The More, the Merrier

The sequence whereby vaccines originally intended for a limited purpose or target population are awarded a larger and larger market share logically culminates in the prized government mandate enforcing them on everyone. As we saw, such universalization pre-supposes a deep, abiding faith that vaccines are inherently beneficial and in no sense a major public health risk, which makes it look acceptable to promote all vaccines to the fullest extent possible and achieve maximum compliance with each new mandate.

Writing in medical journals and news magazines, prominent advocates routinely exhort physicians to improve their vaccination rates, offer practical tips for overcoming patient resistance, and downplay the risks and contraindications that parents continually worry about, and that still crop up in the literature. Part pep talk and part sales pitch, such motivational efforts have long since reached out beyond any narrowly defined pediatric constituency to target other age groups as well.

In “Adult Immunizations: How Are We Doing,” a typical example of the genre, a leading infectious disease specialist calculated the number of lives that could be saved by vaccinating adults with the same zeal and thoroughness that we bestow on our children:

30,000 lives could be saved yearly if adult immunization recommendations were implemented. Between 50,000 and 70,000 adults die each year from influenza, pneumococcal infection, and hepatitis B. This exceeds the number of automobile deaths, and far outweighs mortality from these diseases in children. Those for whom vaccines are contraindicated are fewer than those who fail to be immunized because of the following, which are not contraindications but often thought to be:
1) local reactions to past vaccines, with fever less than 104_; 2) mild acute illness, with or without fever; 3) antibiotic treatment or convalescence from recent illness; 4) household contact with a pregnant woman; 5) recent exposure to infectious dis- ease; 6) breast-feeding; 7) history of allergies, including to penicillin or most other antibiotics; and 8) family history of allergies, adverse reactions, or seizures.¹¹⁵
 
In other articles, similar concern is expressed for adolescents and young adults, who have been equally neglected by our narrow preference for infants and small children:

Vaccination programs focusing on infants and children have decreased the occur- rence of many vaccine-preventable diseases. But many adolescents and young adults are still being attacked by hep B, chickenpox, measles, and rubella, because our vaccination programs have not focused on these age groups. All not previous- ly or adequately vaccinated should be updated with Hep B, MMR, DT, varicella, and pneumococcus. Influenza and Hep A should be offered to all at high risk.¹¹⁶

The most convincing proof for the universality of the concept is its extension to pregnant women, who have always been considered exempt and inviolate, out of concern for the safety of their unborn that the new imperative bids fair to render obsolete:

Adult immunization rates have fallen short of goals because of misconceptions about the safety and benefits of vaccines. This danger is magnified during pregnancy, when physicians are hesitant to give vaccines and patients to accept them. Routine vaccines that are safe to give during pregnancy include DT, flu, and Hep B. Meningococcus and rabies may be considered. Contraindicated are MMR, varicella, and BCG. Others have not been adequately studied and must be weighed individually. But inadvertent use of any of these is not grounds for termination.¹¹⁷
Ironically, it is widely agreed that mandated childhood vaccination programs have not only achieved but often outstripped their stated goals. According to the CDC National Immunization Survey, all recommended vaccine targets were met or exceeded by 1995:

95% of children aged 19 to 35 months received at least 3 doses of DPT; 92% received at least 3 doses of HiB; 90% received the MMR; 88% received polio; and 68% the Hep B. In fact, the 1996 goals were reached in 1995.¹¹⁸
Even in California, where alternative medicine is widely popular and a thriving subculture openly questions traditional medical practices, vaccination rates have reached extremely high levels, as shown in a 2001 study by the state Health Department:

The California Department of Health examined school immunization records for all children in the state. In the fall of 2000, personal belief exemptions were listed for 0.77%, or 4000 of the 526,000 attending kindergarten. Seventh-graders have higher exemption rates, probably because of the Hep B requirement. Of 500,000 seventh-grade students, 1.3% recorded personal belief exemptions.¹¹⁹

In fact these levels are far in excess of what is necessary to prevent sustained out-breaks of even the most highly contagious diseases, like chickenpox and measles, both of which attack nearly 100% of the people exposed to them for the first time. A study of 1000 Milwaukee-area children with measles found that  modest improvements in low levels of immunization among 2-year-olds confer substantial protection against measles outbreaks. Coverage of 80% or less may be sufficient to prevent sustained outbreaks in an urban community.¹²⁰

While these campaigns all tacitly assume that it is permissible and even desirable to add on as many different vaccines in as many doses as we think fit, the preponderance of evidence points to exactly the opposite conclusion, as we saw. If all vaccines tend to promote, intensify, activate, or reactivate whatever chronic disease tendencies already exist, then the risk of adverse reactions is not rare or incidental, but inseparable from the process, and indeed, I fear, in direct proportion to the total number of vaccinations given.

