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Shot Down

 

Baby-proofed and bathed in natural light, the apartment had a lovely view of the Hudson River. The playgroup hostess had thoughtfully provided a packet of organic applesauce for each baby. The talk quickly turned, as it often does with new parents in the same neighborhood, to pediatricians. One mom had found one she liked – not easy in this era of managed care and brusque manners. “But what is her stance on vaccinations?” our hostess inquired anxiously. “Uh, she’s all for them,” the first mother replied cautiously. After an uncomfortable silence, the hostess revealed that her sister had “a lot of education” about vaccines, and she herself was not planning to inject her child with any of that poison. “What about when she goes to school?” we asked, trying not to sound judgmental. Our hostess was unruffled. By that time, she asserted, so many people will be refusing vaccines, that the state laws – which currently require children attending public school or licensed daycare to have up-to-date shots – will have to be changed. “People,” she explained, “are beginning to wake up.”

People who don’t vaccinate their kids tend to talk in these terms. They used to be passive “sheeple,” doing what the doctors and the experts told them. Once they informed themselves, they realized the full horror of injecting helpless infants full of toxins. Kristen Monaghan, a stay-at-home mother in Manhattan’s Gramercy neighborhood whose husband works in asset management, recalls that with her first child, Rubin (now twenty-one months), “I was afraid to educate myself.” But when she was expecting her second, August, Kristen and her husband attended a talk by Dr. Larry Palevsky, a local anti-vaccine activist and pediatrician. Kristen’s husband was reluctant to go, assuming that Kristen was worrying needlessly. But she says that, during the break in the lecture, “We turned to each other and said, ‘We’ve been such idiots.’”

Unlike many anti-vaccine activists, Dr. Palevsky comes across in conversation as a reasonable person. He talks about data and scientific “literature,” not about government plots and cover-ups. “Parents become convinced,” he explains, “that the risk of illness is worse than the risk of the vaccine. But there’s no data to support that statement. There are no studies of the long-term effect of vaccinations.” He later adds that there are no studies looking at the “real short-term effects of vaccinations, either.” It is, of course, these kinds of statements that parents find most terrifying.

They’re also pretty misleading; the Centers for Disease Control has a system in place to rigorously track what it calls “adverse events” associated with vaccinations, and does in fact study the patterns. For most of the vaccines currently used, severe adverse reactions – coma, brain damage, death – have been reported in less than one in a million children, according to the CDC, so rarely that it is usually difficult to know whether the vaccine even caused the problem. Compare that with the risks associated with the diseases themselves. The HIB (Haemophilius influenzae) vaccine prevents bacterial meningitis. Before that vaccine’s introduction in 1987, about one in 200 children under five in the United States got Hib meningitis every year, and 600 died of it, while others were left mentally retarded or deaf. Now that people are immunized, incidence of Hib has declined by 98%. As recently as our parents’ generation, it was not unusual to see kids in wheelchairs or iron lungs: polio survivors. Indeed, 13,000-20,000 cases of paralytic polio were reported each year before the shot was introduced in 1955. Now, polio has been eliminated not only in the United States, but the entire western hemisphere.

One of the most common claims made by anti-vaccination activists is that thimerosal, a mercury-based preservative used in some vaccines, has contributed to an apparent increase in autism. That connection has never been established. A 1998 study published in the Lancet, the British medical journal, purported to find a link, but was completely discredited – and in 2004 retracted by the Lancet itself, as well as by ten of the article’s twelve authors. The study had numerous methodological flaws and one of its authors had accepted more than $100,000 from lawyers investigating a vaccine lawsuit. Dr. Henry Bernstein of the Children’s Hospital at Dartmouth, a member of the American Academy of Pediatrics’ Committee on Infectious Diseases who believes that vaccines were “the number one public-health breakthrough of the last century,” says of the discredited study, “it’s pretty discouraging when something like that can lead so many people not to vaccinate their children.”

While research has found that too much mercury – in fish, for instance – can cause some cognitive problems for children, there is, according to an exhaustive 2004 study by the Institute of Medicine, no evidence of a connection between mercury and autism. Indeed, in Denmark, autism rates increased after thimerosal was removed from vaccines. Still, as a result of widespread parent concerns about thimerosal, the vaccines that babies now receive contain very little mercury (a measure that the Centers for Disease Control took mainly to restore public confidence in vaccines). But the vaccine-autism connection still has vocal adherents – including some parents of autistic children, as well as activists who oppose vaccines for their own ideological reasons – and continues to be aired in media reports as a possibility. “His father claims Alex wasn’t autistic – until he got certain vaccinations containing a mercury preservative,” reads one of untold scores of recent articles and news programs that give the views of concerned parents and medical experts equal weight.

