Capstone Submission 5

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Should the U.S. government implement and enforce vaccine

compliance in order to protect public health?

Prepared by Jade Yamamoto

Submitted to Professor Beth Eakman

CAPS 4360.12

Summer 2015

ABSTRACT

In recent years, the United States has witnessed a resurgence of communicable diseases—such as

measles and pertussis—that were previously believed to be eliminated in first world countries. The

rising case numbers related to these diseases correlate with a reverse in vaccine compliance seen in

the American population. In result, some believe that vaccines should be mandated and compliance

should be enforced. However, the other side of the debate raises concerns of vaccine safety and

government interference. This project examines the question of what should be done concerning

vaccines and concludes that, while the government has an obligation to protect its citizens, forced

vaccine compliance may not be the best or easiest solution.

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TABLE OF CONTENTS

Capstone Final Submission 4 End Notes 17 Works Cited 19 Bibliography 21

Previous Submissions 24

Submission One 26 Submission Two 41 Submission Three 51 Submission Four 56 Submission Five (Revision One) 64

Appendices 74

Appendix One 76 Appendix Two 79

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Should the U.S. government implement and enforce vaccine compliance in order to protect public health?

Capstone Final Submission

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Jenny McCarthy, Alicia Silverstone, and Kristin Cavallari: what do these celebrities all have in

common? Movies, modeling, MTV headlines? Famous husbands and faux pas fashion choices?

Their bleached-blonde hair? A quick Google search will confirm these similarities, but in recent

years these three woman have added another component to their alphabetic résumé: anti-vaccine

activists.

No doubt you’ve seen them plastered across tabloids and 15 second sound bites on the

news: angry crowds standing in front of clinics, crowing from their soapbox about mercury

poisoning and toxicity and all natural alternatives. Towards the front will be the poster celebrity, the

McCarthys or the Silverstones or anyone with enough social currency to garner the most news

coverage. Because of these celebrities and their status—specifically their lack of medical knowledge

and their capacity for dramatics—the image of the anti-vaccine movement has been shaped into a

monolith of irrationality and false science.

Michelle Schneider, however, is not Jenny McCarthy.

Currently, Schneider is the Legislative Outreach Coordinator for Texans for Vaccine Choice.

A relatively new organization, Texans for Vaccine Choice works to promote the preservation of

personal liberties and informed consent. As such, they oppose “any measures to limit vaccine choice

rights, persecute those who exempt themselves or their children from immunizations, track

immunization history without consent, or coerce citizens into medical procedures to which they

object.”i Unlike the media’s illustration of “anti-vax” mothers, Ms. Schneider was very calm and

articulate when discussing the finer points of her organization.

“We came about in February of 2015,” she said during a phone interview. Her voice was

steady and pleasant, neither aggressive nor sermonic. “A North Texas member of the House of

Representatives announced to the media on a Friday afternoon that he intended to file a bill to

eliminate what are called ‘reason of conscience exemptions’ from childhood vaccination

requirements for public schools. So a bunch of active parents came together on Facebook and

decided that we needed to do something about this to prevent it from happening. Within about six

weeks, we grew to about 1300 members from all across the state.”ii

Before Texans for Vaccine Choice, Schneider was formerly the Social Media Director at

Autism Media Channel and the co-author of Evolution Of A Revolution: From Hope to Healing: How

Thinking Parents are Recovering Their Children and Uncovering the Truth.iii She has also written numerous

articles about autism and government policy/social conceptions regarding inoculation.iv While the

tone of some of these articles may come off as aggressive, and Schneider does refer several times to

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case studies and peer-reviewed publications but never specifically cites them, it is difficult to liken

her to Jenny McCarthy.

In a phone interview, Schneider revealed that, first and foremost—before being an activist

or a political entity—she is a mother of three, and it is because she identifies herself so strongly as a

mother that she is so passionate about her work. “I have a fully vaccinated seven-year-old daughter,

a partially vaccinated four-year-old daughter, and a completely unvaccinated two-year-old son,” she

told me over the phone on a bright Tuesday afternoon. While her children laughed and played in the

background of our conversation, Schneider revealed her experience with inoculation and the

reasoning behind her own personal, alternative schedule.

“The reason they [her children] all have different experiences is that I had vaccinated my

seven-year-old up until four years [old] completely and that was the last time she was due for shots

so, for her age, she is completely vaccinated. At twelve months, my daughter Reece [her four-year-

old] was due for one shot to catch her up on a series, the HIB series, and that was on a Friday

afternoon. By Sunday, which is when we had her first birthday party, we noticed a huge difference in

her demeanor.”

Schneider paused, and took a deep breath. When she began again, her voice was subdued,

sincere in its sadness. “There was lack of engagement [from her daughter Reece], lack of eye contact,

lack of affect in general, and from there it sort of snowballed over the subsequent months. Various

health conditions began coming up and then eventually she was diagnosed with encephalopathy.

She’s also got a hearing loss disorder, a genetic disorder that affects her hearing and thyroid, and

there’s multiple other diagnoses: seizures and autism and a number of different health conditions

that she suffers from. Currently, we have an opened petition in the US Federal Court of Claims and

the Vaccine Court.”v

She paused once more, and in the background one of her children shrieked with laughter, to

which she responded with a quiet and polite hushing noise. “So that’s sort of our history,” she

concluded. “And obviously when I became pregnant with our third child it was kind of an easy

decision: this [inoculation] was not benefiting our family, the risk vs. the benefit was not panning out

the way it should for our family, and we just decided to avoid that risk all together, and he is [her

youngest son] completely unvaccinated.”

In this interview, Schneider touches upon a key component of the anti-vaccine movement

that the media often overlooks. The debate over vaccine schedule compliance is usually portrayed as

extremely polarized: it’s either all or nothing. On the “all” side—the side that argues for full

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compliance to the CDC recommended vaccine schedule—are pitted the “professionals” the

“experts”: doctors and scientists, health care providers from A-Z. These individuals are portrayed as

authoritative and knowledgeable—which is understandable, given their qualifying credentials. They

cite medical studies and empirical evidence, quote CDC and FDA findings and conclusions. The

overwhelming message is simple: “Vaccinate your children according to (the CDC recommended)

schedule.” And who is an ordinary citizen to argue with such upstanding and valued institutions?

Inoculation is touted as the only sane and responsible choice for parents to make.

But what the media (surprisingly) does not articulate is that this controversy is more nuanced

and intricate than it appears at first blush. The other side of this debate is not so much the

“nothing” side, staunchly against the very principle of inoculation itself. The other side, Michelle

Schneider’s side, is actually more varied and, most importantly, more reasonable than people

assume. As stated above, Schneider and her family follow an alternative or selective schedule, and

within the organization of Texans for Vaccine Choice, perhaps within the anti-vaccine movement

itself, this is more the norm rather than the strict refusal of all vaccines.