Whether unaware of or simply untroubled by this possibility, in January 2004 the ACIP updated its Recommended Childhood and Adolescent Immunization Schedule:
3 Hep B shots in the first 24 months, beginning at birth;
3 DPT at 2, 4, and 6 months, and a 4^th 5-24 months;
3 HiB at 2, 4, and 6 months, and a 4^th at 12-18 months;
2 injectable polio at 2 and 4 months, and a 3^rd at 6-24 months;
One MMR at 12-18 months;
One chickenpox at 12-24 months;
3 pneumococcus at 2, 4, and 6 months, and a 4^th at 12-18 months; and
One influenza yearly, beginning at 6 months.¹²¹

This means 22 different vaccinations for each child in the first 2 years, many with two or more components, and that’s only the beginning. For ages two through 18,
Influenza vaccine annually [another 16 from 2-18 years of age];
3-4 Hep A shots recommended, from 2-18 years;
DPT booster at 4-6 years, followed by DT at 11-12 years;
Injectable polio booster at 4-6 years;
MMR booster at 4-6 years; and
Chickenpox booster at 4-6 years.¹²²

This makes 25 more mandatory or recommended vaccinations between 2 and 18, a total of close to 50 by the time they enter college, not to mention whatever new vaccines lie in store for them in the future. Moreover, as young adults they will become eligible for yet another series of boosters to carry them into old age. Thus slowly, incrementally, and inexorably, purely as a matter of policy and without any real public health emergency, vaccination has become the normal, acceptable means for reducing the incidence of any identifiable acute infectious disease whatsoever, often simply to save money or time lost from productive work, a strategy which now involves every individual in every age group and necessitates repeated doses throughout life.

To stop this juggernaut, I would assign top priority to reducing the total vaccine burden borne by our population, especially infants and young children. In my view, this should be done, first of all, by postponing vaccination as long as possible, at least until two or ideally three years of age, to give young immune systems ample opportunity to develop in a wholesome and natural way, by learning how to mount fevers and other vigorous, acute responses to infection, before reprogramming them more chronically.

Second, we should preserve the clear distinction between diseases that represent a clear and present threat to life and limb, such as DT and polio, and others that originate from organisms in our normal flora, like HiB and pneumococcus, or are nuisances that we elect to vaccinate against for economic or other policy reasons, such as influenza, MMR, and chickenpox, or problem diseases that we feel helpless to influence in any other way, like Hep B and undoubtedly AIDS on the horizon.

With no urgent medical need for it, the MMR was brilliantly successful as a public relations stunt, proving that vaccination could work as a general strategy by nearly erasing three ubiquitous acute diseases as a simple demonstration of its validity. Yet it is wholly counterproductive to impose the MMR on populations like ours, which through centuries of adaptation had already tamed these viruses into routine diseases of childhood that most kids in reasonably good health would benefit substantially from coming down with and recovering from.

In industrialized countries like the United States, recommending vaccination for all children could make a little bit of sense for DT and polio, while the other vaccines could still be made available to those who request them. As for pertussis, I cannot support large-scale use unless a vaccine is developed with a much better safety record than any we have now. Since the pressure to vaccinate early derives mainly from the risk of pertussis in young infants, dispensing with that vaccine will also encourage waiting longer before giving DT and polio. In my opinion, the MMR, chickenpox, and Hep B vaccines have no legitimate use on a mass scale and should not be recommended. Vaccinating the whole population in advance of bioterrorist threats like anthrax and smallpox is useless, since weaponization renders these organisms impervious to vaccines, and also unnecessary, since the likelihood of their use remains vanishingly small.

A Sacrament of Modern Medicine

Just as vaccinating everybody against everything at every possible opportunity satisfies the ideal requirements of an enormously profitable venture for manufacturers, the aggressive marketing strategies I have described are not so different from what successful businesses often do to maximize their bottom line. As we saw, their sweetheart deals with state health departments, foreign governments, and federal and international agencies, involving millions of doses guaranteed at their chosen price, along with the famous “hard sell” of doctors and patients that accompanies them, entail nothing more mysterious or unfamiliar than old-fashioned crony capitalism getting a free ride.

This debacle was all about greed. Luckily, the vaccine was never made available to the poor countries that might have benefited from it, because its $30 unit price was far beyond their reach, while the U. S. government, which never tried to persuade the manufacturers to lower it, gladly provided easy access into the domestic market. In like manner, the anthrax vaccine controversy ended in scandal because the government policy of requiring it of all military personnel resulted in too many high-profile casualties and defections for the company’s shoddy practices and the Pentagon’s condoning of them to be kept hidden any longer.

Thus unrestrained even by market forces, abetted by corporate welfare at the tax-payers’ expense, and rubber-stamped by their allies in government, the thriving biotech industry has amplified these problems exponentially by creating new vaccines against any desired viruses or bacteria as fast as they can identify, isolate, and propagate them, often for no better reason than their technical capacity to do so. In short, we can expect a rich harvest of new vaccines in the future, some on the drawing board, others already in stock and awaiting only a convenient opportunity and marketing strategy to launch them:

While its incidence has declined in the past decade, hepatitis A is still responsible for nearly 60% of acute viral hepatitis in the United States. It seems unfortunate that outbreaks continue to occur in one of the most affluent countries in the world, given that a highly immunogenic, safe, and effective vaccine is available. Routine vaccination in early childhood would lead to a dramatic reduction in the infection within a decade. The failure to begin such a program is a missed opportunity.¹²³

However ubiquitous they may be, corporate greed and worldly ambition are only the most familiar and obvious side of the story, the motives that many industries share. In degree if not in kind, vaccines are uniquely blessed and indeed sanctified above all other industrial products by their extraordinary triumph at the mythic or unconscious level, as a veritable panacea for a health care system that seems embattled and in deep trouble almost everywhere else.

