This article was reprinted from Mothering magazine, issue 155, July–August 2009.

©Mothering Magazine, Inc. 2009

For more information, or to check out other available publications from Mothering,
visit our website: www.mothering.com
 vaccin
de
doug piburn

36 | J u l y – Au g u s t 2 0 0 9
ne
ebate
by Jennifer Margulis

Many argue that

unvaccinated children
put others at risk.
What does the evidence say?

J u l y – Au g u s t 2 0 0 9 | 37
 Just hours after my daughter
was born, in 1999, at Atlanta’s Crawford
Long Hospital, a nurse bustled in with a
metal tray. “Time for her hep B vaccine!”
she announced in a chipper voice.
I was 29 years old. I had never
The desire
questioned the efficacy or importance
for more
of vaccines, and was completely unaware
information that some people suspected there might
about the safety, be a link between autism and vaccines.
efficacy, and As a child, I had received the full round
even the necessity of recommended vaccinations. My
mother is a microbiologist, my father
of vaccines has
a chemist, and I grew up with a healthy
led to a growing respect for science and medicine. When,
number of in my early twenties, I spent a year
parents choosing working in international development in
an alternative West Africa, I updated my vaccination
history and got shots for several exotic
vaccination
illnesses, following to the letter the
schedule for Centers for Disease Control’s (CDC)
their children. schedule of recommended vaccines.
But . . . vaccinate a newborn against
a sexually transmitted disease? My
husband and I had both tested negative
for STDs, and had been in a monogamous
relationship for three years. I looked at
the tiny, perfect baby in my arms, her
legs still cocked in the fetal position,
whose entire life now depended on me.
We told the nurse that, before we made
a decision, we wanted more information
about the disease and the recommended
vaccination. Her eyes narrowed in anger
and her entire demeanor toward us
changed, as if we were creating a health
threat merely by asking questions.
A few days later, during a routine
visit to our pediatrician, we asked what
she thought of the hepatitis B shot, and
explained somewhat guiltily that our
daughter had not received it in the
hospital. “Hepatitis B? That’s no longer
recommended for newborns,” she replied
matter-of-factly. “I have a fax about it on
my desk. It’s a good thing you refused
that vaccine.”1
We left confused, thinking how badly
we would have felt had we agreed to
vaccinate our daughter with a vaccine
no longer recommended for newborns.
We also wondered why the nurse in the
hospital had been so hostile. As to why a
newborn should be vaccinated against a
sexually transmitted disease she had no
chance of catching (unless she needed a
blood transfusion, which she didn’t), that
question remained unanswered.
The desire for more information
about the safety, efficacy, and even
the necessity of vaccines has led to a
growing number of parents choosing
an alternative vaccination schedule for
their children. Some now have their
children vaccinated against only certain
diseases, some spread out the shots over
a longer schedule, and some choose not
to vaccinate at all. Newborn in arms,
I began to research, realizing that in
order to be educated about vaccines, I

Editor’s note: NOTES vaccines, the US Public Health Service and

Due to the length of this article and the
accompanying detailed references and
citations, we have changed our usual
style of endnotes for this article only.
1. Until I began the research for this article,
I didn’t know why the hepatitis B shot
had been temporarily contraindicated
for newborns. In July 1999, in response
to public concern about thimerosal, the
mercury-based preservative found in some
the American Academy of Pediatrics issued
a joint statement requesting that thimerosal
be removed from vaccines, and that the
birth dose of hepatitis B be withheld from
newborns whose mothers tested negative
for hepatitis B. [See American Academy of

38 | J u l y – Au g u s t 2 0 0 9
first needed to learn about the diseases they protected
against. It quickly became clear that making these
choices was not going to be easy; my husband and I
would need to learn about and consider each vaccine
individually.
In the years since my oldest daughter was born, the
vaccine debate has been fueled by books and articles
that examine the link between autism and vaccines, and
that give parents detailed information not included in
the CDC-published handouts found in every doctor’s
office. These include David Kirby’s Evidence of Harm:
Mercury in Vaccines and the Autism Epidemic—A
Medical Controversy (St. Martin’s Press, 2005), as well
as more general books about vaccines—such as Dr.
Stephanie Cave and Deborah Mitchell’s What Your
Doctor May Not Tell You About Children’s Vaccinations
(Warner Books, 2001), Aviva Jill Romm’s Vaccinations:
A Thoughtful Parent’s Guide (Healing Arts Press, 2001),
and, most recently, Dr. Robert W. Sears’s The Vaccine
Book: Making the Right Decision for Your Child (Little,
Brown, 2007). Celebrities such as actress and former
Playboy model Jenny McCarthy, who believes her
son was damaged by vaccines, and actor Jim Carrey,
have brought attention to the vaccine issue, as have
books by staunchly pro-vaccine advocates—such as
Dr. Paul A. Offit’s Autism’s False Prophets: Bad Science,
Risky Medicine, and the Search for a Cure (Columbia
University Press, 2008), which traces the history of
the disease and concludes that there is no connection
between autism and vaccines.
Some vaccine advocates think the abundance of
information now available, especially from websites
that often are neither edited nor peer-reviewed, is
unfortunate and often inaccurate. They argue that most
parents are not trained scientists, and cannot effectively

Pediatrics, “Joint Statement of the American
Academy of Pediatrics (AAP) and the United
States Public Health Services (USPHS),”
Pediatrics 104, no. 3 (September 1999):
568–569. See also Department of Health
and Human Services, Centers for Disease
Control and Prevention, “Notice to Readers:
Thimerosal in Vaccines: A Joint Statement that all newborns receive it at birth, at 1 to
of the American Academy of Pediatrics 4 months, and again sometime between 6
and the Public Health Service,” Morbidity and 18 months, regardless of a baby’s risk for
and Mortality Weekly Report 48, no. 26 (9 contracting the disease.
July 1999): 563–565.] Now that thimerosal
has been removed from the hepatitis B
vaccine, the CDC is again recommending

