Rebuilding The Faith

Unfounded claims of a link between childhood vaccines and autism have led many parents to hesitate to—or choose not to—schedule routine immunizations for their children. Restoring public trust is vital if health officials are to have any hope of decreasing the number of unvaccinated or under-vaccinated children in this country.

“I didn’t really have any concerns about getting my son vaccinated,” says Ashley Cadwallader of James City County. “I have trust in the doctors he sees to know that he would not get anything that was unnecessary or harmful to his health.”

Cadwallader’s response is similar to that of the majority of today’s parents who grew up getting vaccinated as a rite of passage prior to starting school each year. But increasingly, doctors are hearing concerns from parents about the safety and necessity of many vaccines, with some parents flatly refusing to have their children receive some or even all of the recommended vaccines, despite established scientific consensus about vaccine safety. Poor scientific research, unexplained escalating rates of autism and the checkered history of pharmaceutical companies and vaccine safety have created the perfect breeding ground for misinformation, wild speculations and outright conspiracy theories.

Caught in the middle of it all are parents, who have at their fingertips an overwhelming amount of information from all manner of experts, both real and self-proclaimed. The arguments both for and against vaccinations can be compelling, especially from parents whose children began exhibiting signs of autism shortly after being vaccinated. A quick read through the list of ingredients found in some childhood vaccines—aluminum, formaldehyde, thimerosal—can give even the most ardent supporter of vaccines a moment’s pause. For some parents, faced with so much contradictory information on the safety of vaccines, it seems safer to forgo the injection of “toxins” into their children and face the relatively low risk that their children will be exposed to diseases like polio or measles.

Almost all states allow parents to claim exemptions to the law requiring vaccinations for school-aged children, and the number of parents taking advantage of this option has been growing at an alarming rate. Two Oregon cities—Ashland and North Portland—have gained national attention for their vaccine exemption rates which, in 2009, were 24 and an astonishing 78 percent, respectively. These numbers have health officials worried that we will see a resurgence in diseases that they had once hoped would soon be eradicated.

Seeds of Doubt

Vaccines have been controversial since Edward Jenner first invented the smallpox vaccine in 1796. Rather than being overjoyed at the prospect of never contracting such a horribly disfiguring and often fatal disease, people opposed the idea, claiming that it was unethical to be treated with material from cows. When the vaccine became mandatory in 1853, it was met with protests as a violation of personal freedom. It would be another century before the disease was eradicated from Europe and North America, and not until 1980 did the World Health Organization declare: “The world and all its people have won freedom from smallpox, which was the most devastating disease sweeping in epidemic form through many countries since the earliest times, leaving death, blindness, and disfigurement in its wake.”

Just 18 years after this proclamation, British gastroenterologist Dr. Andrew Wakefield published a paper in the medical journal The Lancet suggesting a possible association between the MMR (measles/mumps/rubella) vaccine, bowel disease and autism. The study sparked a health scare that has led to hundreds of thousands of parents around the world refusing to vaccinate their children out of fear that it could cause autism. Several large-scale, peer-reviewed epidemiological studies were conducted to investigate Wakefield’s claims, but none found any link between autism, gastrointestinal disorders and either the MMR shot or thimerosal, the mercury preservative that was previously used in the vaccine.

In January 2010 The Lancet retracted Wakefield’s paper from public record, and in May the author was found guilty of serious professional misconduct due to his “unethical” research that resulted in unfounded fears over the vaccine. His name was removed from the medical register, a British record of doctors.

But the seeds of doubt concerning the safety of vaccines had already been planted, and many parents, including Kari Higgenbotham, of Chesapeake remain skeptical.

Higgenbotham’s oldest son, Eric, was diagnosed with infantile autism at age two and a half. But Higgenbotham says she can pinpoint the moment Eric—whom she remembers at 18 months as a “normal, healthy toddler with a strong vocabulary and [good motor skills]—began to regress: the day he received the MMR vaccine. Within weeks of the shot he stopped talking altogether. “It was a complete turnaround,” says the mother of two. “The change was overnight.”

Eric’s younger brother Chase, at Higgenbotham’s insistence, has not been immunized for “anything except chickenpox,” the vaccine for which is required before starting kindergarten. “Some agree with me, some don’t,” she says. “Everybody has their opinion, but a lot of parents believe what I believe.”