No purely financial or commercial motive can account for the sincere and nearly universal veneration accorded to the idea of vaccination by doctors and patients alike, which not only exempts vaccines from the ordeal of criticism that every new scientific discovery must rightly endure, but also makes the mere hint of disapproval seem disloyal or sacrilegious, and even inspires the physicians who administer them to volunteer their own children for the latest experiments.
Quasi-religious sentiments of this kind are evident in the writings of Dr. Paul Offit, the aforementioned Merck consultant who recently claimed that young infants are capable of generating protective humoral and cellular responses to many vaccines simultaneously, perhaps as many as 10,000 at a time, by what he calls a “conservative estimate.”¹²⁴  In this sense, the vaccination project must also be understood in mythic and spiritual terms, as a kind of baptismal initiation into the religion of modern medicine.¹²⁵  Whichever of these motives seem uppermost in any given case, the result is the same: compulsory vaccination has promoted a kind of self-righteous fanaticism that is often invoked to justify various abuses and infringements of the rights of parents, children, and the public at large.

From the 1940’s through the Reagan years, compliance with vaccination laws was achieved mainly by intense social pressure to conform that doctors, school boards, friends, neighbors, and relatives brought to bear against deviant parents, whose unvaccinated kids were regarded as the chief reservoir of the few diseases at issue and therefore a substantial threat to the vaccinated kids and everyone else as well. In the mid-1980’s, as we saw, this simplistic rationale was demolished by the large measles outbreaks in highly vaccinated populations, where most of the cases had been vaccinated, and parents wondered how, if the vaccine were any good, unvaccinated kids could threaten anybody but themselves.¹²⁶

During the Clinton years, as both the number of required vaccinations and the public resistance to them began to multiply, the government and public health authorities began implementing a tracking system for identification and surveillance of noncompliant parents, based on computerized government databases that raised widespread alarm and fears of “Big Brother” overriding personal privacy, notwithstanding official denials and reassurances to the contrary:

Community- and state-based immunization registries are computerized systems that contain data about children’s vaccines, a tool to maintain high vaccination coverage. Such registries consolidate records from different providers, provide generate reminder notices, and produce an official record. Remaining challenges include balancing the need to protect privacy with gathering and sharing inform- ation to benefit the public and individuals. $178 million in Federal funds has so far been awarded to state and local health departments to develop such registries.¹²⁷

With the added impetus of President Bush’s “War on Terrorism” and the Home-land Security bureaucracy created in its name, the threat to civil rights began to frighten eminent legal experts and health activists all over the country, as in the following “News Release” that was sent to me over the Internet and gave only a phone number as its source:

Attorneys for the CDC have advanced legislation that suspends civil rights in case of a declared biological emergency. The Emergency Health Powers Act gives governors and public health officials the power to arrest, transport, quarantine, drug, and vaccinate anyone suspected of carrying a potentially infectious disease. An article by Prof. Lawrence Gostin of Georgetown that tried to balance the need to control disease with protecting individual rights was removed from the Boston Globe website. The law gives state public health authorities dictatorial powers with scant legal recourse for internees. Its definition of a public health emergency is highly subjective. Once it is declared, most civil liberties are suspended, with states declaring ownership of private property. Persons refusing to submit to medical exams and tests are subject to misdemeanor charges and forced isolation. If authorities suspect that they have been exposed to infectious diseases or pose a risk to public health, detention may be ordered for them. If an attack is carried out or even suspected, thousands could be held in camps, and physicians assisted by police be required to perform medical tests and exams. Individuals may be forcibly vaccinated or medicated, and those refusing would be guilty of a crime and subject to arrest, isolation, or quarantine, while the state and public health authorities are exempt from liability associated with the death or injury of detainees or damage to their property.¹²⁸

In a sizeable number of divorce and/or child custody hearings and lawsuits that have come to my attention, the plaintiff, almost always the husband or ex-husband, seeks to win or regain physical custody of his children on grounds that his wife or ex-wife was negligent or unfit as a parent by failing to comply with vaccination laws, even if he had acquiesced in her position and failed to challenge it for all the time they were together.¹²⁹

Even in Canada, where vaccinations remain optional but are held in comparable esteem by the medical establishment, the QuČbec College of Physicians revoked the medical license of Dr. Guylaine LanctŮt, a physician who strongly opposed routine vaccination,, simply for espousing ideas that they found “derogatory to the honor and dignity of the medical profession,” and for disseminating information to the public that they proclaimed to be “inaccurate, deceptive, inappropriate, and contrary to accepted medical science.” ¹³⁰

Vaccination has also lurked behind the scenes in the criminal prosecution of some parents for “shaken-baby syndrome,” a form of encephalopathy secondary to traumatic brain injury. In an infamous case from Florida, the father served 8 years of a life term for murder in the state penitentiary, and recently won his release only when the Medical Examiner’s testimony that convicted him proved to have been falsified in several key respects,¹³¹ while my own review of the baby’s medical records, corroborated by several other physicians, found them consistent with the possibility of an encephalopathic reaction to the DPT vaccine, which he had received only a few days before.

