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Anti-immunization on the Web
Harry Goldhagen, SCP Communications, Inc.
Infect Med 15(7):453-458, 1998. © 1998 Cliggott Publishing, Division of SCP Communications
Abstract and Introduction
AbstractHow dangerous are vaccines? Many Web sites are designed to prevent people from getting vaccinations for themselves or their children. But there is also a wealth of resources for physicians seeking to educate the public on the benefits of immunization.
IntroductionThe report in the February 28th issue of The Lancet about a possible association among inflammatory bowel disease, autism, and measles-mumps-rubella (MMR) vaccine (based on 12 cases) fueled an already existing trend in the alternative medicine movement: the avoidance of immunization. There are many reasons people avoid vaccinations: religious beliefs, fear of side effects (especially permanent neurologic side effects and death), and political convictions (freedom to choose). Nevertheless, the overwhelming benefits of vaccination should lead all ID clinicians, pediatricians, family practitioners, and others who administer vaccines to be aware of the arguments against vaccination and to be prepared to counter them.
Of course, there is no question that vaccines are associated with side effects and that they do not protect everyone. Most of these side effects are mild and transient, but very rarely, the side effects are quite serious, such as the 8 to 10 annual cases of paralytic poliomyelitis in the US related to the use of the live, attenuated polio vaccine.[2,3] (This finding led to the recommendation by the American Academy of Pediatrics [AAP] and the Advisory Committee on Immunization Practices [ACIP] of the CDC to use the inactivated polio vaccine in most cases for the first 2 doses.) As Larry Lutwick, MD, stated in this journal in a recent "Bug of the Month" column, "Nothing done through the art of medicine is absolutely safe, a fact known to all scientists and physicians but not to judges, trial lawyers, or juries. . . . It is all a risk/benefit analysis, a trade-off, where preventing the target disease outweighs any real or theoretical vaccine risks."
Despite the fact that serious side effects from vaccination are extremely rare, there is a strong movement to help parents avoid vaccinating their children. (I find it strange that there is not a similar movement to keep children out of moving cars, since the number of children injured or killed in automobile accidents in a single year dwarfs the number of children injured by vaccines through all the years they have been used.[5,6])
National Vaccine Information Center
A great deal of anti-immunization propaganda can be found on the Internet. There are dozens of sites relating heart-rending personal, anecdotal accounts of permanent neurologic disability or death related to vaccine use. Perhaps the leading site in the anti-immunization field is the National Vaccine Information Center (NVIC), which is operated by Dissatisfied Parents Together. This site turned up frequently when I used common search engines like Lycos to find immunization information. Its title gives the impression that this is a government-funded site. However, the syringe with the incredibly long needle (Fig. 1) and the profiles of 3 adorable children who suffered side effects from vaccination immediately signal the site's message: Immunization is dangerous.
Some information about the risks and side effects of vaccines on the NVIC site is accurate. Nevertheless, there is an overwhelming, unbalanced emphasis on the risks of vaccination, and any layperson reading this information is bound to be alarmed at some of the "facts" presented here. For instance, under the heading "Vaccination Decisions for Parents," the first line states, "Vaccination is a medical procedure which carries a risk of injury or death. As a parent, it is your responsibility to become educated about the benefits and risks of vaccines in order to make the most informed, responsible vaccination decisions." A similar statement can be made about any medical procedure. Although there is some useful information at this site, many of the discussions are speculative and one-sided, such as those on the page "Vaccines and Chronic Illnesses," which lists the rather controversial or dubious connections between MMR vaccine and juvenile diabetes, multiple vaccines and autism, and OPV and Gulf War syndrome.
Vaccine Information & Awareness
A related site, which discusses vaccine avoidance from a more political perspective, is Vaccine Information & Awareness (VIA) (Fig. 2). The basic philosophy of Karin Schumacher, the author of this site (who also maintains the NVIC Web site), is "to ensure that Freedom of Choice is not taken away from each parent. The decision to vaccinate is one that should and must be made by the parent alone." Unfortunately, there is no mention of involving the clinician in this decision or of the laws and regulations governing vaccinationthis basic mistrust of physicians and government regulatory agencies pervades this movement. VIA hopes to increase the number of states that grant a "philosophical exemption" on top of the already existing religious and medical exemptions (the philosophical exemption is already available in 17 states, according to this site) and to broaden the currently existing exemptions.
