in the 1970s, doesn’t see any hope of eliminating philosophical exemptions. “I don’t think that one would win the battle in the legislature on getting rid of philosophical or personal belief exemptions,” he said. “Looking at the trajectory of our society over the last several years, I find it hard to imagine. If anything, we’re going the other way.” Walter Orenstein thinks philosophical exemptions at the very least should be much more difficult to obtain. “I believe that a decision not to vaccinate is of equal gravitas to [the decision] to vaccinate,” he said. “And there should be a procedure whereby people have to read information, understand information, and sign that they understand the risks they are putting that child through. Right now, in some places, it’s a hell of a lot easier to get an exemption than to get your child vaccinated.” Orenstein sees his proposal as of value only for those who choose what he calls “exemptions of convenience.” “For people who are adamantly opposed to vaccines,” he says, “I don’t think this will make that much difference.”
Another solution would be for the medical community to respond more directly to the threat of decreasing immunization rates.
Recently, hospital administrators have been mandating influenza vaccines given yearly for healthcare providers. Regarding influenza, certain facts are unassailable: people sickened by influenza come into the hospital, healthcare providers can spread influenza virus from one patient to another, patients who catch influenza in the hospital can suffer severe and fatal illness, and hospitals with higher rates of immunization among healthcare providers have lower rates of influenza. Despite these facts, influenza vaccination rates among healthcare providers have been woeful—hovering around 40 percent. So, in the name of patient safety, hospital administrators are doing something about it.
In 2009, eight hospitals in the United States mandated influenza vaccine for their employees. Some took a softer approach: if a healthcare provider refused vaccination, administrators required a surgical mask to be worn throughout the day. Others took a harder line. At the Children’s Hospital of Philadelphia healthcare providers who refused influenza vaccination were given two weeks of unpaid leave to think about it. If they still refused, they were fired. As a consequence, immunization rates among healthcare providers at the hospital rose from 35 percent in 2000 to 99.9 percent in 2010. Administrators at Children’s Hospital knew they were responsible for a vulnerable population; so they stood up for them.
Doctors are also doing something that decades ago would have been unthinkable: they’re refusing to see parents who won’t vaccinate their children.
For doctors, it’s a lose-lose situation. Doctors who refuse to care for unimmunized children are sending a strong message. They’re saying vaccines are so important that they cannot be asked to withhold them. The problem with this approach is that by refusing to see unimmunized children, doctors lose any chance of convincing parents of the value of vaccines; worse still, these children will likely remain unimmunized and vulnerable. On the other hand, if doctors continue to see unimmunized children, they’re sending a tacit message that it’s an acceptable choice. And it’s not a choice that parents are making for their child only; it’s a choice they’re making for other children, including those in the doctor’s waiting room. The measles outbreaks in 2008 are a perfect example of how parents’ choices for their children affected others. When unimmunized children developed fever and a rash, parents brought them to their pediatricians’ offices, where other children, some too young to be immunized, were exposed. Doctors’ offices became epicenters of measles transmission. Now, doctors are asking: who will stand up for children in our waiting rooms if not us?
Brad Dyer, a pediatrician in Lionville, Pennsylvania, has written a vaccine policy that is posted throughout his office. “We call it the manifesto,” he says. The document, titled “The Importance of Immunizing Children,” reads, in part, as follows:
We firmly believe in the effectiveness of vaccines to prevent serious illnesses and save lives.
We firmly believe in the safety of vaccines.
We firmly believe that all children and young adults should receive all of the recommended vaccines according to the schedule published by the Centers for Disease Control and Prevention and the American Academy of Pediatrics.
We firmly believe based on all available literature, evidence, and current studies that vaccines do not cause autism or other developmental disabilities.
Furthermore, by not vaccinating your child you are taking selfish advantage of thousands of others who do vaccinate their children, which decreases the likelihood that your child will contract one of these diseases. We feel such an attitude to be self-centered and unacceptable.
We are making you aware of these facts not to scare you or coerce you, but to emphasize the importance of vaccinating your child. We recognize that the choice may be an emotional one for some parents. We will do everything we can to convince you that vaccinating according to the schedule is the right thing to do. Please be advised, however, that delaying or “breaking up the vaccine” to give one or two at a time over two or more visits goes against expert recommendations and can put your child at risk for serious illness (or even death) and goes against our medical advice.
Finally, if you should absolutely refuse to vaccinate your child despite all our efforts, we will ask you to find another healthcare provider who shares your views. We do not keep a list of such providers nor would we recommend any such physician.
Following the posting of the policy, only a handful of parents left Dyer’s practice. “Parents have said, ‘Thank you for saying that. We feel much better about it,’” he says.