J u l y – Au g u s t 2 0 0 9 | 39

But how great are
the risks of the
actual illnesses?
Some of the diseases
that still appear on
the schedule of
routine vaccinations
are now so rare
in the US that an
unvaccinated child
has no quantifiable
risk of catching them,
and therefore no
quantifiable chance
of spreading them to
other children.
sift through what they read to get to the truth.
These vaccine proponents—including Dr.
Martin G. Myers, a professor in the Department
of Pediatrics at the University of Texas Medical
Branch at Galveston, former director of the
Department of Health and Human Services’
National Vaccine Program Office, and coauthor
with Diego Pineda of Do Vaccines Cause That?!
A Guide for Evaluating Vaccine Safety Concerns
(Immunizations for Public Health, 2008)—
argue that vaccines are fundamentally safe. They
believe that the risk of side effects has been
grossly overreported by the media, and that this
risk is negligible compared to the danger society
will face if vaccine-preventable diseases reinfect
the general population because large numbers
of parents have stopped having their children
vaccinated.
“I don’t know any rational person who could
truly be anti-vaccine, because the benefits are
so profound,” said Dr. Louis Cooper, Professor
Emeritus of Pediatrics at the College of
Physicians and Surgeons of Columbia University,
and former president of the American Academy
of Pediatrics (AAP), to a group of some 65
listeners at the Federal National Vaccine
Advisory Committee-sponsored community
meeting on vaccine safety in Ashland,
Oregon,2 where approximately 28.1 percent of
kindergartners had a religious exemption from
vaccination in the 2007–2008 school year, and
24.0 percent of kindergartners filed for religious
exemption for the 2009 school year. 3, 4 Vaccine
advocates like Cooper argue that it has been
“proven” that there is no link between vaccines
and an epidemic of autism. (At the meeting,
Cooper publicly dismissed as “crap” Dr. Andrew
Wakefield’s 1998 study,5 which pointed out the
fact that vaccine-induced measles seems to occur
in the intestines of autistic children and called
for more research on the possible connection.)
They also deny the possibility that vaccines
may be partly responsible for the astronomical
rise in recent years in the rates of autism, asthma,
and other autoimmune diseases.6 Though,
according to nationally renowned physician
Dr. Robert W. Sears, to date no study of vaccine
safety has used a control group of unvaccinated
children large enough to be statistically
significant,7 the most outspoken proponents of
vaccines find no flaws in the scientific studies
that purport to show that vaccines are safe, and
label people who voice concerns about vaccine
safety “misinformers” and “pseudoscientists.”8
Vaccine advocates argue that parents who
choose not to vaccinate create a serious health
risk for everyone, and that their children are
safe from disease only because everyone around
them is vaccinated. “When you have a pocket of
children who are unvaccinated, that pocket is
much more likely to support contagious diseases,
like whooping cough or measles,” explains
Dr. Offit, a pediatrician and chief of infectious
diseases at Children’s Hospital of Philadelphia.9
Citing a study in the Netherlands of a 1999–2000
measles outbreak among 3,292 people,10 Offit
argues that it’s not just unvaccinated children
who are at risk for contagious disease: the
study suggests that you are more likely to
get a vaccine-preventable disease if you are

2. Ashland Middle School, Ashland, OR (10 January 2009).
3. Jackson County Department of Health and Human
Services pamphlet, Immunization: It Takes a Village to
Protect a Child (2008).
4. “The 28.1 percent Ashland kindergarten religious
exemption statistic comes from data compiled by
the Oregon Immunization Program, March 2007. The
Jackson County kindergarten religious exemption rate
for 2007 was 6.1 percent. The Ashland kindergarten
religious exemption rate from March 2009 was 24.0
percent, and the Jackson County rate was 5.1 percent.”
Mothering communication with Lorraine Duncan, Oregon
Immunization Program Manager, Public Health Division,
Department of Human Resources (17 April 2009).
5. A. Wakefield et al., “Ileal-Lymphoid-Nodular
Hyperplasia, Non-Specific Colitis, and Pervasive
Developmental Disorder in Children,” Lancet 351, no.
9103 (28 February 1998): 637–641.
6. In March 2005, the National Institutes of Health issued
a 144-page report to Congress stating that autoimmune
diseases, which include “more than 80 chronic, and
often disabling, illnesses that develop when underlying
defects in the immune system lead the body to attack
its own organs, tissues, and cells,” “collectively…affect
14.7 to 23.5 million people [in the US]. For reasons
unknown, their prevalence is rising.” (National Institutes
of Health, “Progress in Autoimmune Diseases Research”

40 | J u l y – Au g u s t 2 0 0 9
A my E lli o tt

I don’t know any rational person who could truly be anti-vaccine, because the benefits
are so profound. — Louis Cooper, MD

fully vaccinated and living in a generally
unvaccinated community than if you are
unvaccinated and living in a highly vaccinated
community.
The assumption that unvaccinated children
put others at risk has led to widespread criticism
of vaccine-hesitant parents in the mainstream
press. “People think you’re really selfish,” said
JoNel Aleccia, a health writer for MSNBC.com
who interviewed me.11 And it’s not only news
media that criticize parents. In an episode of
ABC ’s Private Practice that aired on January 8,
2009, an unvaccinated boy infected with measles
in Switzerland creates a huge health scare in
the doctor’s office, then dies. The mother had
chosen not to have him and his younger brother
vaccinated because her oldest son had slipped
into autism after receiving vaccines. At the
end of the episode, a doctor from the practice
forcibly vaccinates the mother’s youngest son.
This episode of Private Practice was not only
sanctioned by the AAP, it was created in close
collaboration with them. According to an
AAP newsletter sent out to members a month
after the show aired,12 several AAP members
had helped craft the storyline. Attached to the
newsletter is a letter from AAP president Dr.
David T. Tayloe, Jr. thanking Anne Sweeney,
president of the Disney-ABC Television Group,
for ABC ’s thoughtful depiction of what can
happen when children are not vaccinated: “This Above:
episode depicts the serious consequences that Dr. Louis Cooper,
photographed in
can occur when parents choose to skip or delay his home in New
giving vaccines to their children for reasons York City

[March 2005]: www.niaid.nih.gov/dait/pdf/ADCC_Final.
pdf.) The CDC’s Autism and Developmental Disabilities
Monitoring Network estimates that one in every 150 eight-
year-olds in America has an autism spectrum disorder.
(CDC, Autism Information Center, “Frequently Asked
Questions—Prevalence,” www.cdc.gov/ncbddd/autism/
faq_prevalence.htm) According to the CDC, 6.7 million
children currently suffer from asthma. (CDC, FastStats,
“Asthma,” www.cdc.gov/nchs/FASTATS/asthma.htm)
7. Personal communication with Dr. Robert W. Sears,
MD (10 February 2009).
8. These are terms that Martin G. Myers and Diego
Pineda use throughout their book, Do Vaccines Cause
That?! See, for example, Chapter 5, “Misinformation
and the Return of Infectious Diseases” (Galveston, TX:
Immunizations for Public Health, 2008), 76–110.
9. This and subsequent quotations: personal
communication (5 February 2009).
10. S. van den Hof et al., “Measles Epidemic in the
Netherlands, 1999–2000” Journal of Infectious Diseases
186, no. 10 (15 November 2002): 1483–1486.
11. JoNel Aleccia, “Vaccine-Wary Parents Spark Public
Health Worry: More Opt Out for Fear of Reactions, But
Do They Endanger Everybody Else?,” MSNBC (22 August
2008): www.msnbc.msn.com/id/26291109/.
12. “AAP Assists in Pro-Immunization Story Line on ‘Private
Practice’ ” AAP News OnCall 4, no. 8 (February 2009).

