When Parents Say No To Child Vaccinations
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WHEN PARENTS SAY NO TO CHILD VACCINATIONS
By Donald G. McNeil Jr.
New York Times
November 30, 2002
VASHON ISLAND, Wash. Kate Packard, the school nurse here, has a nightmare
she sums up in five words: "measles coming across the water."
If measles did make the 20-minute ferry ride across Puget Sound from Seattle
hardly unthinkable, since a case occurred last year near a ferry terminal
in West Seattle public health officers say the whole Vashon Island school
district could be shut down until the island's last case disappeared or an
emergency vaccination drive took effect.
Eighteen percent of Vashon Island's 1,600 primary school students have
legally opted out of vaccination against childhood diseases, including
polio, measles, mumps, rubella, diphtheria, whooping cough, tetanus,
hepatitis B and chicken pox. The island is a counterculture haven where
therapies like homeopathy and acupuncture are popular, and where some cite
health problems among neighbors' children that they attribute to
Most families opting out of vaccination here have obtained "philosophical
exemptions" from normal vaccination requirements exemptions that in
Washington and several other states, including California and Colorado, can
be claimed simply by signing a school form.
Across the country, about 1 percent of all children are exempt from
vaccination, said Dr. Walter A. Orenstein, director of the National
Immunization Program at the Centers for Disease Control and Prevention. The
agency's surveys suggest that more than 90 percent of all American children
have had most shots, except for the new chicken-pox vaccine.
But from Vashon Island to Boulder, Colo., to towns in Missouri and
Massachusetts, there are "hot spots" where many children go unprotected. In
a 1999 survey, 11 states reported increases in exemptions.
Clusters of unvaccinated children are not only in potential danger
themselves, health officials say, but are also a threat to the "herd
immunity" that walls out epidemics, sheltering fetuses, infants too young to
be immunized, old people with weakened immune systems and even vaccinated
classmates who remain at risk because no vaccine is 100 percent effective.
When only a few parents use "herd immunity" to let their children escape the
small risks of vaccination, the system still works.
But health officials become concerned in states like California, where it is
easier for a parent to sign the waiver form than to have a child vaccinated.
"People take the path of least resistance," said Daniel A. Salmon, a
vaccination expert at the Johns Hopkins School of Public Health. "What I do
to my child can put other children at risk." In 1989-90, measles broke out
among unimmunized immigrant children in Southern California, causing 43,000
cases and 101 deaths.
Vaccine resisters cite an array of reasons. "Sometimes it's distrust in
government, feeling it's in bed with the vaccine industry and `everyone's
making money off our kids,' " Mr. Salmon said. Sometimes the objections are
religious, as among Christian Scientists and some Amish congregations.
Sometimes a community is scared when a child is truly harmed by side
effects; the live polio vaccine, for example, is thought to cause about
eight deaths a year.
Some parents are upset at the sheer number of injections a child must get
usually about 20 by age 2. Others are convinced despite evidence to the
contrary that vaccines are highly likely to cause severe health problems,
like seizures and autism.
Here on Vashon Island, a community of 10,000, word spread quickly when the
10-month-old baby of Gail O'Grady, a midwife who also works at Minglement
Natural Foods, died unexpectedly in his crib in 1984 two weeks after his
first immunization; when Pam Beck's daughter Rachel suffered four years of
seizures that began minutes after her first whooping-cough shot; when Nancy
Soriano's son, Alex, developed autism after tetanus and polio vaccinations.
Some doctors they consulted disagreed, but all three mothers were sure
vaccines were to blame.
Alex, Ms. Soriano said, changed from "a bright-eyed, happy, beautiful kid"
to a severely autistic 4-year-old who "lived curled up in a ball, screaming
and screaming and screaming." She says she has nearly cured him by removing
milk and glutens from his diet.
Public health specialists suggest that the resistance to vaccines is a
consequence of the success of vaccinations: People, they say, no longer fear
diseases they have never seen.
"I remember how the fear of polio changed our lives not going to the
swimming pool in summer, not going to the movies, not getting involved with
crowds," said Dr. Edward P. Rothstein, 60, a Pennsylvania pediatrician who
helps the American Academy of Pediatrics make immunization recommendations.
