- The Washington Times - Tuesday, November 14, 2000

On several occasions in recent years, Department of Health and Human Services Secretary Donna Shalala and others have asked parents to have their children vaccinated against hepatitis B, chickenpox and other diseases.

Some physicians are concerned that parents are not getting the complete story about the pros and cons of these vaccines. In fact, parents may be putting their children at great risk if they follow government vaccine mandates without taking into consideration the individual medical needs of their children.

According to the government's own statistics, children under the age of 14 are three times more likely to suffer adverse effects including death following the hepatitis B vaccine than to catch the disease itself. Children are in an extremely low-risk group for this disease, which is usually transmitted between multiple sex partners,drug abusers or adults who work in health care professions.

Question: Why give the Hepatitis B vaccine to newborn infants when such children are not at significant risk?

Answer: Public health officials took a "get 'em when we have them under our control" attitude rather than recommending the vaccine for those at significant risk. In contrast, vaccination for yellow fever and prophylaxis for malaria are recommended when people are at risk for these diseases, for example when people plan to travel where these diseases occur and are active. Pre-treatment is not recommended when the risk is much less. The same principle should apply to hepatitis B and other immunizations, with patient and doctor balancing the severity and likelihood of the risk against the severity and likelihood of complications.

A number of public health officials have admitted that vaccines for illnesses such as chicken pox were recommended because government officials calculated that the cost and inconvenience of parents' lost time from work taking care of children with chicken pox was greater than the costs of chicken pox vaccination. What about the families who already have a designated parent at home to care for children when they're ill? Why mandate vaccination for all children if the costs including human costs such as time and energy for some families would be less than the costs of vaccination? Instead of government officials, shouldn't parents decide if chicken pox vaccination is worth it or not to them and their children?

Some of the impetus for mandated vaccination reflects a concern for fairness. If only some children are vaccinated against chickenpox, the argument goes, other children are also at least partially protected because the likelihood of the spread of chicken pox is decreased. This is called "herd immunity," in that all members of the group, e.g., children, are protected to some degree, even if only some of the group are vaccinated. On the other hand, if exposed to the infectious agent the non-vaccinated children are more likely to suffer the infection.

Some people are more comfortable having as many vaccinations as possible because of the unpredictability and severity of the possible disease. Other people are more comfortable having as few vaccinations as possible because of the possible complications.

Vaccines can and do save lives. But we are concerned that vaccine mandates pressure or even force physicians to violate their responsibility to keep the patient's benefit uppermost. If the government mandates a vaccine, some physicians will give the vaccine routinely and consider parents' concerns and questions impertinent; these physicians feel that the government mandate overrules their need to individualize treatment. As a result, vaccine mandates put a significant number of children at unnecessary risk in addition to violating the patient-physician relationship.

Because of these concerns, the Association of American Physicians and Surgeons recently voted unanimously for a moratorium on vaccine mandates.

We believe that parents, with the advice of their doctors, should make decisions about their children's medical care not government agencies. We think the safety of every child and patient's civil rights should be the first considerations.

Dr. Robert J. Cihak of Aberdeen, Wash., is president of the Association of American Physicians and Surgeons. Dr. Michael Arnold Glueck of Newport Beach, Calif., has written extensively on medical, legal, disability and mental health reform issues.

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