“There are some [members] who vaccinate completely, some vaccinate on an alternative

schedule, some don’t vaccinate at all. Vaccination isn’t the issue,” Schneider stressed. “It’s more the

overarching issue of privacy and liberty. What we focus on is not necessarily the safety and efficacy

of vaccines and we definitely don’t recommend a particular schedule, that’s not really our place, but

what we do is try to, in many different ways, is we try to protect our right to decide what goes into

our bodies and the bodies of our children, and the right to make medical decisions for ourselves and

our children.”vi

The media’s portrayal of anti-vaccine individuals is emblematic of the controversy itself. It’s

not just the “wisdom” of Jenny McCarthy vs. the knowledge of physicians; the issues and their

implications are more gray and undefined than that. Both sides of this debate have valid concerns

and honorable values; in fact, they share many of the same values and concerns. The welfare and

health of a child is paramount; it is genetically encoded in the smallest building blocks of humanity

to protect our progeny. Each side of the vaccine debate holds, what they believe to be, a child’s best

interest at heart: stalwart pro-vaccine individuals advocate for strict compliance to the current CDC

recommended schedule of 26 childhood immunizations. However, anti-vaccine individuals aren’t as

extreme or unreasonable as previously portrayed. A majority of “anti-vax” individuals, like Michelle

Schneider, are actually ordinary parents, with no political or secondary agenda, who only want to

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make a decision that they feel is best suited for their family and circumstance, whether that decision

is to forgo vaccination completely or adopt an alternative schedule.

So now, the debate over vaccine compliance becomes less clear cut. It’s no longer science v.

science fiction, medical professionals against the likes of Jenny McCarthy. It becomes the rights of

an individual v. the rights of community. No case is the same and, unfortunately, no solution can be

completely satisfactory. There has to be some compromise. But, in the face of epidemic hysteria, the

question is how can such a compromise be reached.

• • • • •

In the early months of 2015, news stations across the United States tracked the spread of a

potent measles strain that originated in California’s Disneyland amusement park. From January 1 to

May 29th, 173 people from 21 states reported a confirmed diagnosis.vii In light of America’s large

population, these numbers and cases might seem insignificant or at least unimposing; there is also

the temptation to call this an “isolated event.” But in 2014 the United States reported a record

number of 668 confirmed measles cases from 27 states. This was the greatest number of cases seen

since measles’ eliminationviii from the United States in 2000.ix

Given these collective numbers, it seems viruses and microbes of bygone eras are rallying for

a nostalgic reunion tour. In the wake of 2014’s Ebola scare,x which—given the news coverage—for

a while appeared to be teetering on the edge of a full-scale, global epidemic, American citizens

quickly grew tense and concerned with the growing number of measles cases, especially since the

majority of potential victims tended to be infants and children. It’s an instinctual urge we have to

protect our young; it’s primordial, potent, fierce as a wild lioness defending her cubs. Eula Biss,

author of On Immunity: An Inoculation, references the Grecian hero Achilles, whose mother—

motivated by love and fear—dipped him in the river Styx to try and make him immortal, to try and

make him invincible. Take away the mythology and magic, inoculation falls under the same premise

of dipping our children in the Styx: it is an effort to protect and fortify them.

The crux of the problem here, the crux of the vaccine compliance debate, however, is what

exactly do parents have to protect and fortify their children from. Is it from archaic sounding

illnesses such as pertussis, rubella, and rubeola (measles)? Or is it from the more modern, toxic

sounding thimerosal and ethylmercury?

• • • • •

Although it has received increasing media coverage as a modern malady in recent years, Eula

Biss gives a surprising reminder that inoculation is actually a precursor to modern medicine, not a

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product of it. The first “vaccine,” a term used loosely in this context, was created to combat

smallpox, a lethal disease that killed thousands in earlier centuries. In 1774, however, an English

farmer—after realizing that milkmaids who contracted cowpox (a less dangerous cousin of the

variola virus) were immune to contracting smallpox afterward—took a darning needle and injected

infected cow pus into the arms of both his wife and child.xi While this act might seem to us barbaric

and nauseating, it did save the farmer’s family and paved the way for modern vaccines, subsequently

saving the lives of millions by building the foundations of herd immunity.xii

While nothing as severe as smallpox is currently running rampant in America, the debate

over inoculation still circles the question of whether or not vaccines are more monstrous than the

diseases they prevent. Opponents of vaccine compliance argue that vaccines, at least in some

capacity, are toxic. The ethylmercury containing preservative thimerosal is often cited as the most

prominent culprit, after it’s infamous link to autism was reported in the late 1990s. This link

appeared in the wake of a sharp rise in autism diagnoses. According to pediatrician Jeffery Baker, as

more and more parents were faced with this diagnosis, they were also “met with long waiting lists

and primary care doctors who seemed barely familiar with the condition. Placed in this predicament,

parents turned to one another and the Internet.”xiii

One theory that came into prevalence and attempted to explain the increase in autism

diagnoses was the “leaky gut” theory. This theory proposed that an abnormality in intestinal

permeability could admit intestinal toxins affecting the nervous system at an early age.xiv In 1998, Dr.

Andrew Wakefield and twelve other scientists utilized this theory in their study of the MMR vaccine

and alleged a link between the vaccine and the development of autism in young children.xv

Wakefield’s article, although redacted by The Lancet (the journal it was originally published in) and

debunked by a multitude of subsequent studies, sparked the largest vaccine compliance reversal in

the last half century. What is interesting, however, is that mercury has been used as a preservative in

vaccines since the early 1900s. Before the use of such preservatives, one of the most troublesome

safety issues afflicting early 20th century child immunization was that of bacterial contamination. This

could easily occur on a sporadic basis, when general practitioners might have to draw vaccines from

multidose vials under poor hygienic conditions. The need for effective preservatives was readily

apparent and represented one of the most important safety issues for the promoters of new

vaccines.xvi

However, concerns over mercury and mercury based preservatives arose in the latter half of

the 20th century, when citizens of Minimata, Japan were discovered to have methylmercury

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poisoning from a factory dumping waste into their water supply.xvii A global treaty was called for the

banning of mercury in consumer products, but The World Health Organization recommended that

thimerosal be excluded from the ban in the interest of global health and the American Academy of

Pediatricians supported the recommendation. Nevertheless, in April of 1998 the Center for

Biologics Evaluation and Research (CBER) at the FDA initiated a formal risk assessment of

thimerosal in vaccines; they found that a minority of infants could receive as much as 187.5 mg of

ethylmercury during the first 6 months of life but, lacking any standard for ethylmercury, the CBER

team compared this exposure to standards for methylmercury (its more dangerous and toxic cousin)

and discovered that it exceeded standards set by the Environmental Protection Agency.xviii In result,

and under the onslaught of numerous anecdotes detailing children experiencing adverse reactions to

vaccines—uncontrollable screaming, raging fevers, deterioration in mental function—“thimerosal

was removed from every childhood vaccine except multidose flu vaccines by 2002.” xix

While legally, and perhaps ethically, these health organizations never violated any standards,

many citizens and parents felt that their trust had been violated. Even after the redaction of

Wakefield’s article, too many people had lost faith in health providers and doctors; many felt lied to

and deceived. And there were still the numerous cases of rapid onset autism or other neurological

problems that doctors did not have answers for. Consequently, some parents who felt let down by

their health providers began to rely on their own intuition and their own research. Alternatives to

the “official” inoculation model—which has been accused of causing “immune overload” or

overwhelming a child’s vulnerable and still developing immune system—also began to arise. Dr.