Will this army of skeptics shake the foundation of mandatory shots? Lorena, another Manhattan mother, also decided after hearing Dr. Palevsky speak, that “the body can take care of itself.” (She asked that her last name be withheld. “Dr. Palevsky made me paranoid,” she explains, citing “stories of parents being pursued by the state.”) Lorena, who has a one-year-old, does not trust drug companies: “I think they are unethical. Look what they’re trying to do now [with the HPV vaccine] – make it mandatory for fifth and sixth grade girls to be vaccinated for a sexually transmitted disease! They’re going to hell.” She brings up the – certainly disgraceful – history of pharmaceutical companies testing dangerous drugs on people in the Third World. Like many anti-vaccinators, Lorena also believes that vaccines are weakening our immune systems.

Will this army of skeptics shake the foundation of mandatory shots? Is my playgroup hostess correct in her predictions of mass revolt? It’s unlikely that the public health establishment will so easily give up universal vaccination – which has, many doctors agree with Dr. Bernstein, saved more lives than any other single innovation (with the possible exception of the decline in cigarette smoking). But my hostess is right about one thing: she’s not alone in choosing not to vaccinate her child.

Among well-educated, comfortably off parents, the ranks of vaccine-resistors are increasing. (Of course, plenty of parents fail to vaccinate their kids not by choice, but because they’re poor and lack access to decent healthcare.) Some states with a large number of skeptical, alternative-minded people – Massachusetts, Oregon, Washington, New York – have seen, in the past six years, a declining percentage of children vaccinated against polio, diptheria, measles, mumps and rubella. Of the school requirements, my playgroup hostess may not be far off the mark: it is becoming easier in many states to opt out of vaccinations. I spoke with many parents who were planning to get religious exemptions – which in New York State are easy to come by, even if you’re an atheist (all states except Mississippi and West Virginia permit parents to opt out on religious grounds, according to the National Vaccine Information Center, an anti-vaccination group). Eighteen states permit opting out for “philosophical, personal or conscientiously held” beliefs; most of these laws were passed in the last decade. Texas has made it even easier to avoid vaccines: in 2005 the state enacted a law permitting a parent to opt out for any reason.

Though parents who don’t vaccinate have usually done mountains of research, and are fluent in the language of evidence and science, they’ll often admit that their decision isn’t ultimately about the facts. Says Lorena, “my gut tells me. I just know that I will not vaccinate my child.” A pediatrician in the Northeast who blogs anonymously on these issues – and accepts non-vaccinators in his practice – tells me that worried inquiries from parents about the autism link have increased, probably because of media coverage. Some people do have bad reactions to vaccines, this doctor acknowledges, “but hysteria is never a good thing. And we’re at near-hysteria right now.”

Vaccine resistance bears the familiar markers of Generation X parenthood. Why now? Partly because, although there have been vaccine skeptics for as long as there have been vaccines, they tend to be most vocal when major childhood diseases are in retreat (not many Africans are worrying about autism right now). Side effects from vaccines are not unknown, of course, and since few of us know anyone who has had a vaccine-preventable disease, more and more parents question the risk. Diseases like polio, says Dr. Bernstein, are “out of sight, out of mind, so many parents may not feel the need to have their children vaccinated.” In its current form, vaccine resistance bears the familiar markers of Generation X parenthood. Attachment parenting has, for many of us, created a kind of cult of personality around ourselves, in which we alone know what’s best for our children. We also fetishize our emotional bond with our kids as sacrosanct yet weirdly fragile. Jo Rendell and Brad Lewis, a Greenwich Village couple (a novelist and NYU professor, respectively), have allowed their three-year-old, Bennie, to have some shots but have avoided others. They eschew “Well Baby” visits, because, as Jo puts it, “We know when he’s sick.” Brad – a psychiatrist – explains their resistance to vaccinating Bennie in part as a psychic one: “We were just building a rapport with him, a sense of trust. We had no language to explain to him what was going on.” Jo agrees: “We intuited that it would be traumatic for him.”

As Susan Gregory Thomas documents in Buy Buy Baby: How Consumer Culture Manipulates Parents and Harms Young Minds, this generation of parents is anxious not to be taken for dupes, yet our skepticism can be superficial and capriciously directed. We are often, as Arthur Allen points out in his new book Vaccine, more willing to believe a random article on the internet than scientists who have spent their lives studying vaccines. Many of us have been oddly credulous about the anti-vaccine activists, some of whom are charlatans who make Merck look like the Boys & Girls Club. In addition to serving the worthy purpose of reminding us that every medical intervention has risks, many of these characters have terrified parents with vaccine fears that are simply ridiculous, in one case evoking the possibility of “brain-eating bugs.” Some anti-vaccinators have even made a career of providing expert-witness testimony to defend defendants in “shaken baby” cases, claiming that the children’s injuries come not from abuse but from shots.