J u l y – Au g u s t 2 0 0 9 | 41
 H o llis healy
that are not based upon best medical evidence. It also
attempts to present some parents’ fear of vaccines as just
that—fear—and not fact. Many young parents today
do not appreciate the danger of vaccine-preventable
childhood diseases because they have never seen them
firsthand. This Private Practice episode illustrates the
reality of one such disease at its worst, and shows the
regret that can accompany a decision not to vaccinate.”
The implications are clear: Not vaccinating is based
on uninformed decisions and puts the entire society
at risk, and parents who choose not to vaccinate
their children should expect them to die. “I consider
vaccinations a moral obligation to one another
in society,” said one caller to an Oregon Public
Broadcasting call-in show about vaccines on which
I was being interviewed about our family’s choices.
Identifying herself as a physician and a parent, the caller
continued, “Those who choose not to vaccinate rely on
the rest of society to prevent epidemics of polio and
measles from ravaging our communities.”13
But Aviva Jill Romm, MD, author of Vaccinations:
A Thoughtful Parent’s Guide, who spent 20 years in
alternative medicine before completing a medical
When you have a pocket of children who are unvaccinated, degree at Yale University, objects to the idea that
that pocket is much more likely to support contagious parents who choose not to vaccinate are ignorant and
diseases, like whooping cough or measles. —Paul Offit, MD irresponsible. “Pediatricians need to let go of this
knee-jerk reaction that parents who don’t vaccinate are
irresponsible,” Romm contends. “Many of the parents
I know who have chosen not to vaccinate are actually
fairly well-educated, actively contributing members of
society. They are physicians, educators, people involved
in government, law professors, medical professors, and
Above: academic professors.”14
Dr. Paul Offit,
in his office in Dr. Robert W. Sears, MD, the son of attachment-
Philadelphia parenting proponents William and Martha Sears and

13. Oregon Public Broadcasting, Think Out Loud, “Taking Shots,” hosted
by Emily Harris (7 January 2009): http://stream1.opb.org/media/tol/
episodes/2009/0107.mp3. The show and some comments are posted at
www.opb.org/thinkoutloud/shows/taking-shots/.
14. This and subsequent quotations: personal communication (29
January 2009).

42 | J u l y – Au g u s t 2 0 0 9
 author of The Vaccine Book, agrees.
In Sears’s practice in Orange County,
California, 20 percent of his 2,000
patients are not vaccinated at all, about
30 percent are partially vaccinated, and
about half are vaccinated according to
CDC guidelines. “It’s most often parents
with a higher level of education choosing
not to vaccinate,” Sears reports, adding
that this is not because these parents are
smarter, but because they are more likely
to question and research everything
having to do with their children.
Sears, who describes himself as “pro-
vaccine but willing to offer alternative
schedules that parents feel more
comfortable with,” thinks the pro-
vaccine movement is doing parents a
disservice by categorically dismissing
their fears about vaccine safety and
labeling parents who don’t vaccinate as
negligent or selfish. “I think that any
doctor who tells a patient ‘You have
absolutely nothing to worry about,
there’s no chance of a severe reaction’ is
making a false statement,” Sears says.
“A better way to put it is, ‘Vaccines are
very important, diseases can be severe,
and I’d say the benefits of the vaccines
outweigh the risks, but you need to be
aware that there is a very small risk of a
severe vaccine reaction.’”15
According to Sears, parents in his
practice choose not to vaccinate because
they would rather take the natural risk
15. This and subsequent quotations: personal
communication (10 February 2009).
16. Even before the development of the polio
vaccine, when the disease was widespread, most
infected people were asymptomatic, and less than
1 percent of cases of poliovirus infection resulted in
paralysis. See Note 8: 26–27.
that their child may catch an infectious
illness than the perhaps small risk posed
by vaccines. These parents decide that they
do not want to intramuscularly inject their
child with something that is artificial—i.e.,
not part of the natural course of life. “It’s
not a natural exposure to the disease,”
Sears explains, stressing that though he
does not agree with this point of view,
he understands it. “It’s chemicals, it’s
artificial. And by giving it to their child,
they are taking a risk. Even though it’s
a smaller risk than the disease risk itself,
these parents are less comfortable with
that kind of artificial risk.”
The parents I know
But how great are the risks of the who have chosen
actual illnesses? Some of the diseases not to vaccinate
that still appear on the schedule of
routine vaccinations are now so rare in are actually fairly
the US that an unvaccinated child has well-educated,
no quantifiable risk of catching them,
actively contributing
and therefore no quantifiable chance
of spreading them to other children. A members of society.
good example of this is polio. In the They are physicians,
1940s and 1950s, polio caused a serious
health epidemic;16 since then, however,
educators, people
wild polio has been eradicated in the US. involved in
In fact, polio became so rare here that government,
even the most staunch proponents of
vaccines admit that there was a greater
law professors,
risk of contracting and being paralyzed medical professors,
by polio from the vaccine (which used and academic
to be a live virus administered orally)
than contracting the naturally occurring professors.
disease itself.17 For several years there —Aviva Jill Romm, MD
17. Ibid.
J u l y – Au g u s t 2 0 0 9 | 43
 In the absence of facts,
doctors and others
are trying to frighten
people into vaccinating
or not vaccinating.
That fear includes
the notions that
unvaccinated children
pose a great threat
to others and that parents
of these children are not
being responsible.
­—Jay Gordon, MD
The CDC now
recommends that
children receive no
fewer than 50 injections
against 16 illnesses by
the time they are 18
years old—more than
four times as many
injections (including
oral polio) as when I was
growing up in the 1970s.
were zero infections of wild polio among crisis now.” He is less concerned about
US children; the vaccine itself was possible side effects of vaccines than he is
paralyzing eight children a year.18 about the potential overall effect on the
However, instead of discontinuing immune system of multiple vaccines. “I
mass polio vaccinations—which were would rather use the long-term, tried-
now clearly more dangerous than wild and-true ways to prevent epidemics—
polio itself—an inactivated form of sanitation, nutrition, hygiene, health-
the polio vaccine went into use. It is awareness—and save the emergency
this vaccine that the CDC currently measures, like mass vaccinations, for
recommends to all American children at true emergencies.”21
2 months, 4 months, 6 to 18 months, and Like polio, diphtheria is a serious
4 to 6 years—even though the last cases of illness that once posed a quantifiable
naturally occurring polio in the US were health threat in the US. It was so feared
in 1979, and the last case of imported in the 19th and early 20th centuries that
polio was more than 15 years ago.19 it was called “the strangling angel of
In fact, John Iskander, MD, MPH, children.”22 However, this severe throat
Associate Director for Science at the infection, which is caused by a bacterium
CDC ’s Immunization Safety Office, tells and is treatable with antibiotics and an
me that polio is now so rare in the US antitoxin, now occurs so rarely that most
that it is impossible to undertake a study doctors trained within the last 20 years
to assess the risk an American child has can’t recognize its symptoms. According
of catching the disease.20 Translation: An to the CDC , there are approximately
American child not vaccinated against “0.001 cases per 100,000 population in
polio poses no health risk to anyone. the US since 1980,” which translates
“When polio was a major health crisis, into 1 case per 100 million people, a
the quickest way to eliminate it was to number that is barely measurable.23
vaccinate kids against polio,” says Dr. An unvaccinated Pennsylvanian who
Howard Morningstar, who graduated had visited Haiti died of diphtheria in
from Yale Medical School, completed his 2003,24 but no American child has died of
residency in family medicine at Brown diphtheria in the US in at least 15 years.25
University, and has been working as a “We do not have to worry about
family physician in Ashland, Oregon, for contracting diphtheria anymore,” admits
13 years. Morningstar reveals that most of John Iskander.26 Yet because the disease
his patients are not vaccinated according has not been eradicated worldwide, and
to CDC guidelines, “But there’s no polio because other countries, particularly