But my favorite illustration of the sacramental power of the vaccination concept lies in the voluntary and largely instinctive self-censorship practiced in its favor by the news media, which almost never make statements or issue opinions of their own that vaccines actually hurt anybody, apart from those attributed to interested parties such as parents or medical experts. The only exception to that rule that I know of was this article from the Boston Globe that let the cat out of the bag just this once:

INOCULATIONS PUT ASPIN IN D. C. HOSPITAL.

 Defense Secretary Les Aspin was in “clearly improved” condition but remained in the Intensive Care Unit of Georgetown University Hospital yesterday after suffering breathing difficulties triggered by routine inoculations. “He’s definitely on the road to recovery,” the spokesman said, but would remain in the ICU to be monitored, because he has a history of heart problems, and fluid collected in his lungs. He entered the hospital because of shortness of breath aggravated by a “mild, pre- existing heart condition,” the Pentagon said. He became ill the day before, after receiving a number of immunization shots in preparation for overseas travel.¹³²
Although Aspin’s hospitalization remained newsworthy for several days, there was no further mention of his vaccinations, and readers who had missed the original story were given the impression that he merely suffered a flare-up of his pre-existing heart condition, which was true enough, thus superbly illustrating the theme of invisibility that furnished the basic subtext and starting point of this inquiry.

To dispel the aura of sanctity that hallows the vaccination concept and protects it from closer scrutiny, it is enough to show that vaccines are no panacea for the health care system, to see them for what they are, instruments of medical science with power to do harm as well as good, like any other drug or procedure, and to hold them to the same standards of safety and efficacy, by obliging them to run the same gauntlet of lively criticism and open debate.

Who Decides?
I have always wondered who decides that a particular disease represents such a grave or urgent threat to the public health that everyone has to be vaccinated against it, whether they want to be or not. Yet simply asking the question is enough to remind us of what on some level we already know, that these important deliberations invariably take place behind closed doors without any public input or oversight. The fantasy scenario that immediately springs to mind cannot be far from the truth: a government conference room where officials of the CDC, the FDA, and the American Academy of Pediatrics meet the vaccine manufacturers themselves, to decide which vaccine to recommend or mandate next, and to devise a suitable marketing strategy for promoting it. Whatever the out-come, this “good ol’ boy network” rarely seems to meet a vaccine that it doesn’t like.

I can easily imagine a real emergency where swift actions need to be taken for the public good that people of conscience might disagree with. But that is not the issue here. Whether because or in spite of the vaccinations that have been mandated in the past, or perhaps for other totally unrelated reasons, no vaccine-preventable disease now poses any urgent threat to the health of the nation, and most of the vaccines now in use are marketed largely from motives of policy, as we saw, whether to save lost wages, to gain access to a group that would otherwise be elusive, to eradicate a disease that has been a problem in the past, or simply to make a lot of money for the manufacturer.

Like many other physicians, I believe it is neither wise nor legitimate to privatize our health system to the extent of surrendering decisions in the public domain that clearly affect the health and welfare of everyone to private corporations that are devoted mainly to turning a profit. In conformity with the laws of all other civilized countries, I consider health to be a basic human right of everyone, not merely a privilege of the few who can afford to pay whatever the providers feel entitled to charge for it, as our own President and Congress still adamantly insist. The issue of vaccination is too important to be decided in backroom deals behind closed doors, and must be opened to public discussion and debate at every level and at every stage.

I do not believe and have never maintained that all vaccines are wholly bad or evil and to be avoided under all circumstances. In all my writings, I have simply tried to show that there is a major downside to their use that needs to be acknowledged frankly, studied carefully, and factored into all future deliberations about them. To that end I advocate a basic pro-choice position, that under most circumstances, and in the absence of any public health emergency, it should be left to the free and informed decision of the parents about which vaccines, if any, are given to their children.

Toward a More Comprehensive Model of Biomedical Research

Devising adequate vaccine policies will also require more comprehensive studies of their adverse effects and actual mechanisms of action than any previously undertaken, and to succeed they will have to be designed in a new and radically different way. In the first place, they will need to look well beyond the narrow focus of our present studies on the reduced incidence of the typical acute disease and the titers of specific antibodies, our only available standards of vaccine “efficacy,” both of which correlate very imperfectly with true immunity, as we have seen.

Secondly, estimating the safety of vaccines and identifying adverse reactions to them must include learning to recognize their non-specific effects, as we have seen. To render these phenomena more visible, three major changes in research methodology will suffice. First, it will be necessary to investigate the full range of adverse effects of each vaccine and vaccine combination, involving every organ and tissue of the body, as well as more global measures of health and functioning, such as neurological development, school performance, sensory-motor integration, mental and emotional maturity, and suffering and disability from other diseases. These investigations must also be carried out for enough time to reveal significant chronic patterns, i. e., for years or decades at least.

Finally, the overall health status of the children receiving vaccines has to be com-pared with that of those who do not receive them, an obvious requirement which assigns special priority to finding the unvaccinated children. Far from being “spoilers,” as they are often regarded, this control group, along with the parents who choose not to vaccinate them, must be sought out and protected as our last, best hope for enabling such studies to be carried out, to whom society as a whole and even the parents who choose to vaccinate ironically owe a major debt of gratitude.