As for the retracted paper? “It concerns me that doctors published the paper and then pulled back,” Higgenbotham says. “There’s got to be some truth behind it.”

Dr. Darren Witte, a pediatrician in Chesterfield who’s also board-certified in internal medicine, says many parents share Higgenbotham’s suspicion. “When it comes time for their child to get the MMR vaccine, parents still often say, ‘Isn’t that the one that causes autism?’”

Compounding the problem is the fact that vaccines have really become victims of their own success. “We’ve done such a great job eradicating [certain] diseases in this country that people don’t see the scary consequences of them any more,” says Witte. “Even many pediatricians today have never seen [devastating] diseases like polio. So because parents have never seen the disease, they don’t perceive the risk of the disease, only the risk of the vaccine. They’ve never seen someone with polio, so they feel as though they’re giving their child something unnecessary.”

Dr. Linda Meloy, medical director at the Virginia Commonwealth University Medical Center Newborn Nursery, who also conducts various clinical research projects on vaccines, agrees. When I travel on medical mission trips to places like Guatemala and Romania, I see the effects of the diseases we immunize against here in the U.S.,” she says. “People in those countries are very anxious to get vaccinated because they’ve seen the damage these diseases do, but many don’t have the means to afford [the vaccines]. And then I come back to the U.S., and here we are a country that can afford vaccines and yet we don’t get them because we don’t see the need.”

Herd Immunity

There are hundreds of thousands of people in this country who cannot be vaccinated for legitimate reasons—some are genetically unable to respond to the vaccines, while some have immunodeficiencies that do not allow them to be vaccinated. Infants who are too young to be vaccinated are also often the earliest victims of disease outbreaks, as are the elderly, whose immune systems are weaker. It is these vulnerable members of our society who rely on the protection vaccines provide the rest of us to keep from becoming ill. But so-called herd immunity is only effective if at least 85 to 90 percent of the population is vaccinated. The more children who remain unvaccinated, the weaker the herd immunity and the greater the chance of outbreaks of diseases rarely seen in the U.S., like measles.

Since 1963, when a measles vaccine was first licensed, measles cases in the U.S. have decreased by more than 99 percent. The disease was actually on the verge of being eradicated in the U.S. when, in 2008, an unvaccinated child caught measles while traveling with his family in Switzerland and brought the disease back to the U.S. The resulting outbreak spread to 127 people, most of them unvaccinated, in 15 states. It is easy to forget that measles is still a significant cause of vaccine-preventable death among children in other countries. Worldwide, in 2005, over 300,000 children under age five died from measles. Health officials point out that the prevalence of international air travel makes it possible for people to be exposed to any disease, from anywhere in the world, at any time.

Staggering Vaccinations

Torn between the recent autism scares and the reassurances of the medical community, many parents like Kristyn Ritner of Williamsburg searched for a compromise. “I did not have any concerns getting my first-born daughter vaccinated,” Ritner recalls, “but it was totally different when it came to my son because by then I had heard of the supposed ‘link’ between autism and vaccines. Of course, my pediatrician assured us that there is no medical proof of a link, but to put my mind at ease, I decided to space his vaccines out. The fear of autism was the driving force behind my decision, and I also felt strongly that he didn’t need to be loaded up on multiple vaccines all at once.”

Jennifer Inman, also of Williamsburg, has chosen to stagger the vaccine schedule for her 15-month-old son Ian. She says her decision was not influenced by the possibility of a vaccine-autism link, but, like Ritner, she opposes the idea of giving bundled vaccines to newborns, who are “still adjusting to life outside the womb.” The practice “goes against my gut feeling,” explains the NASA physicist. “I’m all for vaccines, but I don’t want to do eight in one day.”

In an attempt to help parents address these concerns, Dr. Robert Sears, a board-certified pediatrician, wrote The Vaccine Book: Making the Right Decision for Your Child (Little Brown and Company, 2007). In his book, Sears lays out an alternative vaccination schedule to the one recommended by the Centers for Disease Control and Prevention. He suggests that parents:

Only get their children two vaccines at a time (instead of as many as six) to decrease the chance of chemical overload from grouping so many vaccine chemicals all together at once.

Get only one aluminum-containing vaccine at a time (instead of the recommended four).

Get only one live-virus vaccine component at a time to allow the body’s immune system to better handle the live viruses in the vaccines.