Robert Sears wrote The Vaccine Book, in which he details two alternatives to the current CDC

recommended vaccine schedule: a selective vaccine schedule and a complete alternative vaccine

schedule. Under the selective option, Sears recommends covering only “important” vaccines, leaving

out hep B, polio, measels, mumps, and rubella. Under the complete alternative option, Sears

recommends spreading out all the vaccines a child would receive in a two year span over the course

of eight years, to lessen the number of substances a child is injected with and to lessen the chance of

severe, adverse reactions.xx

• • • • •

Another pivotal component of vaccine schedule compliance, that hinges on the public’s

already waning trust, is how litigation and compensation is handled regarding adverse reactions and

events. What is interesting about vaccine compensation, however, is that plaintiffs do not sue or file

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against the manufactures like Merck, but must file in a separate courtxxi and, if the plaintiff wins their

case, it is the federal government, not the vaccine maker, that pays compensation.xxii

In the 1980s, the Office of Special Masters of the U.S. Court of Federal Claims, often

referred to as “the Vaccine Court,” was set up as a no-fault alternative to the civil courts. According

to an NPR article written by Anders Kelto, “to deal with the possibility of rare but devastating

vaccine injuries, the panel made a conscious decision to favor the families when the compensation

program was created. To execute this goal, the court does not require petitioners to prove beyond a

reasonable doubt that they or their child have been harmed by a vaccine. They must simply

demonstrate, through ‘a preponderance of the evidence,’ that it's more likely than not that the

vaccine caused the injury – a 51 percent chance, roughly speaking.”xxiii

Hand in hand with the Vaccine Court is the National Childhood Vaccine Injury Act of 1986

(NCVIA), which “preempts all design defect claims against vaccine manufacturers in which the

plaintiff seeks compensation for injury or death caused by a vaccine's adverse effects.”xxiv This act is

itself shrouded in controversy. In the mid 1980s, “there was a significant increase in the number of

vaccine-injury suits against vaccine manufacturers, possibly attributable to heightened media

coverage at the time about the risks of vaccinations. […] Manufacturers worried that juries would

award substantial damages to sympathetic plaintiffs regardless of whether the manufacturers were at

fault. Experiencing difficulty obtaining liability insurance, some manufacturers withdrew from the

market. By December 1984, the Centers for Disease Control and Prevention (CDC) predicted the

United States would experience vaccine shortages as early as January 1985.”

In result, Congress drafted the NCVIA in an attempt to have a more accessible and less

adversarial alternative to the traditional tort system. The Vaccine Court was intended to be a safety

measure because, while most experts stalwartly agree that vaccines are safe and should be taken, “at

the same time, vaccines do injure some patients—although serious harm is extraordinarily rare—

and a fundamental principle of the US legal system is that injuries caused by unsafe products should

be compensated.”xxv

However, the Vaccine Court’s intentions and its perception by the general public create an

interesting dichotomy. The Vaccine Court tries to decide (within reason) on the side of the

plaintiff—after all, as Laura Haertlein points out “It is difficult for one hundred and seventy-four

pages of scientific data and dry expert testimony to effectively counter an emotional story about a

child who, shortly after being vaccinated, was diagnosed with a serious illness”xxvi—but these

decisions actually undermine what little trust the public has left in vaccines. Haertlein states that

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“Compensating too many undeserving petitioners undermines the integrity of vaccine safety.

Accordingly, this threatens to create a public health problem: If the standard of proof in the Vaccine

Court is too low, the court implicitly validates public fears about vaccines and impacts public

willingness to get vaccinated. To maintain public trust in vaccines, the standard of proof in the

Vaccine Court must be clearer and more scientifically rigorous.”xxvii

However, there are some major scientific and medical requirements that the Vaccine Court

must see met in each case. Haertlein explains that “The Vaccine Act explicitly forbids the court from

finding actual causation based solely on a petitioner’s statements unsupported by medical records or

expert medical opinion.”xxviii And, in “Althen v. Secretary of Health & Human Services, the Federal

Circuit announced a new, three-prong standard of proof for off-table claims. Under Althen,

petitioners must present ‘(1) a medical theory causally connecting the vaccination and the injury; (2)

a logical sequence of cause and effect showing that the vaccination was the reason for the injury; and

(3) a showing of a proximate temporal relationship between vaccination and injury.’ If a petitioner

satisfies all three prongs, the government must prove, by a preponderance of the evidence, an

alternate cause for the petitioner’s injury.”xxix

So, as Anders Kelto addressed in his article, there is a major ongoing controversy regarding

the Vaccine Court and its duties/obligations. One side—the side of the plaintiffs, families who have

experienced adverse reactions or events—hold that the Vaccine Court’s standards/requirements are

too stringent. On the opposite side, there is the compelling argument that these same standards are

too low at current and this may “decrease public confidence in the safety of vaccines that actually

cause injury to only a very small number of persons.”xxx And, at the same time, this sub-controversy

works to influence the overarching debate of vaccine compliance. If the public looses trust

completely in the government, if they begin to consider the Vaccine Court and its awards of

compensation as an admission of guilt on behalf of vaccines, vaccine compliance rates may

experience severe negative backlash.

• • • • •

And yet, in spite of the Vaccine Court and its implications of medical conflict of interest,

proponents of vaccine compliance—which include most physicians, health professionals, and

parents—still hold that all able-bodied individuals should be vaccinated according to CDC

recommendations, especially against communicable and potentially lethal diseases such as measles.

Despite the anecdotes of terrible adverse reactions, proponents maintain that vaccines are safe. In a

telephone interview, Wesley J. Hodgson, the School Compliance Coordinator of the Immunization

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Branch Texas Department of State Health Services stated “There are systems in place to monitor

those [adverse vaccine reactions]. The Centers for Disease Control…” Here he paused to collect his

thoughts. “First of all the CDC ensures that vaccines are tracked to see if there are any possible

problems with them so they can have early warning, and do a recall with the vaccine if there’s a

problem. I wouldn’t compare it to a car recall because it works much faster, but there’s a monitoring

system in place, so that’s what I wanted to get across to you.”

Hodgson then went on to break down the vaccine monitoring systems, carefully and with

copious detail. He was calm and self-assured, confident in his information. “There are three primary

vaccine safety activities,” he began. “The Vaccine Adverse Event Reporting System, known as

VAERS, is an early warning system where people can report vaccine concerns and it helps the

Centers for Disease Control and the Food and Drug Administration to detect possible side effects

or adverse events following vaccination. Then there’s also the Vaccine Safety Data Link and that’s a

collaborative effort between the CDC and other healthcare organizations using de-identified health

records to monitor and evaluate adverse events following vaccination. And there’s the Clinical

Immunization Safety Assessment Network, another collaboration with the CDC and some medical

research centers to conduct research into how adverse events might be caused by vaccines. So you

can see there’s a three-pronged approach to monitoring adverse events to help protect the safety of

the vaccine and also the individual, which is our main concern.”