Owing to the profusion of different vaccines and combinations, it is impossible at present to study each individual vaccine one by one. Therefore, I propose the simplest kind of survey to begin with, to compare the overall health picture of those vaccinated according to the official schedule with those minimally vaccinated at age three with tetanus and polio alone, and with those not vaccinated at all. If what I have said proves to be true, as I fear it will, then the lightly vaccinated and unvaccinated children should turn out to be substantially healthier, freer from chronic disease, more alert mentally, and more stable emotionally than the fully vaccinated ones, and to outperform them in school, with fewer absences, higher test scores, and the like. That is my prediction and my deepest concern. If any can prove me wrong, let them come forward, and I will thank them from the bottom of my heart.

Vaccine Laws and Exemptions.
Achieving even these modest reforms also involves rethinking our present vaccine laws and the allowable exemptions from them. Under our federal Constitution, which leaves to the states all residual powers not explicitly assigned to the central government, vaccination and the practice of medicine generally fall within the authority of each state, with some important local and regional differences. Regarding mandatory vaccination, all states recognize a medical exemption, based on recommendations from Board-certified pediatricians or other licensed physicians, but these are only valid for one vaccine at a time, and for one of its approved effects, and has to be renewed regularly or even yearly. Because of these limitations, medical exemptions rarely do justice to the feelings of my patients, and even when they do, are by no means uniformly successful, as we saw.

Almost half the states also recognize a so-called “religious” or “philosophical” exemption, based on membership in some Church or denomination which is on record as being opposed to vaccination, such as Christian Scientist or Jehovah’s Witnesses, or in the most liberal interpretation, simply a deeply-held“philosophical” conviction that opposes the practice. In Massachusetts, where I practice, the law as written includes the narrower word “religious,” but the courts have interpreted it very liberally to extend into the purely personal realm of the individual conscience.
Much closer to the actual beliefs, attitudes, and special circumstances I typically encounter in my practice, the religious exemption has generally been honored whenever my patients have claimed it, but serious difficulties remain that it does not address. Even in this most liberal interpretation, the religious or philosophical exemption is an absolute, across-the-board rejection of the concept of vaccination per se, designed to accommodate a dogmatic belief system in the “abolitionist” or “conscientious objector” mold. In other words, the law protects the right of any citizen to dissent from established beliefs by being equally rigid and inflexible on the other side. It doesn’t allow parents to make intelligent medical decisions for their children, such as choosing some vaccines but not others. While this “pro-choice” position is respected by open-minded physicians, nurses, and school boards in some areas, such wording has yet to be written into the laws of any state, and draft laws proposing such changes have so far been rejected by every state legislature which has considered them, although by smaller and smaller margins each year.

As the biotech industry continues to crank out new vaccines at without limit or restraint, and new and ever-broader applications are being found for the old ones, the widespread belief that the total number of vaccinations does indeed matter provides the best guarantee that the optional or pro-choice position will eventually prevail. As their ultimate strategy for circumventing even this modest ceiling on their profits, the vaccine manufacturers are busy at work developing a single vaccine containing a dozen or more individual components and administered in a single dose, whether injected, ingested, or perhaps even inhaled, to be repeated at rare intervals, and thus presumably arousing less public outcry.

Cost-Benefit Analysis and the “Bottom Line
With that in mind, I want to consider the ultimate claim of the advocates of compulsory vaccination, which its critics have so far ignored, its alleged effect on reducing the bottom-line costs of health care. As we saw, this viewpoint attained its peak of influence during the Clinton era. Borrowing the newly popular “cost-benefit analysis” from the economists who used it to analyze the Federal budget into a list of allegedly discrete “line items,” vaccination advocates 1) estimated the number of additional cases of any acute disease to be expected in an unvaccinated population; 2) multiplied it by the cost of caring for each case, including doctor and hospital fees and time lost from work, to obtain the total cost saved by the health care system; and then 3) divided it by the cost of vaccinating, i.e., the unit cost per vaccination times the number of doses given, to compute the “benefit-cost ratio.”

In 1992, before President Clinton took office, Dr. Georges Peter of Brown made the economic case for mandatory vaccination, based on its high benefit-cost ratio:
One of the most important medical developments in the 20^th century has been the control of once-common childhood infectious diseases by the administration of highly effective vaccines. With the exception of safe water, no other modality, not even antibiotics, has had such a major effect on mortality reduction and population growth. Of particular importance in the current era of escalating health care costs is the fact that effective childhood vaccines are highly economical and thus represent an efficient use of society’s resources. A highly favorable benefit- cost ratio -- the ratio of the reduction in the cost of disease to the cost of the vaccination program -- has been substantiated by many studies in the United States. For example, the MMR program led to savings of nearly $1.4 billion in disease costs in 1983, with a benefit-cost ratio of 14.4:1. By a similar analysis, for each dollar spent on pertussis vaccine, $2.10 is saved in health care costs.¹³³