18. Department of Health and Human Services, Centers
for Disease Control and Prevention, “Vaccines and
Preventable Diseases: Polio Disease—Questions and
Answers” (6 April 2007): www.cdc.gov/vaccines/vpd-
vac/polio/dis-faqs.htm. See also, Robert W. Sears, The
Vaccine Book: Making the Right Decision for Your Child
(New York: Little, Brown and Company, 2007), 75.
19. Department of Health and Human Services,
Centers for Disease Control and Prevention, “Vaccines
and Preventable Diseases: Polio Disease—Questions
and Answers” (6 April 2007): www.cdc.gov/vaccines/
vpd-vac/polio/dis-faqs.htm.
20. Personal communication (10 January 2009).
21. This and subsequent quotations: personal
communication (5 February 2009).
22. Cem S. Demirci, MD, and Walid Abuhammour, MD,
“Diphtheria,” eMedicine (updated 29 July 2008): http://
emedicine.medscape.com/article/963334-overview.
23. Department of Health and Human Services,
Centers for Disease Control and Prevention,
“Diphtheria” (6 October 2005): www.cdc.gov/ncidod/
DBMD/diseaseinfo/diptheria_t.htm.
24. P. Lurie, et al., “Fatal Respiratory Diphtheria in a
U.S. Traveler to Haiti—Pennsylvania, 2003,” Morbidity

44 | J u l y – Au g u s t 2 0 0 9
J as o n Dailey

It’s one of those topics where there is fundamental disagreement even about
what counts as fact. —John Lantos, MD

in Eastern Europe, sometimes see spikes in
diphtheria infections,27 the vaccine continues to
appear on the CDC ’s schedule of recommended
vaccines and is given—in combination with
the tetanus and pertussis vaccines—to children
at ages 2 months, 4 months, 6 months, 15 to 18
months, and 4 to 6 years. However, as with polio,
an American child who has not been vaccinated
against diphtheria and does not travel abroad
has no quantifiable chance of spreading the
disease to another American child.
The same argument can be made about two
other diseases on the schedule of routine
childhood vaccinations: tetanus and hepatitis B.
Tetanus is caused by a bacterium found in the
soil, on dirty, rusty metal, and on dirty needles.
A child not vaccinated against tetanus, while
at risk for contracting the disease himself,
poses no risk to anyone else.28 Hepatitis B is
primarily transmitted through unprotected
sex, the sharing of unclean needles, and from
an infected mother to her newborn. Unless a
child sick with hepatitis B is exchanging blood
or other body fluids with another person’s
child, an unvaccinated child has no chance of
spreading the disease.
Measles is one of the diseases frequently Above:
invoked by vaccine proponents to illustrate the Dr. John Lantos,
shown here with his wife,
irresponsibility and selfishness of parents who Martha Montello,
choose to not have their children vaccinated. outside their home

and Mortality Weekly Report 52, no. 53 (9 January 2004):
1285–1286; www.cdc.gov/mmwr/preview/mmwrhtml/
mm5253a3.htm.
25. According to Tejpratap Tiwari, MD, medical
epidemiologist at the CDC, the last reported
diphtheria death in a probable (not lab-confirmed)
childhood case occurred in an unimmunized four-
year-old boy in 1994. Prior to that, the last diphtheria
death in a culture-confirmed childhood case occurred
in an unimmunized nine-year-old female in 1982
(e-mail communication, 8 April 2009).
26. See Note 20.
27. Charles R. Vitek and Melinda Wharton, “Diphtheria
in the Former Soviet Union: Reemergence of a
Pandemic Disease,” Emerging Infectious Diseases 4, no.
4 (October–December 1998): 539–550; www.cdc.gov/
ncidod/eid/vol4no4/adobe/vitek.pdf.
28. Given that tetanus is most commonly contracted
by stepping on a rusty nail, some parents wonder
why this vaccine would be given to children when
they are two months old, and again when they are
four months old, as at this age infants have no chance
of getting the disease.

J u l y – Au g u s t 2 0 0 9 | 45

If the vaccines are effective,
then those who get
vaccinated should
have nothing to fear
from the unvaccinated.
—Barbara Loe Fisher
One study, published
in the March 2009
Pediatrics, suggests
that children who get
measles are less likely
to have allergies.
Above:
Barbara Loe Fisher,
cofounder of the nonprofit
National Vaccine Information
Center and the mother
of a vaccine-injured child
46 | J u l y – Au g u s t 2 0 0 9
Unlike polio, diphtheria, tetanus, and
hepatitis B, measles is a viral infection
that is highly contagious and easily
spread. Between 2000, when measles
was declared to be eliminated from the
US, and 2007, an average of 63 cases of
measles were reported annually. But
from January to July of 2008, 131 cases
of measles were reported to the CDC ,
sparking widespread concern among
public health officials.29 “With the
outbreaks of pertussis, measles, and now
Haemophilus influenzae type b,” says
Paul Offit, “we have reached a point
where it’s clear that a choice not to get
a vaccine can be harmful not only to
your child but to the child who comes in
contact with your child.”
Yet the measles vaccine is thought
to have a rate of effectiveness of close
to 90 to 98 percent,30 and Offit readily
admits that the very small percentage of
vaccinated children who might contract
measles if exposed to it would have only
a mild case of the disease, assuming
they had some immune response
to the vaccine. A child who follows
the recommended guidelines for the
measles-mumps-rubella (MMR) vaccine
and is vaccinated against measles at
between 12 and 15 months of age, and
again between 4 and 6 years, should
have a negligible risk of contracting the
disease. Although the Private Practice
episode depicted measles as a disease
29. “Update: Measles—United States, January–July
2008,” Morbidity and Mortality Weekly Report 57, no.
33 (22 August 2008): www.cdc.gov/mmwr/preview/
mmwrhtml/mm5733a1.htm.
30. W. Atkinson et al., eds., Epidemiology and
Prevention of Vaccine-Preventable Diseases, 10th ed.
co u r tesy o f b a r b a r a l o e fishe r
that causes almost instant death, before
the MMR vaccine, measles was a routine,
even ubiquitous, illness of childhood that
rarely led to complications in otherwise
healthy children.
Some health-care providers and many
parents who choose not to vaccinate
believe that there may be long-term
benefits to getting a disease like measles,
including lifelong immunity and a
strengthening of the immune system
overall. One study, published in the
March 2009 Pediatrics, even suggests that
children who get measles are less likely
to have allergies.31 But whatever your
opinion about measles, we know that the
vast majority of measles cases are mild,
and we are told that a child vaccinated
against measles will have an even milder
case. There seems to be no real risk to
vaccinated children from unvaccinated
children of being exposed to or of having
any complications from this disease.
“If the vaccines are effective, then those
who get vaccinated should have nothing
to fear from the unvaccinated,” points
out Barbara Loe Fisher, cofounder of the
nonprofit National Vaccine Information
Center and the mother of a vaccine-
injured child. “If the vaccines are not as
effective as the companies, government,
and pediatricians have told us, then what
a person does when they get vaccinated
is they take a high risk of having a
vaccine reaction as well as a high risk of
(Washington, DC: Public Health Foundation, 2008),
138.
31. Helen Rosenlund et al., “Allergic Disease and
Atopic Sensitization in Children in Relation to Measles
Vaccination and Measles Infection,” Pediatrics 123, no.
3 (March 2009): 771–778.
A ss o ciate d P r ess