Regarding the concern of “immune overload,” Hodgson gave the following response: “This

concept has been studied extensively by the CDC and they’ve found it to not be an issue. And the

reasons for this is…well consider this analogy: When a child contracts the common cold, they are

exposed to 4 to 10 antigens at time; additionally, a child exposed to strep is exposed to 25 to 50

antigens. This demonstrates that the immune system is capable of addressing and handling multiple

antigens at one time without much of a problem. Our vaccines, in comparison to these diseases, do

not contain anywhere near this number of active antigens.”xxxi

A concept that is of major concern however, Hodgson stressed, is the principle of “herd

immunity,” which is where the number of vaccinated individuals is high enough that viruses have

trouble moving from host to host and cease to spread, sparing both the unvaccinated and those in

whom vaccination has not produced immunity.xxxii Herd immunity is particularly crucial for those

who cannot be vaccinated due to compromised immune systems. According to an NPR article

written by Lisa Aliferis, six year old Rhett Krawitt was diagnosed with leukemia when he was an

infant. While Rhett is now in remission, his immune system remains ravaged and vulnerable due to

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the cancer and subsequent chemo treatments. Because of this, Rhett cannot be vaccinated and must

rely on the herd immunity of his community to protect him from the spread of infectious disease.xxxiii

However, the Krawitt family lives in California, a state that has the highest number of vaccine

schedule non-compliance. According to Liza Gross, studies conducted in California found five hot

spots, including a 1.8-mile area in Vallejo, where 22.7 percent of kids were under-vaccinated. More

than 10,000 toddlers lived within the five clusters. The team also identified five clusters where all

vaccines were refused for the babies and toddlers in the study. This clustering effect is detrimental,

Gross states, as last year, when a record number of California parents claimed personal belief

exemptions, health officials reported the most measles cases seen here since 1995 and the most

whooping cough cases since 1947.xxxiv

While these “free-riders,” as Janice Wood-Harper labels them, are “generally tolerated, or

certainly are not subjected to any penalties, as long as vaccination rates in the population remain

high, as more individuals become free-riders and non-immunity nears a critical point where it

threatens significant harms to society from increasing outbreaks of measles epidemics, then it

becomes important to question the morality of free-riding” and, in conjunction, the morality of

compulsory inoculation.xxxv Proponents of vaccine compliance argue that individuals who are not

vaccinated due to personal objections, and subsequently (although unknowingly) pass along

communicable diseases, are violating their bodily integrity, a value their share with their opponents

but viewed from a different perspective. Some individuals, like Rhett Krawitt, simply cannot be

immunized for health reasons and are therefore at risk as the number of unvaccinated people rise.

• • • • •

While the United States has never had a federal compulsory vaccination law, there were

several instances that came close. Biss cites that “George Washington, a survivor of smallpox,

wrestled with the question of whether or not to require inoculation for revolutionary soldiers long

before vaccination became a question of conscience. In 1775, roughly a third of the Continental

Army fell ill to smallpox while laying siege to Quebec. Several times, Washington ordered

inoculation and then withdrew the order days later. Finally, with rumors in the air of a British plan to

spread smallpox as a form of biological warfare, Washington ordered the inoculation of all new

recruits.”xxxvi Biss goes on to discuss that in the early 20th century some states had compulsory laws,

but 2/3 of the states did not, and a couple states had laws against compulsion.xxxvii However, vaccine

compliance was much higher in the 20th century, in the generation that Biss calls the “Polio

Pioneers.” Living in the wake of war and in the shadow of the A-bomb, the generations of the 20th

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century took the risk of inoculation, even though the polio and smallpox vaccines were far more

dangerous than any of our current childhood vaccinations; it is estimated that the risk of death, Biss

states, was about one in a million.xxxviii

However, the “better safe than sorry” mentality of our parents’ and grandparents’ generation

has fallen out of favor. Diseases like smallpox and polio have been eradicated from the first world

and, therefore, the fear associated with them has dissipated. Hodgson emphasized this fact. “I think

one of the contributing factors to people not wanting to get their children vaccinated,” he said. “Or

not considering it important is the fact that no one’s seen these diseases, really, because of the

effectiveness of vaccines, and I think this leads to a certain degree of complacency. Back in the 50s,

when the polio counts were so high and individuals could actually see the ravages of the disease—

the paralysis and iron lungs—people really ran to go get their immunizations. But that’s not the case

now. People don’t see measles or diphtheria, I mean we still have pertussis more than anything, but

they still don’t see that either. They’re all horrible diseases; you can die from them. Immunizations

are one of the most effective prevention efforts in public health ever.”xxxix

Hodgson also stressed that inoculation was for the good of the individual as well as the good

of the community. “The individual should be immunized to protect them against diseases, as well as

the general public. An individual that is not immunized can infect the general public, and so that’s an

issue there. They can bring it into the community. The cornerstone to the immunization program is

to prevent deadly diseases from reaching the citizens. Vaccines are highly effective in preventing

death and disability, and they save billions of dollars annually. A decision to vaccinate is to help

protect not only the individual but the entire community from diseases. A decision not to vaccinate

puts the individual and the community at risk because of that susceptible population that can

transmit the disease if they contract it to the rest of the population. But when a community reaches

what’s called a “herd” level of immunity, that’s when…think of a large cluster of people in a circle.

If one or two are unvaccinated in the middle, but you have all of these protected people around

them, that will prevent the unimmunized from getting infected because there is no transmission

possibility because everyone is immune. So you’ll have some individuals that are not vaccinated that

will still be protected from the disease. Therefore, the likelihood that a infected person would

transmit the disease to a susceptible person is greatly reduced.”xl

Sadly, though, enforced vaccine compliance is no longer seen as a safety precaution, but

rather a violation of civil rights. American, democratic ideals and principles do not coincide well

with the utilitarian foundation of required vaccines. While utilitarianism prides itself in wanting the

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greatest good for the greatest number, in our individualistic society, this is sometimes viewed as

unfair, inhumane, unconstitutional. Citizens don’t want to be viewed as just another number, a part

of the aggregate whole; they want to be valued intrinsically, individually. “The good of the many

outweighs the good of the few,” has become too callous of an idea for us. We can’t swallow it. So,

we reject it. As the anti-vaccine movement has so infamously done.

• • • • •

Eula Biss makes another interesting point when she notes that “perhaps what matters is not

whether people are right on the facts [about vaccines] but whether they are frightened.”xli She goes

on to say “What vaccines do not cause is significantly harder to establish than what they do cause.

While a substantial amount of evidence is acceptable as proof that an events does and can happen,

there is never enough evidence to prove that an event cannot happen.”xlii As demonstrated above,

safety and health are the crux issues in the vaccine debate, and whether an individual stands in

solidarity or opposition of the CDC recommended schedule or an alternate version, it all boils down

to what is considered the safest route for each child and, unfortunately, until science evolves to be

more exact, the “safest route” will continue to be different for every individual.

However, this controversy also brings to light interesting questions and concerns about

government interference and the protection of a priori rights. The government has an obligation to

protect its citizens: from wars, national disasters, and, yes, even disease. Vaccines are the manifest of

this effort. But the question is, at what point does a problem become compelling enough to invoke

government involvement? At what point must individual rights become subsequent to the good of

the community, the nation?

This sounds like the description of the next up and coming dystopian novel or movie, in

which a totalitarian government enforces Machiavellian dogmas. But this is a real debate, something

that is happening right now, and unlike novels or movies, with their nice and neat climaxes and

denouements, there is no nice and neat solution here. There isn’t a cure-all or a big sweeping

revelation that will solve this controversy once and for all. In real life, things are messy; they’re

murky. And we have to wade through the mire, trying to find an answer for ourselves. For some,

like Hodgson, the answer is total vaccine compliance. For others, like Michelle Schneider and her

family, the answer they’ve arrived at is something more personal and specific to their circumstances

and their experiences. Ask a panel of ten people about who is “right” in this debate—the likes of

Hodgson or Schneider—and more than likely there will be ten different and separate opinions.

Yamamoto 16

Perhaps, currently, we are too close to this controversy. Perhaps, in ten, fifteen, twenty years,

we will know definitively who was right and who was wrong; hindsight and 20/20 being what it is.