While these soon became the favored calculations for arguing on behalf of child-hood vaccinations and for silencing effective opposition to them, they uniformly ignore the rampant but still largely unseen epidemic of nonspecific effects that I have described, including ear infections, asthma, eczema, allergies, ADD, autism, auto-immune diseases, and the whole spectrum of common diseases of childhood, each of which contributes its own enormous chunk to those same exorbitant costs that vaccinations are supposed to be keeping down. To give one familiar example, this study of childhood ear infections was published in 1982, fully ten years earlier:
Otitis media is the most frequent diagnosis made by physicians who care for children. It has been estimated that approximately $2 billion is spent annually on medical and surgical treatment of this disease in the United States. This figure includes expenses for the estimated 1 million children who receive tympanostomy tubes and over 600,000 who yearly undergo tonsillectomies and adenoidectomies, which are mainly for the prevention of such infections.¹³⁴

These figures would of course have been much higher had they been calculated at the time of Professor Peter’s study, not to mention comparable figures for asthma, autism, allergies, and the other ailments we have been discussing, all of which have attained truly epidemic proportions in the twelve years since 1992. I have never claimed that vaccines are solely responsible for creating these diseases, and cannot estimate with any degree of accuracy the percentage of their total medical and social costs that are attributable to the adverse reactions I have described. But merely to recognize that such reactions occur with the kind of frequency that I see in my practice, coupled with the fact that vaccines are required of every child, is sufficient to establish that this hidden factor is enormous in size, and that the benefit-cost ratio will look shockingly different once we factor it in.

I therefore propose the appointment of a bipartisan government Commission to investigate the medical and social costs of the leading childhood diseases, with the help of a panel of medical economists whom they would select, and with the understanding that its deliberations be conducted in a public forum and its final report include a wide range of testimony from the medical and public health community and all sectors of the general public. In particular, the Commission should be directed 1) to calculate the total medical and social costs of the common problems that all pediatricians commonly deal with, such as asthma, autism, allergies, eczema, ear infections, pneumonia, sinusitis, ADD, learning disabilities, behavior problems, and the like; 2) to try to measure the fraction of them that should be ascribed to vaccine-related causes; and 3) to multiply the first by the second to obtain the real cost of giving children all recommended vaccines on the approved list.

If we estimate the vaccine contribution at 20% of the total cost of each of these diseases, which I fear is much smaller than the true figure, it is evident that these hidden factors exceed by several orders of magnitude any conceivable savings that even the most rabid vaccine advocates have ever claimed for them. Far from being a bargain, I would argue that vaccines are in fact exorbitantly expensive on every level, and must bear an important share of responsibility for the skyrocketing costs of the present health care crisis as a whole, over which representatives of the government, the insurance industry, and the medical profession merely shake their heads in confusion and disbelief. In short, they provide a splendid example of what CFOs refer to as a “hidden cost center.”

Finally, even if vaccination programs could be proven effective in achieving their stated goals, the goals themselves may be of dubious value. As Rene Dubos once aptly warned, in words sounding even more prophetic today:
“The faith in the magical power of drugs often blunts the critical senses, and comes close at times to a mass hysteria involving scientists and laymen alike. Men want miracles as much today as in the past. If they do not join one of the newer cults, they satisfy this need by worshipping at the altar of modern science. This faith in the magical power of drugs is not new. It helped give medicine the authority of a priesthood, and to recreate the glamour of ancient mysteries”.¹³⁵

The idea of eradicating measles, polio, and the rest has come to seem attractive to us because the power of medical science makes it seem technically possible: we worship each victory of biotechnology over Nature as a bullfight celebrates the triumph of human intelligence over brute beast. Yet it is absurd to suppose that, even if we managed to eliminate measles, polio, and all other acute diseases of mankind, we would be any the healthier for it, or that other even more serious ailments would not quickly rise up to fill their place. From a medical no less than an economic viewpoint, trading off the epidemic diseases of the past for the ubiquitous chronic diseases of today hardly seems like a good bargain, at least in the industrialized world, where major infectious diseases were already in rapid decline owing to basic improvements in hygiene, sanitation, air and water quality, and so forth.

In that sense, the quasi-religious fervor of the vaccine establishment offers an appropriate metaphor for the privatization and commercialism of the American medical enterprise as a whole, with its uncritical and idolatrous worship of biomedical science and technology, its identification, expropriation, and commodification of every available life function for the sacrosanct twin purposes of mastery and profit. The deeply irreligious and infinitely hazardous myth that technical solutions can be found for illness and all other authentic human problems seems seductively attractive because it bypasses the problem of healing, which is a genuine miracle in the sense that it requires art and caring and individualized attention and therefore can always fail to occur.