The bottom line with pertussis is that it’s not a perfect vaccine. —James Shames, MD

not having the vaccine work.”32
What about the idea that pockets of
unvaccinated children can threaten the entire
herd? Because the necessary scientific studies
have not been done, it’s difficult to answer this
question. I called The Principia, a Christian
Science school with two campuses, one for
preschool to high school students and another
for college students, in the St. Louis, Missouri,
area. Christian Scientists have a wide range of
beliefs, and the Church of Christ, Scientist, allows
its members freedom of choice in vaccination
and other types of health care; however, many
Christian Scientists choose not to vaccinate their
children because of their belief in the power of
prayer to prevent and heal illness. Of the 1,025
students at The Principia in 2008, more than 90
percent—956—filed vaccine exemptions. Despite
the high numbers of unvaccinated children at
the school, in the past ten years there have been
no outbreaks on either campus of measles or any
other diseases preventable by legally mandated
vaccines, and no deaths from these diseases.33
Whooping cough, aka pertussis, is another
highly contagious disease that worries public-
health officials, but unlike the measles vaccine,
the pertussis vaccine is only 80 to 85 percent
effective.34 According to the CDC , there
were approximately 25,616 cases of pertussis
nationwide in 2005,35 and 15,632 in 2006.36
Most teenagers and adults who have whooping
cough don’t know it—the disease is mild and
annoying (the cough can linger for up to three
months), but usually not serious enough to
warrant even a visit to the doctor.
Above:
In infants, however, whooping cough can be
Dr. James Shames,
life-threatening. “The bottom line with pertussis medical director
is that it’s not a perfect vaccine,” explains James of Health and Human
Services for Oregon’s
Shames, MD, the medical director of Health Jackson and Josephine
and Human Services for Oregon’s Jackson and Counties

32. This and subsequent quotations: personal
communication (15 January 2009).
33. Personal communication, Laurel Walters,
Communications Director, The Principia (April
2009).
34. See Note 30: 89.
35. Department of Health and Human Services, 36. Ibid.
Centers for Disease Control and Prevention,
“Summary of Notifiable Diseases—United
States, 2006,” Morbidity and Mortality Weekly
Report 55, no. 53 (21 March 2008): 77; www.cdc.
gov/mmWR/PDF/wk/mm5553.pdf.

J u l y – Au g u s t 2 0 0 9 | 47
 No matter what Josephine Counties, who believes the frequency another, perhaps mutual, contact.”
measures you take of the disease is underreported.37 Whooping Gordon further asserts that a parent who
cough is fatal in 1 percent of the infants under chooses not to vaccinate her own child is not
to boost your child’s
the age of six months who contract it. The accountable or responsible for another child
natural immunity, CDC estimates that 10 to 20 people die of contracting a vaccine-preventable disease.
there is no way whooping cough each year out of a population Instead, the burden of protecting an infant
to eliminate risk: of 307,212,123.38, 39 Vaccine proponents worry that from a contagious disease is on the infant’s
there are risks to if everyone in Jackson County decided to refuse parent, not on the parents who choose not to
the pertussis vaccine (which is routinely given take the risk of injecting their child with a
vaccinating, and risks
at 2 months, 4 months, 6 months, 15–18 months, pharmaceutical product that is known to cause
to not vaccinating. and 4–6 years), it would affect the well-being adverse reactions and is not always effective.
of the county in general, and infants could die. “Parents must protect [infants too young to
This fear, however, is purely theoretical, and have received a full complement of shots and
Because the studies of not based on any statistics. Ashland, which is immuno-compromised children] by keeping
autism and vaccines in Jackson County, has one of the lowest rates them away from too many other children.
do not include control of childhood vaccination in the US, but in the Period,” Gordon writes. “Newborns and young
40

groups of large enough last ten years no child or 41adult in the county has
died of whooping cough.
numbers of completely
If a child does catch a vaccine-preventable
unvaccinated children, disease, is it really possible to trace with
it’s disingenuous certainty where the disease came from? For Jay
of scientists and of Gordon, MD, a pediatrician with more than 30
the mainstream press years of experience and an assistant professor
of pediatrics at the UCLA Medical School, the
to claim that the link
answer is no. “When children or babies who
between autism and have been in contact with other children (or
vaccines has been adults) contract most illnesses, there is no
disproved. feasible way to know from whom they got the
disease,” Gordon writes in First Impressions,
an online companion to the Michigan Law
Review.42 “Whether one is talking about a
routine winter viral illness, chicken pox, or
whooping cough, the contagion could have
come from a child with overt disease signs
and symptoms, an asymptomatic carrier, or
babies are at risk any time they are in public. We
can only vaccinate against a very small minority
of contagious illnesses; it is unwise to bring
your newborn into preschool when you pick up
your toddler, and equally risky to attend older
children’s birthday parties with this baby.” 43
Public health officials point to the death of an
unvaccinated baby in Minnesota in 2008 as an
example of how dangerous it is not to vaccinate.
But of the five children who became infected
with Haemophilus influenzae type b (Hib), a
bacterial infection that can cause meningitis,
pneumonia, and blood and bone infections,
two had been vaccinated against Hib.44, 45
About a year before, on December 13, 2007, the
pharmaceutical giant Merck & Co. had recalled
more than 1 million doses of the Hib vaccine
because equipment used in manufacturing it
was found to be infected with Bacillus cereus, a

37. Personal communication (10 January 2009).
38. Centers for Disease Control, “Pertussis (Whooping
Cough)—What You Need to Know” (13 January 2009):
www.cdc.gov/features/pertussis//.
39. Central Intelligence Agency, “United States,” The
World Factbook (updated 9 April 2009): www.cia.gov/
library/publications/the-world-factbook/print/us.html.
40. See Notes 3 and 4. For the 2007–2008 school year,
2.1 percent of incoming kindergartners in all states
filed for philosophical exemption, 0.7 percent filed
for medical exemption, and only 0.3 percent filed
for religious exemption, according to information
compiled by self-reported data from each state by the
Department of Health and Human Services, Centers
for Disease Control and Prevention and obtained
via e-mail from the Centers for Disease Control and
Prevention, National Center for Immunization and
Respiratory Diseases.
41. Carol Irwin, RN, Community Health Nurse,
Jackson County Public Health, personal e-mail
communication (3 March 2009).
42. Jay Gordon, MD, “Commentary: Parents Should
Not Be Legally Liable for Refusing to Vaccinate
Their Children,” Michigan Law Review 107, First