The language used at this sitepro-choice versus pro-vaccineis ominous. The notion that vaccination is an individual choice goes to the root of the American psyche, the free-thinking, independent, individualist view of political and social decision-making. (Luckily, there is no pro-choice movement for stopping at red lights, another government regulation that improves public safety.) This nation, and the entire world, cannot be safe from communicable diseases if a large proportion of the population is not vaccinated. The site goes on to state that freedom of choice about vaccination is not a right guaranteed under the First Amendment, as are free speech, a free press, and separation of church and state.
The VIA site has a list of vaccine "facts" (under "Did you know?") that might be a bit surprising to clinicians, including:
Other Anti-immunization Sites
The VIA site includes a list of more than 35 sites worldwide (under "Organizations & Support Groups") dedicated in some way to the dangers of vaccines and the avoidance of immunization. It is quite illuminating to scan sites with names such as "Vaccines: The Truth Revealed (Fig. 3)," "Citizens Against Vaccination," "The Tragedy of Vaccinations," and "Dangerous Vaccines." For instance, the authors of "Vaccines: The Truth Revealed" state, "Many people assume that vaccines are merely the means of fighting disease. This brief section will introduce you to the truth about the risks of vaccines, and why they are dangerous." The Introduction goes on to talk about the dangers of vaccination, including this lurid discussion of how vaccines are made:
"Vaccine production is a disgusting procedure. To begin, one must first acquire the disease germa toxic bacterium or a live virus. To make a live vaccine, the live virus must be attenuated, or weakened for human use. This is accomplished by serial passagepassing the virus through animal tissue several times to reduce its potency. For example, measles virus is passed through chick embryos, poliovirus through monkey kidneys, and the rubella virus through human diploid cellsthe dissected organs of an aborted fetus!"
The text continues in this vein, using terms like "foul concoction" and "witch's brew" to describe vaccines. There are also a fair number of inaccuracies and exaggerations, as well as downright misinformation, in this "scientific" discussion. (In fact, to reinforce the notion that this information is accurate, the background of the pages on this site looks like light blue graph paper, and there is frequent use of geometric shapes, pie charts, and hatched lines, giving the site a very "scientific" look.)
CDC's National Immunization Program
With so much misinformation and unbalanced, scary information about vaccines so readily available on the Internet, what can a clinician do to educate the general public about immunization? A good source of factual information to counter these commonly held but misguided views is the National Immunization Program of the CDC (Fig. 4). Here, in the publications list, you can find articles on vaccine safety, health education manuals for hepatitis B vaccination, and, most useful in this context, "6 Common Misconceptions About Vaccination" (Table I). The well-thought-out responses to these common but misguided views can serve as the basis for a talk given to school groups, parents, or anyone else involved in vaccine decisions. The links to related sites provide a wealth of additional information from the CDC as well as other well-informed organizations. A warning, though: This site loads slowly because of the many dense graphics and the Java-based news ticker.
Immunization Action Coalition
The mission of the Immunization Action Coalition & Hepatitis B Coalition (Fig. 5), simply stated, is to boost immunization rates for children and adults. The quality of the information is terrific. Most of the reports at this site are created for physicians to distribute to patients, and all the materials found here can be ordered or printed out and distributed for free; these resources are available in many languages. Two newsletters are published at this site, Needle Tips and Vaccinate Adults!, which are worth reviewing, including the complete list of recommended adult vaccinations. In the "Ask the Experts" column in Needle Tips, Harold S. Margolis, MD, answers questions about hepatitis vaccination, and William L. Atkinson, MD, MPH, answers questions about all other immunizations. It is certainly worth reading what parents and clinicians are concerned about.
One of the most useful features of this site is the list of National Resources, which is the most complete one I've seen. This list includes links to print and electronic reference materials from the CDC and other organizations, videos, immunization registries, links to all known Web sites related to immunization, phone numbers for all immunization-related organizations, and even links to all the vaccine manufacturers. Anyone who wants to get more involved in immunization education can sign up here, and there is a list of state coordinators and their phone numbers.
There are many resources on the Web to help clinicians educate parents about immunization and to rebut mistaken but commonly held beliefs about the dangers of vaccination. The best places to start are the home pages of the CDC's National Immunization Program and the Immunization Action Coalition. Good luck in your educational efforts.
Thanks to John T. Sinnott IV, MD, and members of the Infectious Diseases Department at Tampa General Hospital for their valuable comments during a talk on this subject.
Mr. Goldhagen is Managing Editor of INFECTIONS in MEDICINE. He gets his shots every 3 years.