[Editor's note: An earlier version of this story mischaracterized the status of Dr. Wakefield's review by British medical authorities. The GMC will meet again in April to continue its investigation of his practices.]
Last week, the British medical journal that printed the first study linking vaccinations to autism retracted the article and renounced its conclusions. Amid the ensuing media firestorm, Andrew Wakefield, the physician who led the study, has been widely criticized and is facing possible sanctions from British medical licensing authorities.
But Wakefield will soon return to Texas, where he oversees a treatment facility for children on the autism spectrum. The Austin-based facility, called Thoughtful House, still states on its website that “research into a possible connection” between autism and the Measles-Mumps-Ruebella vaccine is “ongoing.” And the vocal minority fighting mandated vaccines for fear of their health implications continues its cries against the immunization culture in America — despite the opinions of medical professionals.
Immunization advocates hope this will be their year: They'll try once again to expand the state’s vaccination database, and the HPV vaccine, which caused a political mess for Gov. Rick Perry in 2006, will soon come back up for debate. Just as hopeful, however, are the predominantly well-educated, middle-class parents who are pushing for a further examination of the long-term effects of vaccines. Scorned by most doctors, they are organized and driven, and their significant political clout may force lawmakers to takes sides in the tussle between personal freedom and public health.
Are vaccines safe?
The outspoken moms and dads at the forefront of the “vaccine-choice” movement are hardly alone in their concerns. A 2000 study in Pediatrics found 25 percent of parents believed too many immunizations could weaken their child’s immune system, while 23 percent worried kids get more immunizations than is healthy.
Texas has a very flexible vaccination policy for school children: Parents can get an exemption simply out of personal preference. Supporters of the rule can thank Dawn Richardson, a “vaccine choice” advocate who has been outspoken in questioning the state’s mandates. As the head of PROVE — Parents Requesting Open Vaccine Education — she lobbied hard to allow her child to attend public school without getting the required shots.
Such activism doesn’t sit well with State Rep. Garnet Coleman, D-Houston. “If you don’t think your child should have a vaccination then they don’t have to have it?” he says incredulously. “You don’t have to have a reason? I really don’t like it.”
Most doctors say parents who make this choice are misinformed or paranoid. “These are the arguments of nut cakes,” says Dr. John Gullett, a retired infectious disease expert from Abilene. Gullett believes the benefits of vaccination far outweigh any potential risk, and that what few risks exist are minimal. The vaccine-choice movement, he says, has no basis in science. “If they believe something, then it must be right,” Gullet says. “And it’s not right.”
Richardson explains that she's isn’t necessarily saying that vaccines don’t work, but she thinks they may cause chronic diseases like autism or autoimmune deficiencies. And she says no one has tested vaccinations to see if they cause cancer or infertility. “Considering the fact that we’re giving these to every single child born in America, don’t you think in the last 50 or 60 years we couldn’t have found a few mice and done some animal studies?” Richardson asks.
At Thoughtful House, the autism treatment facility that Wakefield runs, staff maintain that the charges against him and his scientific methodology are false. “[A] careful examination of the full record will show that the charges made against Dr. Wakefield are unfounded and unfair,” Thoughtful House wrote in an email to the Tribune. “We invite anyone to review the record and to draw their own conclusions.”
But Britain's General Medical Council, in a 143-page report on Wakefield's practices, decided to come back in April to decide whether his shortcomings deserved sanctioning. "The Panel concluded that these findings, which include those of your irresponsible conduct and not acting in the child’s best clinical interests in several instances, would not be insufficient to support a finding of serious professional misconduct," they wrote in their report. "In the next session, commencing 7 April 2010, the Panel, under Rule 28, will hear evidence and submissions from prosecution counsel then Professor Walker-Smith’s own counsel as to whether the facts as found proved do amount to serious professional misconduct, and if so, what sanction, if any, should be imposed on his registration."
Regardless, Richardson says, it isn't just Wakefield's paper that shows the potential dangers of vaccination. She points to the federal Vaccine Adverse Event Reporting System (VAERS), where the public can go to report a reaction or response to a vaccine. According to Richardson, the system doesn’t perform well — parents don’t always know they can make a report, and doctors do a poor job informing them of potential vaccine side effects. She notes that many instances of children experiencing such side effects don’t get reported, so they don’t get the support they need. “A child who is hurt by a vaccine is jut as loved and just as valued” as a child suffering from infectious disease, she says.
Gullett acknowledges that the reporting system is troubled. The system is dependent on doctors noticing a problem or educating parents about what to look for. “There are significant barriers to reporting: inertia, indifference, overwork, uncertainty,” he says.
He knows this firsthand. Earlier this year, he received a vaccination that was quite painful, even though it wasn’t supposed to be. When he called the U.S. Department of Health and Human Services, he says, the agency refused to file a claim. Even though the response to the shot wasn’t normal, “they didn’t want to do anything about it,” he says. “They didn’t file a VAERS report.”
But problems with the system don’t mean the vaccines are dangerous. “There are things that could go wrong, but they’re almost invariably minor,” says Gullett. “People notice the sore arm. They don’t notice that they didn’t die.”
What’s the government’s role?
Coleman has no qualms about mandating vaccines over the complaints of parents like Richardson. “The public health is about the police power of keeping everyone safe,” he says. Parents are making decisions that affect an entire community, he maintains. Since everyone has a different immune system, vaccines can be more effective or less effective depending on the individual. Even the best vaccines only work on about 98 percent of the population, Gullett says. If the rest of the community is vaccinated, diseases have a difficult time entering the population, and those who can’t become immune are still protected —a concept known as herd immunity. “Because we know that herd immunity is fragile, public health has always been about the protection of the overall health,” says Coleman.
Richardson attempts to refute the existence of herd immunity in Texas by pointing to previously low vaccine rates: Currently about 22 percent of children are missing at least one dose of one recommended vaccine. She says there’s never been a study that compared the health outcomes of unvaccinated children to those of vaccinated children. Well, not never. A 2002 article in The Atlantic described a massive outbreak of whooping cough, a vaccine-preventable disease, in Boulder, Colorado, because fewer and fewer parents there were willing to get their children immunized.
Richardson’s proposals don't sway Coleman. “It would be like saying, ‘We don’t have fires any more in houses because we adopted all these codes — why don’t we just get rid of the fire department?” he says. But Richardson argues that some people are at higher risk for adverse reactions than others. “Is it fair for you to have to shoulder more risk for the theoretical benefit of someone else?” she asks.
In some cases, lawmakers have said yes. Last session, for example, the Legislature passed a bill requiring all residential college students to receive an inoculation against meningitis. The act came about after University of Texas student Jamie Schanbaum got meningitis, losing both legs below the knee and most of her fingers as a result of the infection. “Most people recognize that if you’re going to have your child in a setting like public school, there is that requirement,” says State Rep. John Zerwas, R-Simonton, who is an anesthesiologist. “If you’ve ever seen the consequences of [meningitis], it’s horrendous.”
Zerwas, like Coleman, supports vaccines wholeheartedly as a doctor, but he’s hesitant to make too many demands of parents. He says it’s a question of personal freedom. Should a parent be allowed not to give their child vaccinations even if it endangers others? He pauses before answering. “Does the parent have the sole right to do that as the guardian of that child?” he asks. “I think they do.“