"I remember pictures of wards full of iron lungs, hundreds in a room, with
kids who couldn't breathe in them. It affected daily life more than AIDS
Now, with the rare side effects of the live vaccine, "there's a risk of
about eight kids a year dying, so people don't want to be vaccinated," he
said, adding, "When polio was around, people gladly took that risk."
Rubella, Dr. Rothstein went on, "is, for the most part, a nothing disease"
the reason to keep vaccinating against it is to protect fetuses. "In the
1960's," he said, "50,000 to 60,000 babies were born with small heads, or
deaf, or blind or with cataracts" because their pregnant mothers had been
exposed to rubella.
All 50 states allow medical exemptions for children who are
immuno-compromised or allergic to vaccines; 47 states all but Arkansas,
Mississippi and West Virginia allow religious exemptions; and 17 allow
personal or philosophical ones. But how many children receive the exemptions
depends partly on how much red tape is involved, a study in the American
Journal of Public Health found. In states where parents must go to a state
office for exemption forms, get their signatures notarized or produce
letters from a religious authority, exemption rates tend to be lower.
The only states with exemption rates greater than 2 percent, the disease
center said, are Michigan, Washington and Wisconsin.
Still, health officials say that in recent years public sentiment has often
run against vaccination. The news media publicize stories of autism,
seizures and crib death that followed vaccination. More than a dozen
Internet sites specialize in describing the dangers of vaccines.
Vashon Island is both a commuters' haven served by high-speed ferries to
Seattle and a home to the counterculture a place where the telephone
company's garage features a mural of a Frisbee-catching dog. Millionaires
have shore homes while the self-named Rainbow People live in tents in the
In interviews, parents who have signed forms to exempt their children from
vaccination appeared to be educated, attuned to their children's health and
full of opinions about vaccines, though some cited "facts" that the disease
center disputes. Most parents mixed unconventional therapies like
homeopathy, acupuncture and chiropractic, and conventional medicines like
antibiotics and painkillers, Most said they were suspicious of the vaccine
"I consider well-baby care to be a capitalist plot," Maryam Steffen, a
mother of four said only half-kidding.
If anyone would seem to be a living argument for tetanus vaccination, it is
Camille Borst, 25. When she was 12, she stepped on a nail. Her mother, who
opposes vaccination, did not take her to a hospital until her foot was so
inflamed she could not stand on it. But Ms. Borst says proudly that she has
not immunized her own children, Deven, 9, or Casper, 4.
Her mother, Adrienne Forest, 47, who is home-schooling her grandchildren in
a neat, shingled mobile home in a clearing of fir and alder trees, said she
was sorry she let the hospital give Camille other vaccines. "It was a moment
of weakness," she said. The nurses who angrily told her that Camille could
have died "totally freaked me out," she said.
From 1995 to 1999, said Ms. Packard, the school nurse, an epidemic here of
whooping cough, which can be fatal in infants, hospitalized some infants and
left some children with chronic asthma. Ms. Forest's grandson Deven had
whooping cough two years ago and, she conceded, probably passed the disease
to 10 other children, including an infant.
"Yeah, that bothered me," Ms. Forest said. "But I called everybody and we
studied up on what you can do to build up the immune system."
The baby "did just fine," she said. "On Vashon Island, you have middle-class
people who eat healthy and keep warm. If everyone was poor-poor, not
breast-fed, not eating right that might be a reason to vaccinate." But she
and her daughter remain steadfastly opposed.
Meg White, 45, though, now somewhat regrets not vaccinating. Three years
ago, her whole family, including her infant son Julian, had whooping cough
"really, really bad" for more than three months.
"My son would turn all shades of purple," she said. "He stopped breathing
several times and we took him to the hospital. My daughter was terrified of
going to sleep because then it got worse. She would vomit all over the
place. My husband cracked ribs from coughing."
Now, Ms. White said, she would advise other mothers to vaccinate against
whooping cough, polio and tetanus, but only with the newest vaccines. She
still has not vaccinated Julian, now 3, against measles, mumps, rubella or
Julian is in nursery school at Puddlestompers, whose director, Tressa
Aspiri, also changed her mind about not vaccinating after her older children
got whooping cough.
She makes no recommendations to parents when they fill out the school's
vaccination form, she said, though she feels that vaccines are safer than
they were when her children were born in the mid-1980's.
"I still feel strongly that it's the parents' choice," Ms. Aspiri said.
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