Unfortunately, nothing will change if the push to vaccinate comes only from doctors, vaccine advocates, public health officials, and ho
spital administrators. Some parents will always view these groups as biased; and it hasn’t been hard for anti-vaccine groups to appeal to the sentiment that they can’t be trusted.
When parents choose to vaccinate their children, one element is critical to the decision: trust. A choice not to vaccinate is a choice not to trust those who research, manufacture, license, recommend, promote, and administer vaccines—specifically, the government, pharmaceutical companies, and doctors. If we are to again believe that vaccines are safer than the diseases they prevent, we’re going to have to trust those responsible for them. This isn’t going to be easy.
The CDC has been a particularly useful target. The mere mention of the term the government conjures up images of labyrinthine red tape and career bureaucrats who don’t care about anything except their pensions. But anyone who spends time with the people at the CDC responsible for vaccines will come away with a far different impression. People like Walter Orenstein, a pediatrician and former director of the National Immunization Program, who early in his career worked to eradicate smallpox, caring for one of the last cases in India. Or Anne Schuchat, an internist and director of the National Center for Immunization and Respiratory Diseases, whose compassion toward those sickened and, in some cases, killed by the novel H1N1 virus was apparent at every CDC press briefing. Or Larry Pickering, a pediatrician, infectious diseases specialist, and executive secretary of the Advisory Committee on Immunization Practices, who dedicated his early career to understanding how infections in child-care centers could best be eliminated. Or Nancy Messonier, a tireless advocate for children who suffer meningococcal infections. John Salamone, a parent advocate who worked closely with CDC officials during his fight to change polio-vaccine policy, was impressed by what he saw: “They were all incredibly professional, all very caring, all wanting to do the right thing.”
Eventually, we are going to have to appreciate that CDC officials aren’t against us—they are us. Those involved with vaccines include doctors and scientists who are also parents, aunts, uncles, and grandparents. “We’re human,” says Walter Orenstein. “We have children. And we use the same vaccines in our own children as we recommend for anybody else.”
Another group targeted by anti-vaccine groups is vaccine advocates. People like Deborah Wexler, who visits housing projects to talk about the importance of vaccines, and provides free vaccines to Southeast Asian refugees, all through an organization she founded in St. Paul, Minnesota. Or David Tayloe, former president of the American Academy of Pediatrics, who has served his North Carolina community as a practicing pediatrician for more than four decades. Or Amy Pisani, who studied at Gallaudet University for the deaf before becoming executive director of Every Child by Two, an organization that provides vaccine services to low-income families.
Despite the efforts of these advocates for children, journalists with a direct link to the anti-vaccine movement have tried to discredit them. For example, on July 25, 2008, Sharyl Attkisson aired a segment on the CBS Evening News with Katie Couric. (Attkisson also maintains an anti-vaccine blog site.) Attkisson had discovered what she believed really motivated people like Amy Pisani: money. “Every Child by Two,” said Attkisson, “a group that promotes early immunization for all children, admits the group takes money from the vaccine industry, too, but wouldn’t tell us how much. A spokesman [Amy Pisani] told us, ‘There are simply no conflicts to be unearthed.’ But guess who has been listed as the group’s treasurer?—an official from Wyeth and a paid advisor to big pharmaceutical clients.” Attkisson’s implication wasn’t subtle. Every Child by Two was a sham, merely fronting for the interests of Big Pharma. But Attkisson’s guilt-by-association reporting lacks one critical element: quid pro quo. Where is the evidence that Every Child by Two, an organization founded by the wives of a former U.S. president and a former senator (Rosalynn Carter and Betty Bumpers)—with minuscule salaries, a shoestring budget, and a tiny office in Washington, D.C.—is promoting vaccines for any reason other than its belief that they are lifesaving? And where is the evidence that the money that it receives from pharmaceutical companies is used for anything other than outreach to underprivileged children? Attkisson’s report was the worst kind of journalism: damning by association. Pharmaceutical companies provide unrestricted educational grants to groups like Every Child by Two all the time. The key part of those grants is the word unrestricted. Once given, the company has no say in how that money is spent.