Until then, we’ll keep wading through these shades of grey, dipping our children in our version of

the Styx the best we know how.

Yamamoto 17

End Notes:

i Mission statement quoted from organization’s website: http://www.texansforvaccinechoice.com/ ii See Michelle Schneider’s interview transcript in Submission 4 iii Schneider was previously affiliated with an organization called The Thinking Mom’s Revolution.

Within the organization, twenty-four parents came together to write this book detailing how autism and related health issues and developmental disorders have affected their children and families. See “Evolution of a Revolution: From Hope to Healing.”

iv See “Ask Dr. Errol Alden of AAP to Review CDC Vaccine Science Accountability,” “In Response to ‘The Anti-Vaccination Epidemic’ by Paul A. Offit,” and “Texans Who Choose Not to Vaccinate Speak Out.”

v As a matter of public record, Schneider’s petition is available online at the US Court of Federal Claims. See “Schneider v. Secretary of Health and Human Services.” A copy has also been added to the appendices of this project.

vi This is an American ideal; a Libertarian ideal. Under the Libertarian ethical system, individual liberty is valued above all else; people are entitled to use their property and live their life as they see fit, as long as they do not violate the rights of others. Paternalist legislation, which mandated vaccine schedule compliance falls, violates this ideal of self-possession and bodily integrity. For further discussion of ethical systems, see Submission 3.

vii According to the CDC, twenty-two of these patients (14%) were hospitalized, including five with pneumonia. But no other complications and no deaths have been reported. See Clemmons et al.

viii ‘Elimination’ is the word used on the CDC website. See "Measles Cases and Outbreaks." ix Ibid. x See “Ebola in America: Timeline of the Deadly Virus” xi See Biss 51-52. xii The term “herd immunity” will be discussed at length on pages 12-13 of this paper. See also the

list of key terms in Submission 2. xiii See Baker 249. xiv According to Dr. Paul Offit, pediatrician and director of the vaccine education center at the

Children's Hospital of Philadelphia, many developmental conditions first make themselves known around the time of life when kids are also getting vaccinated (ages 0-2 years). But that coincidence of timing doesn't mean there's a causal connection between the vaccine and the condition. See Kelto.

xv Ibid. xvi See Baker 245 xvii See Baker 245, and Biss 90 xviii Ibid. xix See Biss 10-11.

Yamamoto 18

xx See Biss 106 xxi Petitioners must file vaccine-injury claims with the Vaccine Court before filing in state court. Special masters, without a jury, issue decisions on entitlement. The Secretary of Health and Human Services (HHS) serves as the respondent. Within thirty days after a petitioner files a claim with the Vaccine Court, the special master assigned to the case holds a status conference with the parties to assess the merits of the petitioner’s claim and facilitate settlement. If the case goes forward, the Vaccine Court has 240 days to issue a decision or the petitioner can exit the program and bring a claim in state court. After the Vaccine Court issues a decision, a dissatisfied petitioner generally retains the right to reject the judgment and file in state court. Additionally, either party may apply to the CFC for review of a special master’s decision and appeal a CFC decision to the U.S. Court of Appeals for the Federal Circuit. See Haertlein 214.

xxii See Kraemer. xxiii See “Are The Vaccine Court's Requirements Too Strict?” xxiv See Kraemer. xxv See Kraemer. xxvi See Haertlein 225. xxvii See Haertlein 212. xxviii See Haertlein 215. xxix See Haertlein 216. xxx See Haerlein 228. xxxi See Wesley Hodgson’s interview transcript in Submission 4 xxxii See Biss 19, Brown 1856, Wood-Harper 44, and Wesley Hodgson’s transcript in the appendices. xxxiii See “A Boy Who Had Cancer Faces Measles Risk From The Unvaccinated.” xxxiv “Parents Who Shun Vaccines Tend To Cluster, Boosting Children's Risk.” xxxv See Wood-Harper 49 xxxvi See Biss 120 xxxvii Ibid. xxxviii Biss 84 xxxix According to John Kraemer, “In the United States alone, the incidence of vaccine-preventable

diseases declined from more than 1 million cases per year at the start of the 20th century to only a few thousand cases per year by its close.” See Kraemer.

xl See Wesley Hodgson’s transcript in Submission 4

Yamamoto 19

Works Cited

"Are The Vaccine Court's Requirements Too Strict?" By Anders Kelto. Health Shots. NPR. Web. 3

June 2015.

Baker, Jeffery P. "Mercury, Vaccines, and Autism: One Controversy, Three Histories." American

Journal of Public Health 98.2 (2008): 244-53. EBSCO. Web. 3 June 2015.

Biss, Eula. On Immunity: An Inoculation. N.p.: Graywolf, 2014. Print.

"A Boy Who Had Cancer Faces Measles Risk From The Unvaccinated." By Lisa Aliferis. Health

Shots. NPR. Web. 3 June 2015.

Brown, Katrina. "UK parents’ decision-making about measles–mumps–rubella (MMR) vaccine 10

years after the MMR-autism controversy: A qualitative analysis." Vaccine 30.10 (2012): 1855-

64. ScienceDirect. Web. 3 June 2015.

Clemmons, Nakia, et al. "Measles — United States, January 4–April 2, 2015." Centers for Disease

Control and Prevention. N.p., n.d. Web. 5 Aug. 2015.

"Evolution of a Revolution: From Hope to Healing." Team TMR. N.p., n.d. Web. 5 Aug. 2015.

Gross, Karin. "'I know it has worked for millions of years': the role of the 'natural' in parental

reasoning against child immunization in a qualitative study in Switzerland." BMC Public

Health 15.1 (2015): 1-7. EBSCO. Web. 3 June 2015.

Haertlein, Lauren L. "Immunizing against Bad Science: The Vaccine Court and the Autism Test

Cases." Law & Contemporary Problems 75.2 (2012): 211-32. EBSCO. Web. 5 Aug. 2015.

Hodgson, Wesley J. Telephone interview. 10 July 2014.

Kraemer, John D. "Vaccine Liability in the Supreme Court Forging a Social Compact." Journal of the

American Medical Association 305.18 (2011): n. pag. EBSCO. Web. 5 Aug. 2015.

"Measles Cases and Outbreaks." Centers for Disease Control and Prevention. N.p., n.d. Web. 12 June 2015.

Yamamoto 20

"Parents Who Shun Vaccines Tend To Cluster, Boosting Children's Risk." By Liza Gross. Health


Schneider, Michelle. "Ask Dr. Errol Alden of AAP to Review CDC Vaccine Science

Accountability." Editorial. Age of Autism. Ed. Dan Olmsted. N.p., n.d. Web. 5 Aug. 2015.

- - -. "In Response to “The Anti-Vaccination Epidemic” by Paul A. Offit." Editorial. GreenMedInfo.

N.p., 22 Oct. 2014. Web. 5 Aug. 2015.

- - -. Telephone interview. 14 July 2015.

- - -. "Texans Who Choose Not to Vaccinate Speak out." Editorial. Chron. N.p., n.d. Web. 5 Aug.

2015.

Schneider v. Secretary of Health and Human Services. 185 F. U.S. Court of Federal Claims: Office

of Special Masters. Welcome to the US Court of Federal Claims for the United States Court of Federal

Claims. N.p., n.d. Web. 5 Aug. 2015.