Several parents interviewed for this article were particularly disturbed by the number of vaccines given to today’s newborns. Indeed, babies do get more shots now than we did when we were kids. Several new vaccines were added in the 1990s, and that’s clearly part of the reason so many people are up in arms. Some parents, while committed to the concept of vaccination, are now worried enough about potential side effects – or bad interaction between vaccines – that they are asking to have the shots spaced out. Many follow some version of the schedule devised by Stephanie Cave, vaccine skeptic and author of What Your Doctor May Not Tell You About Vaccinations – often giving children just one shot at a time. Plenty of pediatricians are willing to accommodate patients who do this – though few will present the option up front. Other parents staking out a middle ground on the issue have rejected only the chicken-pox vaccination (this, too, is a choice that many pediatricians accommodate). There are some reasonable justifications for opting out of the chicken-pox shots: for most children, chicken pox isn’t a serious illness, and getting it as a kid may provide greater immunity in adulthood, when it’s often more dangerous. The state of the health-care system, especially the fact that so many people receive care through impersonal HMOs, may also be contributing to the anti-vaccine revolt. Dr. Palevsky and Dr. Bernstein don’t agree on much, but both think that people are much more likely to be skeptical of vaccines if they don’t have a strong relationship with their doctor.

The state of the health-care system may be contributing to the anti-vaccine revolt. Unlike most parents who are not vaccinating, Kristen Monaghan does recognize that her choice could be seen as ethically questionable. After all, non-vaccinators don’t expose their own children to the potential dangers of vaccines, yet because most parents in their community probably do, unvaccinated kids are often not in much danger of contracting serious diseases. “I feel sort of guilty – since most of our friends [vaccinate], our kids are safe,” she acknowledges. “But, not guilty enough to get my kid vaccinated!” She does acknowledge the selfishness of her decision: “If the majority of us didn’t do it, who knows what diseases would come back?” Then she dismisses her guilt: “We don’t know what would happen – maybe it would be fine.” Other parents interviewed for this article seemed not to have considered the possibility that they could be free-riding on the system. Brad sees in the very question a “difficulty with difference – why can’t there be different strokes?” Like many vaccine skeptics, Brad and Jo believe that serious diseases were in retreat before vaccines, because of improved sanitation, and that the threat belongs to history.

The problem with this logic is that history has a funny way of repeating itself. You don’t have to look back to the days of feces-filled nineteenth-century streets for examples of outbreaks of preventable diseases. According to Arthur Allen’s book, Colorado is full of vaccine resistors – a combination of libertarians and crunchy back-to-the-garden types – and has, as a result, had numerous hair-raising whooping cough epidemics, one of which was traced directly to a Waldorf School (where the educational philosophy is famously – and harmlessly – fruitcake, but the belief that vaccines weaken children’s immune systems is less well-known). In Germany in the ’90s, many parents stopped vaccinating, and then went on vacation to exotic locales, bringing unpleasant diseases back with them. Despite vaccine resisters’ insistence that they are making a personal choice – which they strongly feel is no one else’s business – their choice has potentially far-reaching social consequences. Deciding to vaccinate isn’t like deciding whether to circumcise, home-school, baptize or give your child a silly name. It’s one that renders “different strokes,” “life-and-let-live” relativism nonsensical, because vaccination only works well if most people do it.

Deciding to vaccinate isn’t like deciding whether to circumcise, home-school, baptize or give your child a silly name. But why would parents think collectively? The social contract is, in many ways, failing us. High-quality day care, for example, is expensive; a year at one well-regarded center on the Upper West Side of Manhattan costs nearly as much as my entire college education. Regina Chiu, an Upper West Sider who is vaccinating her baby but following the slower schedule influenced by Stephanie Cave’s book, admits, “I might have made a different decision if he were in day care.” (Her child is relatively safe from infectious diseases, because he doesn’t interact with many other children.) In many places, public schools are not great. Health insurance coverage for families is increasingly expensive. Most companies don’t provide day care or a decent amount of family leave time. Since society isn’t doing much to help us take care of our kids, many of us conclude that we are, as Judith Warner suggests in Perfect Madness: Motherhood in the Age of Anxiety, on our own. Plenty of us respond by pretending we’re raising our children in a bubble. While that’s understandable, it’s not sensible. By not vaccinating, we’re rejecting one of the few effective things that our society has done for children, and undermining a collective effort to keep everyone safe.

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