 
 NOTES

1. Unpublished letter.
2. Horton, R., “Vaccine Myths,” in Health Wars, New York Review Books, 2003, pp. 207-208.
3. Ibid., p. 206.
4. Morbidity and Mortality Weekly Report in Journal of the AMA 260:198, April 8, 1988.
5. Unpublished letter.
6. Unpublished letter.
7. Coulter, H., and Fisher, B., DPT: a Shot in the Dark, Harcourt Brace Jovanovich, 1985.
8. Mortimer, E., et al., “The Risk of Seizures and Encephalopathy after Immunization with the DTP Vaccine,” JAMA 263:1641, March 23, 1990.
9. Cherry, J., “Pertussis Vaccine Encephalopathy: It’s Time to Recognize It as the Myth That It Is,” JAMA 263:1679, March 23, 1990.
10. “Update: Vaccine Side Effects, Adverse Reactions, Contraindications, and Precautions,” Advisory Committee on Immunization Practices, MMWR 45:22, September 1996.
11. Unpublished letter.
12. Unpublished letter.
13. Scheibner, V., Vaccination: a Medical Assault on the Immune System, New Atlantean Press, 1993, pp. xiii-xv, passim.
14. Ibid.
15. Bernier, R., et al., “DTP Vaccination and Sudden Infant Deaths in Tennessee,” Journal of Pediatrics 101:419, 1982.
16. Torch, W., “DPT Immunization: a Potential Cause of SIDS,” Neurology 32:169, 1982.
17. Ibid.
18. Noble, G., et al., “Acellular and Whole-Cell Pertussis Vaccines in Japan,” JAMA 257:1351, 1987.
19. Cherry, et al., Report of Task Force on Pertussis ands Pertussis Immunization, Pediatrics 81:939, Supplement, 1988.
20. Noble, op. cit.
21. Wakefield, A., et al., “Measles Vaccine: a Risk Factor for Inflammatory Bowel Disease?” Lancet 345:1071, 1995.
22. Wakefield, et al., “Ileal-Lymphoid Nodular Hyperplasia, Nonspecific Colitis, and Pervasive Developmental Disorder in Children,” Lancet 351:637, 1998.
23. Ibid.
24. Wakefield, “MMR, Enterocolitis, and Autism,” Lecture, NVIC International Conference on Vaccination, November 2002.
25. Ibid.
26. Ibid.
27. Megson, M., “Genetics, Vaccine Injury, and Getting Well,” and Cave, S., “Vaccine Injury Therapy,” NVIC Conference Presentations, November 2002.
28. Family Practice News, May 15, 2000, p. 49.
29. Ibid.
30. Ibid.
31. ACIP Update, 1996, op. cit., pp. 7-8 passim.
32. Unpublished case.
33. L. K. vs. Secretary of HHS, No. 99-624V.
34. T. O. vs. Secretary of HHS, No. 99-635V.
35. Mathieu, E., et al., “Cryoglobulinemia after Hep B Vaccination,” Letter, New England Journal of Medicine 335:356, August 1, 1996.
36. “Hepatitis B Vaccine,” The Vaccine Reaction, NVIC Special Report, September 1998, p. 7.
37. Ibid.
38. Ibid.
39. Ibid.
40. Ibid.
41. Ibid.
42. Ibid., p. 9.
43. Moskowitz, R., “The Case Against Immunizations,” Journal of the American Institute of Homeopathy (JAIH) 76:7, March 1983, p. 13.
44. Unpublished case.
45. Moskowitz, Resonance: the Homeopathic Point of View, Xlibris, 2001, pp. 177-178.
46. Moskowitz, “Childhood Ear Infections,” JAIH 87:137, 1994.
47. Moskowitz, Resonance, op. cit., pp. 209-210.
48. Ibid., pp. 215-216.
49. Unpublished case.
50. Davis, B., et al., Microbiology, 2^nd Ed., Harper, 1973, p. 1346.
51. Ibid.
52. Ibid., p. 1418.
53. Neustaedter, R., The Vaccine Guide, Revised Ed., North Atlantic, 2002, pp. 69-74.
54. Ibid., pp. 70-71.
55. Ibid., pp. 71-72.
56. Ibid., pp. 76-77.
57. Ibid.
58. Ibid., pp. 74-76.
59. Cherry, “The New Epidemiology of Measles and Rubella,” Hospital Practice, July 1980, p. 49.
60. Gustafson, T., et al., “Measles Outbreak in a Fully-Immunized Secondary School Population,” NEJM 316:771, March 26, 1987.
61. Chen, R., et al., American Journal of Epidemiology 129:173, 1989.
62. Cherry, “Measles,” op. cit., p. 52.
63. National Vaccine Advisory Committee, “The Measles Epidemic,” JAMA 266:1547, September 18, 1991.
64. Edmondson, M. et al., “Mild Measles and Secondary Vaccine Failure During a Sustained Outbreak in a Highly Vaccinated Population,” JAMA 263:2467, May 9, 1990.
65. Ibid.
66. Ibid.
67. Ibid.
68. Moskowitz, “Immunizations,” op. cit.
69. Moskowitz,“Vaccination: a Sacrament of Modern Medicine,” The Homeopath (UK) 12;137,1992.
70. Adams, W., “Decline of Childhood HĘmophilus InfluenzĘ B Disease in the HiB Vaccine Era,” JAMA 269:221, January 13, 1993.
71. Family Practice News, October 1, 1997, p. 9.
72. “Adverse Events Associated with HiB Vaccine,” WHO Printout, www.who.int/vaccines_diseases/safety/infobank/hib
73. Ibid.