Wood-Harper, Janice. "Informing education policy on MMR: balancing individual freedoms and

collective responsibilities for the promotion of public health." Nursing Ethics 12.1 (2005): 43-

58. EBSCO. Web. 3 June 2015.

Yamamoto 21

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Journal of Public Health 98.2 (2008): 244-53. EBSCO. Web. 3 June 2015.

Biss, Eula. On Immunity: An Inoculation. N.p.: Graywolf, 2014. Print.






Clemmons, Nakia, et al. "Measles — United States, January 4–April 2, 2015." Centers for Disease

Control and Prevention. N.p., n.d. Web. 5 Aug. 2015.

"Evolution of a Revolution: From Hope to Healing." Team TMR. N.p., n.d. Web. 5 Aug. 2015.




Haertlein, Lauren L. "Immunizing against Bad Science: The Vaccine Court and the Autism Test

Cases." Law & Contemporary Problems 75.2 (2012): 211-32. EBSCO. Web. 5 Aug. 2015.

Hodgson, Wesley J. Telephone interview. 10 July 2014.

"How Vaccine Fears Fueled The Resurgence Of Preventable Diseases." By Michaeleen Doucleff.

Health Shots. NPR. Web. 3 June 2015.

Yamamoto 22

Kassianos, George. "What is wrong with the single vaccine?" Pulse 14 Apr. 2003: n. pag. EBSCO.

Web. 3 June 2015.

Kraemer, John D. "Vaccine Liability in the Supreme Court Forging a Social Compact." Journal of the

American Medical Association 305.18 (2011): n. pag. EBSCO. Web. 5 Aug. 2015.

Leask, Julie. "Public opponents of vaccination: a case study." Vaccine 21.32 (2003): 4700-03.

ScienceDirect. Web. 3 June 2015.

Lupkin, Sydney. "Ebola in America: Timeline of the Deadly Virus." ABC News. N.p., n.d. Web. 24

July 2015.




Poland, Gregory. "Understanding those who do not understand: a brief review of the anti-vaccine

movement." Vaccine 19.17-19 (2001): 2440-45. EBSCO. Web. 3 June 2015.

Schneider, Michelle. "Ask Dr. Errol Alden of AAP to Review CDC Vaccine Science

Accountability." Editorial. Age of Autism. Ed. Dan Olmsted. N.p., n.d. Web. 5 Aug. 2015.

- - -. "In Response to “The Anti-Vaccination Epidemic” by Paul A. Offit." Editorial. GreenMedInfo.

N.p., 22 Oct. 2014. Web. 5 Aug. 2015.

- - -. Telephone interview. 14 July 2015.

- - -. "Texans Who Choose Not to Vaccinate Speak out." Editorial. Chron. N.p., n.d. Web. 5 Aug.

2015.

Schneider v. Secretary of Health and Human Services. 185 F. U.S. Court of Federal Claims: Office

of Special Masters. Welcome to the US Court of Federal Claims for the United States Court of Federal

Claims. N.p., n.d. Web. 5 Aug. 2015.

Yamamoto 23

Wakefield, Andrew. "Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive

developmental disorder in children." The Lancet 351.9103 (1998): 637-41. EBSCO. Web. 3

June 2015.




xli Biss 38. xlii Biss 36.

Yamamoto 24

Previous Submissions

Yamamoto 25

Submission One

Yamamoto 26

Jade Yamamoto Prof. Eakman CAPS 4360.01 3 June 2015

Submission One


developmental disorder in children." The Lancet 351.9103 (1998): 637-41. EBSCO. Web. 3 June 2015.

1. Author: Andrew Wakefield is a former British surgeon and gastroenterologist. He was a well respected researcher during the latter part of the 20th century but lost much of his credibility after his study on the MMR vaccine was proved to be fraudulent. 2: Type of source: This article was published in (and then retracted from) the medical journal The Lancet. 3: Audience and Purpose: The audience of this particular study was both medical professionals and the general public, most especially parents who were looking to immunize or had immunized their children and experienced adverse effects. 4: Main Claim: Wakefield and a panel of 12 scientists claimed that in a study of 12 children, eight were believed to have exhibited symptoms of gastrointestinal problems and regressive developmental disorders soon after receiving the measles, mumps, and rubella vaccination (637-638). 5: Evidence and Reasons: According to Wakefield et al., behavioral issues such as autism, accompanied by gastrointestinal symptoms, arose in eight children after they had been administered the MMR vaccine. Five of these eight children had physical adverse reactions to immunization (rash, fever, delirium; and, in three cases, convulsions). In these eight children, the average interval from exposure to first behavioral symptoms was 6-3 days (638). Wakefield implicated the vaccine throughout the study as a causal factor for developmental disorders such as autism, but ended with the caveat, “We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described. Virological studies are underway that may help to resolve this issue” (640).

6: So What?: This article is the cornerstone for the modern anti-vaccination movement. All current controversies stem from Wakefield’s association of the MMR vaccine with the onset of autism. Although this article has long since been retracted and rejected by those in the medical field, it is still quoted and heavily utilized by those opposing vaccinations. For this paper, I use this article as the foundation of the opposition’s perspective.

Yamamoto 27


Health Shots. NPR. Web. 3 June 2015. 1. Author: Michaeleen Doucleff is a digital editor for NPR's Science Desk. She is the deputy host for the global health and development blog, Goats and Soda, and she reports for the Web and radio on disease outbreaks and trends in global health. 2: Type of source: This source was a news article published on NPR’s website. 3: Audience and Purpose: Given the self-exclamatory nature of NPR’s name, the audience of this piece was the general public, and it sought to inform them of a dangerous trend in resurging, preventable diseases. 4: Main Claim: Doucleff reports that several diseases that are easily prevented with vaccines have made a comeback in the past few years. Their resurgence coincides with changes in perceptions about vaccine safety. 5: Evidence and Reasons: Since 2008, the Council of Foreign Relations has been studying all the cases of measles, mumps, rubella, and polio around the world. In 2011, France reported a massive measles outbreak with nearly 15,000 cases. Only the Democratic Republic of Congo, India, Indonesia, Nigeria and Somalia suffered larger measles outbreaks that year. In 2012, the U.K. reported more than 2,000 measles cases, the largest number since 1994. And here in the U.S., the prevalence of whooping cough shot up in 2012 to nearly 50,000 cases. Last year cases declined to about 24,000 — which is still more than tenfold the number reported back in the early '80s when the bacteria infected less than 2,000 people 6: So What?: This article was particularly valuable to my project because it demonstrated scientific evidence that the vaccine controversy is directly and immediately affecting the current population of the world.

Baker, Jeffery P. "Mercury, Vaccines, and Autism: One Controversy, Three Histories." American Journal of Public Health 98.2 (2008): 244-53. EBSCO. Web. 3 June 2015.

1. Author: Jeffery P. Baker is a pediatrician that also holds a PhD in History of Medicine from Duke University. He currently works at the Duke Department of Pediatrics and has published numerous articles on vaccinations and other pediatric concerns. 2: Type of source: This source was a scholarly article published in the American Journal of Public Health.

3: Audience and Purpose: The audience of this article was anyone trying to understand (and perhaps rectify) the current controversy over vaccination, most especially those in the medical field.