48 | J u l y – Au g u s t 2 0 0 9
S te p ha n ie g r o ss

As a nurse, I had just assumed that everything we had been asked to do was based
on good, solid science. But the gaps in the science are, frankly, what we’re still
dealing with now. —Vicky Debold, RN, phd

bacterium associated with food poisoning and
diarrhea.46 Parents in Minnesota who had their
children vaccinated against Hib before the recall
were unknowingly injecting their children’s
bodies with a potentially contaminated product.
For a vaccine proponent such as Paul Offit,
who downplays the dangers of vaccines, the
choice to vaccinate is the only one to make, and
the death of even one child from a vaccine-
preventable disease is unacceptable. But for
the hundreds of thousands of parents whose
children have been damaged by adverse
reactions to vaccines, there is no way to quantify
which child’s life is more important. “You
cannot put a greater value on the life of a child
who is injured or dies from a disease than the
life of a child who is injured or dies from a
vaccine reaction,” says Barbara Loe Fisher.
Vicky Debold, RN, who also has a PhD in
Public Health, has had firsthand experience
with infants who have died as a result of Hib
infections. When she worked as a pediatric
nurse in an ICU in the early 1980s, she saw two
infants die of Hib, and worked with the grieving
parents. Partly because of that experience,
Above:
Debold was a staunch proponent of vaccines, Vicky Debold, at home
and thought that people who were skeptical with her son, Sam, 11,
of them were ignorant and misguided. But in who was diagnosed
with autism shortly after
August 1998 when her own son was 15 months receiving a routine round
old, following a routine round of vaccinations, of vaccinations

Impressions (2009): 95; www.michiganlawreview.org/
firstimpressions/vol107/gordon.pdf.
43. Ibid.: 96.
44. Department of Health and Human Services,
Centers for Disease Control and Prevention, “Invasive
Haemophilus influenzae Type B Disease in Five
Young Children— Minnesota, 2008,” Morbidity and
Mortality Weekly Report 58 (Early Release, 23 January
2009): 1–3; www.cdc.gov/mmwr/preview/mmwrhtml/
mm58e0123a1.htm.
45. One child had received two doses of the Hib
vaccine, in accordance with the CDC recom-
mendations for a five-month-old, another child
had received two doses of the Hib vaccine, but no
booster shot, per CDC recommendations at the time.
Given that vaccinated children far outnumber the
unvaccinated, the fact that three of the five children
who were infected were unvaccinated suggests that
the unvaccinated are overrepresented among those
getting sick.
46. Centers for Disease Control and Prevention,
Vaccines & Immunizations, “Questions and Answers
about Hib Recall” (27 December 2003): www.cdc.gov/
vaccines/recs/recalls/hib-recall-faqs-12-12-07.htm.

J u l y – Au g u s t 2 0 0 9 | 49
 Merck & Co., which he could no longer stand up in his crib,
manufactures the lost interest in walking, and started
having bad diarrhea. “I just thought it
MMR vaccine touted as
was because his legs were sore,” Debold
life-saving medicine remembers. “But within a couple of
in the Private Practice months, I noticed that his speech had
episode that AAP stalled out.” Before he turned three, Sam
doctors helped write, was diagnosed with autism.47
Although Debold had once brow-
donated to the AAP
beaten her sister into getting her daughter vaccine safety that include a statistically
in the “$350,000 to vaccinated, she now believes that her
$499,999” category. own child was damaged by vaccines. “I
think it’s really hard for people who have
actually given vaccines to think something see studies done with from 10,000 to
you did could have caused injury,” Debold
explains. “Vaccines are something that I
willingly participated in for my son. The
Given the enormous natural defense as a mother and a nurse is
that I didn’t do anything wrong.”
amounts of money
But the more Debold researched the
to be made from issue, the more skeptical she became.
manufacturing vaccines, When she went to the library to find
parents wonder how health articles that proved the efficacy and
officials and even the AAP safety of simultaneously receiving
multiple vaccinations, she was shocked
can be impartial.
to find almost none. “The more I
looked, the less I found,” Debold says.
“As a nurse, I had just assumed that
everything we had been asked to do was
based on good, solid science. But the
gaps in the science are, frankly, what
we’re still dealing with now.”
These gaps in the research about
vaccine safety remain a concern for
parents. The CDC now recommends
that children receive no fewer than 50
injections against 16 illnesses by the time
they are 18 years old48, 49—more than four
times as many injections (including oral
polio) as when I was growing up in the
1970s50—but there have been few, if any,
scientific studies comparing the health of
vaccinated and unvaccinated children,51
and to date, no scientific studies of
significant control group of children
who have received no vaccinations at
all.52 Dr. Robert W. Sears would like to
100,000 unvaccinated children, but such
studies do not exist. “In the absence of
facts, doctors and others are trying to
frighten people into vaccinating or not
vaccinating,” writes Dr. Jay Gordon.
“That fear includes the notions that
unvaccinated children pose a great
threat to others and that parents of these
children are not being responsible. In
fact, these parents are choosing what
they consider to be the safest course of
action for their children and pose very
little, if any, danger to other children and
adults.”53
The bottom line is that there’s still a
lot we don’t know about vaccine safety
and the long-term effects of vaccines
on the body’s immune system. “It’s
one of those topics where there is
fundamental disagreement even about
what counts as a fact,” declares John

47. This and subsequent quotations: personal
communication (13 January 2009).
48. Department of Health and Human Services,
Centers for Disease Control and Prevention,
“Recommended Immunization Schedule for Persons
Aged 0 Through 6 Years—United States: 2009”:
www.cdc.gov/vaccines/recs/schedules/downloads/
child/2009/09_0-6yrs_schedule_pr.pdf.
49. Department of Health and Human Services,
Centers for Disease Control and Prevention,
“Recommended Immunization Schedule for Persons
Aged 7 Through 18 Years—United States: 2009”:
www.cdc.gov/vaccines/recs/schedules/downloads/
child/2009/09_7-18yrs_schedule_pr.pdf.
50. According to Barbara Loe Fisher, in the late 1970s,
most children received five DPT shots (15 doses of
three vaccines) and five doses of Oral Polio Virus at 2,
4, 6, and 18 months of age, and between 4 and 6 years,
plus one dose of MMR between 12 and 15 months.
More information about vaccine licensure dates can
be found at a website operated by the Immunization

50 | J u l y – Au g u s t 2 0 0 9
J e n n ife r ma r g u lis

I would rather use the long-term, tried-and-true ways to prevent epidemics—

sanitation, nutrition, hygiene, health-awareness—and save the emergency
measures, like mass vaccinations, for true emergencies. — howard morningstar, MD

