How Safe Are Vaccines?

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My Child, My Choice
If the push-back against vaccines were only about the science, doctors might have an easier time making their case. But there's more going on than that. Parents object to the mandatory nature of the shots—and the fact that their child's access to education hinges on compliance with the immunization regulations. There's also the simple reality that the illnesses kids are being inoculated against are rarely seen anymore. When diseases like polio ran free in the early 1900s, the clamor was less about why we needed vaccines than about why there weren't more of them. Once you've seen your neighbor's toddler become paralyzed, you're a lot more likely to worry that the same thing will happen to yours. "The fact is," says Offit, "young mothers today never grew up with the disease."

What worries him and others is that young mothers of tomorrow will—and that could be disastrous. CDC officials estimate that fully vaccinating all U.S. children born in a given year from birth to adolescence saves 33,000 lives, prevents 14 million infections and saves $10 billion in medical costs. Part of the reason is that the vaccinations protect not only the kids who receive the shots but also those who can't receive them—such as newborns and cancer patients with suppressed immune systems. These vulnerable folks depend on riding the so-called herd-immunity effect. The higher the immunization rate in any population, the less likely that a pathogen will penetrate the group and find a susceptible person inside. As immunization rates drop, that protection grows thinner. That's what happened in the current measles outbreaks in the western U.S., and that's what happened in Nigeria in 2001, when religious and political leaders convinced parents that polio vaccines were dangerous and their kids should not receive them. Over the next six years, not only did Nigerian infection rates increase 30-fold, but the disease also broke free and ranged out to 10 other countries, many of which had previously been polio-free.

As long ago as 1905, the U.S. Supreme Court recognized the power of the herd and ruled that states have the right to mandate immunizations, not for the individual's health but for the community's. That principle, say vaccine proponents, should still apply. "The decision to vaccinate is a decision for your child," says Dr. Jane Seward, deputy director of viral diseases at the CDC, "but also a decision for society."

Some parents have taken to cherry-picking vaccines, leaving out only the shots they believe their children don't need—such as those for chicken pox and hepatitis B—and keeping up with what they see as the life-or-death ones. But that can be a high-stakes game, as Kelly Lacek, a Pennsylvania mother of three, learned. She stopped vaccinating her 2-month-old son Matthew when her chiropractor raised questions about mercury in the shots. Three years later, she came home to find the little boy feverish and gasping for breath. Emergency-room doctors couldn't find the cause—until one experienced physician finally asked the right question. "He took one look at Matthew and asked me if he was fully vaccinated," says Lacek. "I said no." It turned out Matthew had been infected with Hib, bacteria that causes meningitis, swelling of the airway and, in severe cases, swelling of the brain tissue. After relying on a breathing tube for several days, Matthew recovered without any neurological effects, and a grateful Lacek immediately got him and his siblings up to date on their immunizations. "I am angry that people are promoting not getting vaccinated and messing with people's lives like that," she now says.

Health officials are angry too. Encouraged in part by the government report that seemed to clear vaccines of the autism charges, they are beginning to take a harder line with parents who submit vaccine exemptions for nonmedical reasons. In Maryland, where unvaccinated students are not permitted in school, officials last November threatened to take parents to court for truancy violations if their kids did not get all their shots so that they could be cleared for class. On Long Island, N.Y., vaccine objectors are called in for what some parents call "sincerity" interviews with school officials and school-board attorneys to determine how genuinely the vaccines conflict with religious convictions.

Even in cities where such interviews are not required, the tensions are palpable. Says Sue Collins, a New Jersey mother who has not had either of her two sons vaccinated: "Things are getting so nasty. People are calling us bad parents, saying it's child abuse if we don't vaccinate our children." In an effort to avoid potential conflicts, some parents are bypassing the school system altogether, preferring to homeschool their kids so they won't be forced to vaccinate them.