74. Daum, R., et al., “Decline in Serum Antibody to H. InfluenzĘ B Capsule in the immediate Post-Immunization Period,” Journal of Pediatrics 114:742, 1989.
75. Boston Globe, June 11, 1991, p. 9.
76. FP News, August 1, 1992, p. 23.
77. Pevsner, J., Letter, American Family Physician, January 1994, p. 47.
78. Tucker, A., et al., “Cost-Effectiveness Analysis of a Rotavirus Immunization Program for the United States,” JAMA 279:1371, May 6, 1998.
79. Ibid.
80. Keusch, G., and Cash, R., “A Vaccine Against Rotavirus: When Is Too Much Too Much?” Editorial, NEJM 337:1228, October 23, 1997.
81. Murphy, T., et al., “Intussusception Among Infants Given an Oral Rotavirus Vaccine,” NEJM 344:564, February 22, 2001.
82. Ibid.
83. AMA Encyclopedia of Medicine, 1989, quoted in “Chickenpox: the Disease and the Vaccine,” Massachusetts Citizens for Vaccination Choice handout, E. Arlington, MA.
84. American Academy of Pediatrics brochure, 1996, quoted in MCVC, op. cit.
85. “The Vaccine for Chickenpox,” American Family Physician 53:652, February 1, 1996, Patient Information handout.
86. Spingarn, R., and Benjamin, J., Letter, NEJM 338:683, March 5, 1998.
87. Shapiro, E., and LaRussa, P., “Vaccination for Varicella: Just Do It!” Editorial, JAMA 228:1529, November 12, 1997.
88. Simberkoff, M., et al., “Efficacy of Pneumococcal Vaccine in High-Risk Patients,” NEJM 315:1318, November 20, 1986.
89. Eskola, J., “Efficacy of a Pneumococcal Conjugate Vaccine Against Acute Otitis Media,” NEJM 344:403, February 8, 2001.
90. FP News, April 15, 2000, p. 1. .
91. Cantekin, E., Letter, NEJM 344:1719, May 31, 2001.
92, Damoiseaux, R., Letter, Ibid.
93. Medical World News, April 14, 1986.
94. Hurwitz, E., et al., “Guillain-BarrČ Syndrome and the 1978-1979 Influenza Vaccine,” NEJM 304:1557, June 25, 1981.
95. FP News, June 1, 1999, p. 1.
96. Ibid.
97. Ibid.
98. FP News, August 15, 2002, p. 30.
99. Nichol, K., et al., “The Effectiveness of Vaccination Against Influenza in Healthy Working Adults,” NEJM 333:889, October 5, 1995.
100. Family Practice News, August 15, 2002, p. 30.
101. Boston Globe, August 25, 1992, p. 57.
102. Heemstra, T., Anthrax: a Deadly Shot in the Dark, Crystal Communications, 2002, p. 46.
103. Boston Globe, August 3, 1999, p. 1.
104. New York Times, March 11, 1999, via Internet.
105. Heemstra, op. cit., pp. 31-35.
106. Ibid., p. 64.
107. Bates, S., “Anthrax Vaccination in the Military: One Pilot’s Story,” NVIC Conference Presentation, November 2002.
108. Matsumoto, G., “The Pentagon’s Toxic Secret,” Vanity Fair, May 1999, pp. 82-98.
109. Heemstra, op. cit., p. 107.
110. Ibid.
111. FP News, July 15, 2002, p. 10.
112. FP News, loc. cit., May 1, 2004, p. 41.
113. Quoted in Moskowitz, ed., “Smallpox,” AIH Bioterrorism Report, JAIH 96:121, Summer 2003.
114. Ibid.
115. Eickhoff, T., “Adult Immunizations: How Are We Doing?” Hospital Practice, November 15, 1996, p. 107.
116. Averhoff, F., et al., “Immunization of Adolescents,” American Family Physician 55:159, January 1, 1997.
117. Sur, D., et al., “Vaccinations in Pregnancy,” American Family Physician 68:299, July 15, 2003.
118. FP News, April 1, 1997, p. 2.
119. FP News, loc. cit., September 1, 2001, p. 2.
120. Schlenker, T., et al., “Measles Herd Immunity,” JAMA 267:823, 1992.
121. ACIP Childhood and Adolescent Immunization Schedule, FP News, January 1, 2004, p. 9.
122. Ibid.
123. Koff, R., “The Case for Routine Childhood Vaccination Against Hepatitis A,” Editorial, NEJM 340:644, February 25, 1999.
124. Offit, P., et al., in Pediatrics 109, January 2002, abstract by Sherry Tenpenny, D. O.,,“Expert Believes Infants Can Tolerate 10,000 Vaccines,” March 27, 2002, www.mercola.com.
125. Moskowitz, “Vaccination: a Sacrament,” op. cit.
126. Moskowitz, “Unvaccinated Children,” Mothering, Winter 1987, p. 34.
127. MMWR, reported in JAMA 283:2381, May 10, 2000.
128. www.publichealthlaw.net, quoted in “News Release,” No. 71_DITA, November 26, 2001,
129. Private communications with the author.
130. “The Vaccine Reaction,” op. cit., January 1996, pp. 3-5.
131. Orlando Sentinel, August 28, 2004, p..1.
132. Boston Globe, February 23, 1993, p. 1.
133. Peter, G., “Childhood Immunizations,” NEJM 327:1794, December 19, 1992.
134. Bluestone, C., “Otitis Media in Children: to Treat or Not to Treat?” NEJM 306:1399, June 10, 1982.
135. Dubos, R., Mirage of Health, Harper, 1959, p. 157.