Attkisson didn’t stop with Every Child by Two. She also attacked the American Academy of Pediatrics. “The vaccine industry gives millions to the American Academy of Pediatrics,” she said, “for conferences, grants, medical education classes, even to help pay to build their headquarters. The totals are kept secret, but public documents reveal bits and pieces; $342,000 was given to the academy by Wyeth, maker of the pneumococcal vaccine for a community grant program; $433,000 was contributed to the academy by Merck, the same year the academy endorsed Merck’s HPV vaccine. Another top donor, Sanofi-Aventis, maker of seventeen vaccines and a new five-in-one-combo shot just added to the vaccine schedule last month.” Attkisson implied that pharmaceutical companies bought the AAP’s support of vaccines. But the AAP’s recommendations are based on a careful review of safety and efficacy data. Is Attkisson saying that vaccines wouldn’t be recommended by the AAP unless pharmaceutical companies greased its palms? It’s a fantastic accusation. Isn’t it possible that the AAP promotes vaccines for the same reason that the FDA licenses them and the CDC recommends them—that vaccines save lives? Is there any evidence that members of the AAP or Every Child by Two, after looking at data on vaccine safety or effectiveness, have realized that the vaccines fell short of what is necessary to help children? And, if so, then turned a blind eye? Have representatives from any organization designed to further the health and welfare of children—goals that are directly in line with the promotion of vaccines—ever said to themselves, “Sure, the data on vaccine safety don’t look very good here, but we’ll ignore those studies because we receive unrestricted educational grants?” Because that’s what Attkisson was implying—that the relationship is bad for our nation’s children. But if she is going to make that accusation, she will need more evidence than the fact that an association exists.
Attkisson’s attacks weren’t unique. Pharmaceutical companies are often a target for cynicism and distrust. Indeed, few industries are more reviled. And, to some extent, it’s understandable. In order to sell their products, pharmaceutical companies have occasionally acted aggressively, unethically, and even illegally. Pfizer’s $2.3 billion settlement with the government for providing false information about Bextra, a pain medication, and Viagra, a well-known potency product, are probably the most extreme examples of how far companies will go to sell their products. So, by extension, it hasn’t been hard to tarnish the reputations of people who speak on behalf of vaccines. Lora Little, Barbara Loe Fisher, Jenny McCarthy, J. B. Handley, Jim Carrey, Bill Maher, and other anti-vaccine activists have consistently railed against the unholy alliance between vaccine makers and those who promote vaccines. The implication is clear—any association with vaccine makers is unacceptable. The media buy it; congressional committees buy it; parents buy it. And, once bought, the implication effectively eliminates a lot of expertise from the debate—leaving people like Robert Sears, a man with no published experience on vaccine science or vaccine safety, to do a lot of the talking.
There is, however, one problem with the image of the evil vaccine maker. At no time in history has a pharmaceutical company ever engaged in illicit marketing practices for vaccines. Not once. And it’s not because government regulators aren’t watching. They’re watching. Indeed, companies that make vaccines are often taken to task for improper marketing of drugs. It’s unclear why this is true. Maybe it’s because drugs are much more lucrative than vaccines. Or maybe it’s because company employees who make and promote vaccines are more likely than those who promote drugs to have a public health background, so they se
e vaccines as a public service. Whatever the explanation, it seems reasonable to suggest that if we are going to eliminate from the debate anyone who has come in contact with vaccine makers, we should at least get our money’s worth. It would be compelling if at some point in the two-hundred-year history of vaccine manufacture one shred of evidence existed that contact with a vaccine maker led to information that was misleading or incorrect. Sharyl Attkisson, in her hit piece against Every Child by Two and the AAP, never once showed how her unsubstantiated allegation of undue influence by vaccine makers led to anything other than better-educated physicians and healthier children.
At the heart of Attkisson’s attacks is the notion that the government, pharmaceutical companies, and doctors are part of a conspiracy. During his tenure at the CDC, Walter Orenstein was a target. “One of the most frustrating things about the anti-vaccine activity is the conspiracy theories,” recalled Orenstein. “Scientists often argue with each other. We say, ‘Your studies are poor; you’ve misinterpreted your data; you didn’t consider this study.’ But no one ever thinks in a scientific debate that if you say something with which someone else disagrees that you’re lying. I think one of the frustrations I find here is that if we say anything that doesn’t confirm [the anti-vaccine groups’] preconceived notions, we’re automatically labeled as liars.”
Conspiracy theories lie at the heart of the anti-vaccine movement, claiming that the pharmaceutical industry, using undue influence, causes eighty thousand practicing pediatricians and family physicians to lie about vaccine safety. “This season’s fashion in conspiracy theories—for those out of the loop of enlightenment—concerns health,” wrote David Aaronovitch, author of Voodoo Histories: The Role of Conspiracy Theory in Modern History, in the Wall Street Journal. “The Web sites, marginal cable shows, and radio phone-ins are full of tales about how Big Pharma and Bad Government are deliberately spreading diseases or manufacturing scares in order to sell us expensive drugs, gull us into dangerous vaccinations or just simply to create an atmosphere of panic which will allow ‘them’ to take over. We live in an age of conspiracies, or rather, we are more aware of conspiracies than we used to be. It is better to think that someone is in charge of everything than that the world is more often prey to accidents, madness, and coincidence. That’s why movies are full of dastardly but brilliant plotters, and hardly anything happens by chance.”
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