Lantos, MD, a pediatrician and bioethicist
at the University of Chicago and the Center
for Practical Bioethics in Kansas City,
Missouri.54 We don’t know if giving vaccines
in combination with other vaccines is safe. We
don’t know if the aluminum and formaldehyde
found in measurable quantities in some
vaccines and injected intramuscularly into
our bodies has negative health consequences.
Because the studies of autism and vaccines
do not include control groups of large
enough numbers of completely unvaccinated
children, it’s disingenuous of scientists and
of the mainstream press to claim that the
link between autism and vaccines has been
disproved. When public health officials dismiss
parental concerns without adequately studying
them, there is an erosion of public trust.
Given the enormous amounts of money to
be made from manufacturing vaccines, parents
wonder how health officials and even the AAP
can be impartial. In 2008, the pharmaceutical
firm Wyeth, which makes Prevnar, the only
brand of the pneumococcal vaccine widely
used in the US (the Pc vaccine is currently
recommended for children ages 2, 4, 6, and Above:
12 to 15 months), was one of the AAP’s top Dr. Howard Morningstar,
photographed in his office
corporate donors, giving in the “$750,000 and in Ashland, Oregon

Action Coalition and funded by the CDC . www.
immunize.org/timeline. See also Paul A. Offit, MD,
and Louis M. Bell, MD, Vaccines: What You Should
Know (Hoboken, NJ: John Wiley & Sons, 2003), 99.
51. Dr. Bernardine Healy, health editor of U.S. News
& World Report and former director of the National
Institutes of Health, signaled this fact on Larry
King Live (3 April 2009): “I think there is so much
more to learn. Simple things like a comparison of
children who have and have not been vaccinated.
This is something that we have talked about
doing for many years. It has not been done. It can
be done through various models, through case
control models. It can be done retrospectively.
It has to be done.” http://transcripts.cnn.com/
TRANSCRIPTS/0904/03/lkl.01.html.
52. Ibid.
53. See Note 42: 98.
54. Personal communication (23 January 2009).

J u l y – Au g u s t 2 0 0 9 | 51

Vaccines are very important, diseases can be severe, and
I’d say the benefits of the vaccines outweigh the risks,
but you need to be aware that there is a very
small risk of a severe vaccine reaction.
— dr. robert w. Sears, MD
Above:
Dr. Robert W. Sears,
near his home in
Southern California
Doug piburn
Above” category.55 Merck & Co., which manufactures
the MMR vaccine touted as life-saving medicine
in the Private Practice episode that AAP doctors
helped write, donated to the AAP in the “$350,000
to $499,999” category.56 Paul Offit, who wrote an
article excoriating Dr. Robert W. Sears’s alternative
schedule that was published in Pediatrics, the AAP’s
peer-reviewed journal,57 himself has a clear financial
conflict of interest: coinventor of the RotaTeq vaccine,
he is also a coholder of the patent on it.58
“Merck isn’t dumb,” Dr. John E. Trainer III, a family
physician in Jacksonville, Florida, wrote me in an
e-mail. Although Trainer describes himself as “very
pro-vaccine,” he understands why parents have
concerns: Two of his own four children have suffered
vaccine-induced complications. “They aren’t doing this
(solely) to be nice. And they are making enough money
to hire a sales force. They visit us and other docs to try
to sell more vaccines.”59 In the last three years, three
new Merck vaccines have been approved by the federal
government for sale: RotaTeq, Zostavax, and Gardasil.
“What does it mean to force everybody to be
vaccinated?” asks Dr. Howard Morningstar. “It’s a
philosophical decision—it’s not based on rational
scientific facts.” After reading everything we could
about vaccines, calling the CDC , and talking to
dozens of people in the health-care professions
and other parents (most of whom had chosen to
vaccinate), my husband and I chose not to vaccinate
our children against hepatitis B or any of the other
childhood illnesses. Making our choices vaccine
by vaccine, we agonized over whether each was the
right choice. We also did everything we could to
help our children have healthy immune systems to
fight any diseases their bodies might be exposed to.

55. American Academy of Pediatrics, (January 2009): e164–e169; http://pediatrics.

“Honor Roll of Giving,” AAP News 29, no. 11 aappublications.org/cgi/content/full/123/1/
(November 2008): 23. e164.
56. Ibid. 58. Ibid.
57. Paul A. Offit and Charlotte A. Moser, 59. Personal communication (26 January
“The Problem with Dr. Bob’s Alternative 2009).
Vaccine Schedule,” Pediatrics 123, no.1