Yamamoto 28

4: Main Claim: Baker asserts that the current vaccine controversy is actually connected to previous concerns over mercury and autism. According to Baker, the history of each of these controversies bears heavy weight and helps to explain the adversity immunization is currently facing. 5: Evidence and Reasons: Baker details the history of mercury use in vaccines. In the early 20th century, thimerosal—a promising new organomercurial—was first placed in vaccines to combat bacterial infections; in short, it was used as an antiseptic and preservative (245). However, in the 1960s, scientists began to discover the adverse effects of methylmercury after citizens of a Japanese factory village began to fall severely ill (246). The FDA conducted research and found that the trace amounts of ethylmercury found in thimerosal would not affect an individual within their lifetime, but by this time mercury had already become stigmatized in the media (246). Then, in the 1990s, diagnoses of autism began to rise steadily, and the medical profession was caught unawares. In result, parents of these autistic children turned to each other and the Internet for help (249). One hypothetical cause of autism was said to be a “leaky gut”—an abnormality in intestinal permeability that may admit intestinal toxins or opioids affecting the nervous system at an early age—and Dr. Andrew Wakefield linked this theory to the MMR vaccine after conducting a study describing a small number of patients who developed autistic regression and diarrhea following their measles-mumps-rubella immunization (249). 6: So What?: This article was valuable for my project because it illustrated the historical foundations of the MMR controversy, demonstrating that while contention over the MMR vaccine might be a new trend, public distrust of medical authorities is nothing new.



1. Author: Gregory Poland is a doctor with the Mayo Vaccine Research Group, Clinical Pharmacology Unit and Department of Internal Medicine. Poland founded the Vaccine Research Group in 1989 and current runs the department with Richard B. Kennedy, Ph.D. 2: Type of source: This source was a scholarly article published in the journal Vaccine and found on the ScienceDirect database. 3: Audience and Purpose: This article was meant for fellow physicians and individuals trying to more fully comprehend the anti-vaccine movement. 4: Main Claim: Poland asserts that while vaccines are incredibly valuable, a strong anti-vaccine movement is rising, propelled forward by several different factors (2440). 5: Evidence and Reasons: According to Poland, “as infectious disease epidemics have waned and fear of death or disability due to infection has lessened, increasing concerns over possible vaccine side effects and safety have arisen” (2441). Poland points to several other factors that propagate the anti-vaccine movement, one of which being the failure of public health officials to educate both the public and providers on the benefits of vaccines, and the failure of health

Yamamoto 29

systems to develop safety monitoring systems to answer patient concerns with convincing data (2441). Poland also details many of the concerns that the anti-vaccine movement presents, chiefly that immunization is injecting “foreign material” into one’s otherwise healthy body. Other concerns include “the idea that the disease had already begun to disappear prior to the use of vaccines; that the majority of people who get a vaccine-preventable disease were previously immunized; that vaccines cause illnesses and deaths; that vaccine preventable diseases have been eliminated already; that multiple vaccines ‘overload’ the immune system; that vaccines are not ‘natural’ with a preference for disease-induced immunity; and, finally, any variety of political/economic conspiracy theories regarding manufacturer profits, minority issues, and even genocide issues” (2441). 6: So What?: This article was valuable to my project because it outlined most of the major concerns that the anti-vaccine movement has. It also clearly stated many of the main value issues that I will be focusing on in my final paper.



1. Author: Julie Leask is an Associate Professor at The University of Sydney, School of Public Health. She is also the Chief Investigator for the National Centre for Immunization Research & Surveillance. 2: Type of source: This article was published in the scholarly journal of Vaccine and found on the ScienceDirect database.

3: Audience and Purpose: This article was meant for physicians or individuals studying vaccine controversies, although this article focuses on a particular case study in Australia. 4: Main Claim: Leask asserts that in industrialized countries today, opposition to vaccination occurs through organized lobby groups of mainly parents or individual spokespersons whose medical or scientific background lends credibility to their claims (4700). 5: Evidence and Reasons: Leask focuses on one specific opponent of vaccination, Dr. Viera Scheibner, who is Australia’s best known opponent of vaccination; over the past decade, she has toured the world promoting her message that vaccines are ineffective and unsafe (4700). Leask points out that Scheibner actually “has a doctorate in natural sciences. She has no formal health sciences training and has co-authored one article in the peer reviewed medical research literature indexed on Medline between 1966 and June 2002. Her doctorate (RNDr) was in micropalaeontology and examined “Jurassic and Cretaceous foraminifera from the Pieniny Klippen Belt in the Western Carpathians” (4700). However, because of her title and her perceived intelligence, she has become a major player in the anti-vaccination movement across the global, even writing a book titled Vaccination: 100 Years of Orthodox Research Shows that Vaccines Represent an Assault on the Immune System.

6: So What?: Although this source discussed cases and individuals particular to Australia, I thought that it was a perfect demonstration of how the media propagates an issue and how the

Yamamoto 30

general population is quick to believe statements and notions if there is a perceived expertise or authority. Viera Scheibner has a doctorate in micropalaeontology, but most people will see the “Dr.” attached to her name and assume she is an MD, assume that she knows exactly what she is talking about.

Gross, Karin, et al. "'I know it has worked for millions of years': the role of the 'natural' in parental reasoning against child immunization in a qualitative study in Switzerland." BMC Public Health 15.1 (2015): 1-7. EBSCO. Web. 3 June 2015.

1. Author: Karin Gross is the senior scientific collaborator in the Department of Epidemiology and Public Health at the Swiss Tropical and Public Health Institute. 2: Type of source: This source was a scholarly article published in the journal BMC Public Health and found on the EBSCO database. 3: Audience and Purpose: The audience of this piece were physicians and individuals interested in the “natural” rational of the anti-vaccination movement. 4: Main Claim: Gross asserts that there seems to be a large number of parents in the anti-vaccine movement (particularly in Switzerland) that built their arguments against immunization on a strong faith in the strength of the naturally acquired immune system (3). 5: Evidence and Reasons: In interviewing numerous parents, Gross discovered several themes underlying anti-vaccine sentiments. Chiefly, there was a strong belief in the body’s perfect functioning, which has developed over millions of years and was contrasted with the vaccines’ short existence (3). The diseases that these vaccines were for (measles, mumps, etc.), additionally, were seen as mild and non-threatening; they were generally diseases the parents had contracted as a child and had lived through with no serious damage and because of this, parents viewed these diseases as milestones, associating the experience of illness and recovery with progress in the child’s development (3-4). Going further, some parents argued that the strength of the immune system can be built up by healthy food, and that injecting something artificial, “without really knowing what it triggers,” was wrong (4). At the end of the article, Gross poses an interesting question: to what extent [does] the preference for the natural over the artificial reflect a more deeply rooted distrust in the dominant bio-medical health care system (5). In other words, is it that vaccines themselves that are distrusted, or the institutions delivering them? 6: So What?: This source was useful for my project because it encapsulates nicely the issue of bodily autonomy and sanctity that the anti-vaccination movement values.

Brown, Katrina, et. al. "UK parents’ decision-making about measles–mumps–rubella (MMR) vaccine 10 years after the MMR-autism controversy: A qualitative analysis." Vaccine 30.10 (2012): 1855-64. ScienceDirect. Web. 3 June 2015.

