With rare--but real--possible side effects from certain immunizations, lawmakers face an age old public health question.
Arkesea was a healthy, active 15-year-old girl living a normal life in North Minneapolis, until she got hepatitis B. Two weeks later, in July 1998, Arkesea died.
Her family remembers a girl who excelled in math and science and dreamed of becoming a doctor. Neither her doctors nor her parents know how she contracted the disease. She wasn't an IV drug user, she wasn't sexually active, and she didn't receive tainted blood.
Unfortunately, Arkesea was one of the approximately 30,000 children infected with the disease that year. Hepatitis B kills 4,000 to 5,000 people in the United States each year, and approximately 220 people receive liver transplants annually to survive the damage done by the disease. The Centers for Disease Control and Prevention (CDC) estimates that in America today, 1.25 million people are chronically infected. A vaccine to prevent hepatitis B is available and was required during the 1998-99 school year for attendance at elementary schools in 27 states, the District of Columbia and Puerto Rico.
Terry, a beautiful, healthy infant from Alabama, received his first in a series of oral polio vaccines when he was nine weeks old. Less than 72 hours later he was in the hospital and on a respirator. Six months later he died. Terry was one of about 10 children each year whose polio is caused by the vaccine designed to protect them. At its height in 1952, the polio epidemic crippled 21,269 Americans and claimed 3,145 lives. To prevent this ever happening again, the vaccine is required for attendance at elementary schools in all 50 states, the District of Columbia and Puerto Rico. But to ward off cases like Terry's, the CDC now recommends the safer, injected form instead of the oral vacine, even though it is less effective.
As policymakers, legislators must ask if states should require that all children receive vaccines in order to protect individuals and communities from infectious epidemics, or should parents be allowed to refuse immunizations to avoid rare, but sometimes serious, reactions?
As guardians of the public health, legislators determine which vaccines should be mandated, when they are to be used and what groups will be affected. It's a complicated issue. As immunizations become more effective, the diseases they prevent fade from memory, leaving only the vaccines themselves and their rare side effects in the public consciousness.
Proponents such as public health officials, the CDC, the American Academy of Pediatrics, the Food and Drug Administration and child health advocates point out that serious medical problems caused by vaccines occur very rarely--much more rarely than the serious complications and deaths that can be prevented by vaccines. Numerous scientific studies have failed to draw any correlation between vaccines and autism, SIDS, multiple sclerosis or a number of other diseases.
However, the public sometimes has a hard time believing the experts, as we've seen with the Gulf War syndrome and silicone breast implants--cases where experts tried and failed to establish cause and effect. The public believes the experts just haven't tried hard enough, said John Donvan of Nightline in an October 1999 program.
Yet, in our society, pharmaceuticals are tested so stringently that we have devoted an entire federal bureau to the task. In fact, immunizations are subject to a higher standard of safety than other medical interventions because they are given to healthy children. But is this enough?
PUBLIC HEALTH'S ROLE
Vaccines are one of the greatest public health achievements in history. Smallpox has been eradicated worldwide through the use of vaccines. Polio, except for the few cases caused by the vaccine, has been virtually eliminated in the Western Hemisphere and may be eradicated in the rest of the world this year. …