He reasons that by giving children fewer shots at a time, you decrease the risk of side effects and make it easier to determine which vaccine a child is reacting to if a severe reaction occurs.

For Ritner, the alternative schedule was exactly the compromise she was looking for. “When my son Jax was born, we had them give him the initial vaccines in the hospital, even the Hepatitis B,” Ritner says. “But then we have spaced out all his other ones. We would not allow more than two shots per appointment. I think now, at age two, he is almost totally caught up, but it has definitely cost more because we are having to go more frequently to space the shots out.”

While spacing out the vaccines gives some parents greater peace of mind, many doctors, including Dr. Witte, have problems with this alternative approach. “When you stagger vaccines, children aren’t going to be protected as early as they should have been,” he explains. “With a disease like pertussis [whooping cough], the child needs three series of vaccines, and parents are delaying getting them all, so the child is at risk everywhere they go. You can get whooping cough in Wal-Mart.”

Witte also points out that insurance providers may not cover the additional visits needed to stagger the appointments. “When you bundle three vaccines at the two-month visit, it’s covered by your insurance. But if you just do one vaccine and the parents want to come back in a week, they end up paying more for those additional visits or simply don’t find time to come back at all… I’m not a fan of the staggered schedule but will work with parents if they understand the risks.”

Rebuilding the Trust

Dr. Linda Meloy takes issue with the idea of staggering vaccines to avoid overloading a child’s immune system with antigens—the substances in vaccines that tell the immune system to produce antibodies. “The number of antigens in each vaccine has greatly decreased as they’ve been more purified,” Meloy says. “So even though we have more vaccines today, children are still getting far fewer antigens than we used to get when we were children.” She goes on to cite a study led by Dr. Paul Offit, chief of infectious diseases and director of the Vaccine Education Center at The Children’s Hospital of Philadelphia—as well as one of the developers of the Rotavirus vaccine. The study explains how, previously, just one smallpox vaccine contained about 200 antigens, whereas now the 11 routinely recommended childhood vaccines contain fewer than 130 antigens combined. “In the 1960s, we were exposed to over 3,000 antigens in our vaccines,” Meloy explains. “And now we’re down to 126. I try to explain to parents how few antigens their children are really being exposed to even though we’ve increased the number of vaccines. The cleanup that they’ve done in vaccines over the years has been incredible. We used to see lots of bad reactions to vaccines, but now we rarely do.”

In fact, Offit’s study indicates that infant immune systems are much stronger than parents think. The report, “Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant Immune System?”, published in the January 2002 edition of Pediatrics, highlights the following important findings:

Newborns emerge from the relatively sterile environment of the womb into a world teeming with bacteria, viruses and other microorganisms. They commonly encounter a host of challenges to their immune system at the same time and are capable of generating protective immune responses to bacteria and viruses, as well as vaccines, from the moment of birth. This capability is necessary for them to meet the tremendous number of environmental challenges they will encounter in the first few hours and days of life.

Newborns have billions of immunologic cells that are capable of responding to millions of different microorganisms. By quickly making an immune response to bacteria that live on the surface of their intestines, for example, babies are able to keep those bacteria from invading their bloodstream and causing serious disease.

Current research shows that young infants are fully capable of generating protective immune responses to multiple vaccines given simultaneously. Offit’s study also suggests that infants have the theoretical capacity to respond to about 10,000 vaccines at once. Using this estimate, the study predicts that even if all 11 of the routinely recommended vaccinations were given to infants at one time, only about .01 percent of the immune system would be used.

Now pregnant with her second child, Ashley Cadwallader says that in spite of the controversy, she plans to follow the CDC’s immunization schedule for this baby as she did with her first. “My husband and I trusted the doctor’s recommendations for our first child and will do the same with this next one,” she says.

It’s that level of trust that doctors hope to rebuild with their patients—or more specifically, their patients’ parents. “As a mother, I understand you just want to protect your child,” says Meloy. “I don’t think it’s wrong that people question vaccine safety. I think it’s important that we talk about it. Parents often don’t understand why there is a substance like aluminum, for instance, in vaccines, and it sounds scary. But then you explain to them that aluminum causes a lump at the injection site which allows the antigen to stay there long enough to make a good immune response—and that there is less [aluminum] in the injection than what you probably consume when you drink a soda out of an aluminum can—and it doesn’t seem as scary. Education makes the difference.”

Written By Jesse Madden