52 | J u l y – Au g u s t 2 0 0 9
I breastfed them well past two years, and we
educated ourselves about good nutrition and
changed our eating habits. We also gave away
all of the poisonous cleaning products in our
house, began buying organically grown foods,
and made sure our children got enough exercise,
sleep, and outdoor time.
Then, in 2006, when the children were six, four,
and two years old, I was awarded a Fulbright
fellowship to teach and do research in Niger, West
Africa, one of the poorest countries in the world,
where diseases—including typhoid fever, malaria,
measles, schistosomiasis, meningitis, giardiasis,
dengue fever, and hepatitis—are common. A
yellow-fever vaccine is required for entry into
the country. After revisiting every childhood
illness and assessing the health risks posed by
international travel, we decided to vaccinate our
children against only three other diseases, besides
yellow fever: polio, tetanus, and meningitis. We
used the German-made tetanus-only vaccine
instead of a DPT combination, and spaced out
the shots, one at a time, over a period of several
months, so that if our children had a bad reaction,
we would know which vaccine it was.
No matter what measures you take to boost
your child’s natural immunity, there is no way to As parents,
eliminate risk: there are risks to vaccinating, and we all
risks to not vaccinating. It is counterproductive
have a
to terrify parents into vaccinating their children,
common goal:
or to vilify those who choose not to. In the US,
we have the right to refuse a pharmaceutical to keep
product, and it doesn’t surprise me that more our children
parents than ever are exercising that right. The and our nation
CDC , the drug manufacturers, government
as healthy
spokespeople, vaccine advocates, and vaccine
as possible.
skeptics—most of those who make up each of
these groups are also parents. As parents, we all
have a common goal: to keep our children and
our nation as healthy as possible.
Interested in finding out more about the
vaccine controversy? Log on to www.mothering.
com/links for access to our entire section on
vaccines, including the past article, “Chickenpox
Party” by Brian Wimer, Jacquelyn L. Emm,
and Deren Bader; the Vaccinations forum on
our discussion boards; the “Vaccines: Mercury,
Autism & Chronic Disease” reprint (available for
purchase); and a special video of Vicky Debold’s
son, Sam, playing piano.
Jennifer Margulis, PhD, is a professional writer
and the mother of three (9, 8, and 5). She lives in
Ashland, Oregon, and was a Fulbright Scholar in
Niger from 2006 to 2007. Read more about her at
www.jennifermargulis.net.
J u l y – Au g u s t 2 0 0 9 | 53
 va riva x: more harm than
Some parents and many doctors
were surprised by the introduction in 1995 of
the chicken-pox vaccine as part of the CDC ’s
schedule of routine vaccinations. Vaccines
Once have historically been developed to protect
exposed children against serious childhood illnesses,
to wild but chicken pox, a viral infection also known
as varicella, has always been a mild disease.
chicken pox,
Until the vaccine was introduced, it caused
you have
about 100 deaths each year,1, 2 and about half of
immunity, those deaths were among children. According
which is to Barbara Loe Fisher, cofounder of the
important: National Vaccination Information Center and
The disease is co-author of the book A Shot in the Dark (1985),
about the dangers of the whole-cell pertussis
almost always
vaccine, the vaccine was first designed for
more serious children with compromised immune systems,
in adults than but once Merck & Co. had developed the
in children. vaccine, they needed to find a market for it. 3
(Varivax, the only chicken-pox vaccine used in
the US , is made by Merck.)
Now that the chicken-pox vaccine is
required for enrollment in most public schools,
there are far fewer cases of chicken pox in the
US . On one hand, this is a good thing: Fewer
We now have an children miss school, parents don’t have to
epidemic of shingles take time off work, and currently there are
among older children fewer than five deaths per year from wild
chicken pox. Yet these positive benefits come
and adults which with an unforeseen downside. Once exposed
is far more expensive to wild chicken pox, you have immunity,
and actually far which is important: The disease is almost
always more serious in adults than in children.
more painful than Previously, when wild chicken pox broke out
if we had let chicken in the general population, the immunity of
adults who had been exposed to it as children
pox remain endemic
would be boosted by periodically coming in
in the population, contact with the disease. But now that the
and used the natural immunization boost is effectively
gone, this has led to growing numbers of baby
vaccine selectively. boomers who had chicken pox as children
—Barbara Loe Fisher getting shingles, a more serious disease caused
54 | J u l y – Au g u s t 2 0 0 9
by the chicken-pox virus.
“We now have an epidemic of shingles among
older children and adults which is far more
expensive and actually far more painful than if
we had let chicken pox remain endemic in the
population, and used the vaccine selectively,”
explains Fisher. According to the CDC ,
approximately 1 million people a year now
get shingles,4 and there is an increasing body
of scientific data showing that the number of
adults suffering from shingles is on the rise.
One study showed a 90 percent increase in the
number of adults infected with the Herpes
zoster (shingles) virus in Massachusetts
from 1999 to 2003 as the chicken-pox vaccine
become more widespread.5 Other studies have
estimated increases as well.6, 7
John Grabenstein, Senior Medical Director,
Adult Vaccines, Merck & Co., Inc., argues that
the very slight recent rise in shingles—which,
he says, is something Merck & Co. also found
in their shingles prevention study of more
than 38,500 people8—is not related to the
chicken-pox vaccine. “Shingles was with us
even before the childhood vaccine came along,”
Grabenstein points out. “It’s not correct to
say that because we are vaccinating children,
therefore adults are getting shingles.”9 Instead,
Grabenstein attributes the rise in shingles to
the rising life expectancy among American
adults. “The longer you live, the greater your
risk of getting it,” he says. He discounts
the idea that re-exposure to the wild virus
circulating in the population provides a
potential boost to the immune system and is
preventive. “Your exposure to your grandkids
is a minor player,” Grabenstein insists. “The
dominant reason shingles occurs is that the
immune system ages along with the body.”
What everyone does agree on is this:
shingles is a potentially serious and terribly
painful disease. To address the shingles
go o d?
problem, Merck has developed a new
vaccine: Zostavax, licensed by the FDA
in May 2006, and now being
recommended for everyone over 60.
ist o ck p h o t o . co m
Fisher finds this troublesome. “You
have a situation that was created by
vaccination and you have a vaccine to
counteract that situation,” she notes.
It’s not only vaccine skeptics who are
concerned. Dr. John E. Trainer III, a
family physician in Jacksonville, Florida,
who describes himself as “very pro-vaccine,”
has questions about the cost of Zostavax and
its effectiveness. “It’s a coin toss of efficacy,”
he says. “If I give it to a 60-year-old, they
are 50 percent likely to benefit from it. That
means you can flip a coin and see whether
it works or not. The vaccine is expensive,
and the cost to the patient varies widely,
depending on insurance coverage. My
partner and I have not embraced the
shingles vaccine.”10
In addition to the problem of an upsurge
in shingles, the chicken-pox vaccine, which
is a live virus, can cause several side effects
that are as or more dangerous than the disease
itself. Since the chicken-pox vaccine came
into widespread use, reported reactions to it
have included bleeding disorders, pneumonia,
skin infections, severe rashes, and such
nervous-system problems as Guillain-Barré
Syndrome, encephalitis, and seizures.11, 12 Two
young patients of Dr. Robert W. Sears who
received the vaccine have developed benign
thrombocytopenia, a blood-clotting disorder.13
Both of the children in Sears’s practice were
hospitalized, and both took more than two
months to recover. “This doesn’t make me
stop giving that vaccine,” Sears states. “It
just makes me realize that these reactions
can happen.”
NOTES
1. Department of Health and Human Services, Centers
for Disease Control and Prevention, Vaccine Information
Statement (Interim): Varicella Vaccine, “Chickenpox Vaccine:
What You Need to Know,” 42 U.S.C. (13 March 2008): §300aa-26;
www.cdc.gov/vaccines/pubs/vis/downloads/vis-varicella.pdf.
2. For an extended discussion of how the CDC numbers may
be misleading, see Brian Wimer, Jacquelyn L. Emm, and
Deren Bader, “Chickenpox Party: Developing Natural Varicella Since the
Immunity,” Mothering 122 (January–February 2004): 30–37;
chicken-pox
www.mothering.com/articles/growing_child/child_health/
chickenpox_party.html. vaccine came
3. Personal communication (15 January 2009).
4. Department of Health and Human Services, Centers for into widespread
Disease Control and Prevention, “Vaccines and Preventable use, reported
Diseases: Shingles Disease—Questions and Answers (Herpes
Zoster)” (19 October 2006): www.cdc.gov/vaccines/vpd-vac/ reactions to it
shingles/dis-faqs.htm.
have included
5. W. K. Yih et al., “The Incidence of Varicella and Herpes Zoster
in Massachusetts as Measured by the Behavioral Risk Factor bleeding disorders,
Surveillance System (BRFSS) during a Period of Increasing
Varicella Vaccine Coverage, 1998–2003,” BMC Public Health 5 pneumonia, skin
(16 June 2005): 68.
6. G. S. Goldman, “Cost-Benefit Analysis of Universal Varicella
infections, severe
Vaccination in the U.S. Taking into Account the Closely rashes, and such
Related Herpes-Zoster Epidemiology,” Vaccine 23, no. 25 (9
May 2005): 3349–3355. nervous-system
7. G. S. Goldman, “The Case Against Universal Varicella problems as
Vaccination,” International Journal of Toxicology 25, no. 5
(September–October 2006): 313–317. Guillain-Barré
8. M. N. Oxman et al., “A Vaccine to Prevent Herpes Zoster and
Postherpetic Neuralgia in Older Adults,” New England Journal
Syndrome,
of Medicine 352, no. 22 (2 June 2005): 2271–2284; http://content. encephalitis,
nejm.org/cgi/content/full/352/22/2271.
and seizures.
9. This and subsequent quotations: personal communication
(13 April 2009).
10. Personal communication (23 January 2009).
11. See Note 1.
12. Merck & Co. Inc., “Varivax: Varicella Virus Vaccine Live”
(Whitehouse Station, New Jersey: November 2008): www.
merck.com/product/usa/pi_circulars/v/varivax/varivax_pi.pdf.
13. Personal communication (10 February 2009).
—Jennifer Margulis
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