Yamamoto 31

1. Author: Katrina Brown works for the Centre for Patient Safety and Service Quality at Imperial College London. She has published several works regarding immunizations. 2: Type of source: This article was published in the scholarly journal Vaccine, and found on the EBSCO database. 3: Audience and Purpose: The audience for this article were those interested in the history and background of the anti-vaccination movement, specifically in the UK. 4: Main Claim: After conducting numerous interviews, Brown claims that there were 5 thematic foundations for parents’ decision on to whether immunize their children with the MMR vaccine. These themes included 1) vaccine controversy; 2) social and personal consequences of the MMR vaccine; 3) health professionals and policy’ 4) severity and prevalence of measles, mumps and rubella infections; and 5) information about MMR and alternatives (1856). 5: Evidence and Reasons: Regarding the theme of vaccine controversy, Brown found that parents were highly influenced by rumors and stories they had overheard about the MMR vaccine (i.e. ingredients being toxic, low effectiveness, immune overload, autism, etc.) (1858). Parents were also driven by the desire to not be judged by their peers for their decision. “Parents across groups defined their own course of action as the most responsible one: MMR1 rejecters felt that acceptors had taken the easy option and had rejected responsibility for maintaining their child’s health; and MMR1 acceptors felt that rejecters had opted out of making a difficult decision and prioritized their fear over their child’s health” (1859). In the case of health professionals and policy, perceived trustworthiness of these aspects divided MMR1 acceptors and rejecters. The sense that vaccine providers’ clinical judgment may be over-ridden by financial incentives and performance targets emerged strongly among MMR1 rejecters (1860). Most parents also felt that measles, mumps, and rubella were not serious threats, many having experienced them as a child or known someone to have experienced them (1861). Finally, across decision groups, parents expressed frustration with the absence of unbiased and accurate information (1861). In the absence of such information from doctors and other “authorities”, parents turned to alternative sources. 6: So What?: This source was extremely valuable for my project because it broke down parents’ reasoning and motivations to either accept or reject the MMR vaccine. While this study surely does not encapsulate every concern, it does give a comprehensive overview of the main issues centered in the anti-vaccination movement.

“Parents Who Shun Vaccines Tend To Cluster, Boosting Children's Risk.” By Liza Gross. Health

Shots. NPR. Web. 3 June 2015. 1. Author: Liza Gross is a freelance journalist who has written for the New York Times, Washington Post, NPR, National Geographic, and numerous other publications. 2: Type of source: This article was published on NPR’s website.

Yamamoto 32

3: Audience and Purpose: Since NPR is a public program, the audience of this article was the general population, specifically those concerned with the current vaccination controversies and scares. 4: Main Claim: Gross claims that parents who use personal belief exemptions to avoid school vaccination requirements often live in the same communities, which poses an even larger risk for the spread of infectious diseases. 5: Evidence and Reasons: Gross referenced studies conducted in California that found five hot spots, including a 1.8-mile area in Vallejo, where 22.7 percent of kids were under-vaccinated. More than 10,000 toddlers lived within the five clusters. The team also identified five clusters where all vaccines were refused for the babies and toddlers in the study. This clustering effect is detrimental, Gross states, as last year, when a record number of California parents claimed personal belief exemptions, health officials reported the most measles cases seen here since 1995 and the most whooping cough cases since 1947. 6: So What?: This article was useful for my research because it gave numbers and figures to the abstract concept of a measles (or whooping cough) epidemic. These facts clearly illustrate that the anti-vaccination movement is affecting the population of America as a whole.

"A Boy Who Had Cancer Faces Measles Risk From The Unvaccinated." By Lisa Aliferis. Health Shots. NPR. Web. 3 June 2015.

1. Author: For the past decade, Lisa Aliferis has specialized in producing medical reports for television, most recently at Dateline NBC. She also produced health reports for five years at KPIX-TV in San Francisco.

2: Type of source: This article was published on NPR’s website.

3: Audience and Purpose: Since NPR is a public program, the audience of this article was the general population, specifically those concerned with the current vaccination controversies and scares.

4: Main Claim: Aliferis claims that the spread of the highly infectious disease has sparked a debate about people who voluntarily opt out of vaccines or decline to have their children vaccinated. Many people have no choice. They can't be vaccinated for medical reasons. They rely on the people around them to be vaccinated to prevent the spread of infectious disease. 5: Evidence and Reasons: Aliferis reports the story of the Krawitt family. Their six year old son, Rhett, was diagnosed with leukemia at 2. While Rhett is now in remission, he is still immunocompromised, and cannot be vaccinated. The Krawitt family lives in California, which has the highest number of personal belief exemptions for vaccinations. Rhett’s parents have begged their community to vaccinate their children, and also asked of the schools and counties to intercede in order to protect Rhett. Aliferis reports that the Marin County health officer, Dr. Matt Willis, says he is "extremely sympathetic" to the Krawitts' situation, but science does not back up their request to keep kids out of school. Additionally, Willis states, if he were to

Yamamoto 33

exclude unvaccinated children from school, that would mean Rhett and others with a medical exemption from vaccines would have to stay home, too. 6: So What?: This source was useful for my project because it depicted a real life case in favor of mandatory vaccination. Rhett almost died of cancer, and now he might die of a preventable disease because others around him are not vaccinated. This type of story brings into question accountability and responsibility, both on behalf of parents and health/government officials.

Kassianos, George. "What is wrong with the single vaccine?" Pulse 14 Apr. 2003: n. pag. EBSCO. Web. 3 June 2015.

1. Author: George Kassianos is a travel medicine, immunization and travel health practitioner based in the UK and is a member of the British Global and Travel Health Association. 2: Type of source: This article was published in the journal Pulse and found on the EBSCO database. 3: Audience and Purpose: The audience of this article were those interested in the anti-vaccination movement, specifically concerning single vaccines vs. combination vaccines. 4: Main Claim: Kassianos contends that single vaccines are not as effective as combination and could potentially be more dangerous. 5: Evidence and Reasons: Kassianos cites that Japan switched to single vaccines in 1992, after a problem with the mumps virus in their homemade MMR. But, contrary to certain rhetoric, there has not been a decrease in autism in Japan. Nor have single vaccines controlled measles infections. They have actually been less effective, giving rise to multiple outbreaks in Japan. Additionally, Kassianos argues, single vaccines have to be taken over six years; one per year, which increases the chances of adverse reactions. The combination MMR vaccine is only taken twice, at 13 months, and a booster at 4 and a half years old. 6: So What?: This source was valuable for my project because it offered a rebuttal for a major anti-vaccination movement alternative. Many anti-vaccine sources argue in favor of single vaccines, and many parents have opted for them as alternatives for the MMR combination. This article helped to illustrate another aspect of the pro-vaccine perspective.

“Are The Vaccine Court's Requirements Too Strict?" By Anders Kelto. Health Shots. NPR. Web. 3 June 2015.

1. Author: Anders Kelto is now The World's Africa Correspondent. He is based in Cape Town, South Africa, and reports on health and development issues. Prior to joining The World, he worked with NPR, the CBC, and National Geographic. 2: Type of source: This article was published on NPR’s website.

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3: Audience and Purpose: Since NPR is a public program, the audience of this article was the general population, specifically those concerned with the current vaccination controversies and scares. 4: Main Claim: Kelto claims that there is a debate occurring over whether or not the “vaccine court’s” requirements are too strict. 5: Evidence and Reasons: Kelto begins the article detailing the story of Mary and David Wildman. In 1997, their son Nicholas was given the MMR vaccine at the recommended time, as they had been instructed by their doctors. However, after the administration of the vaccine, Nicholas began screaming violently and started to run a high fever. His mother said he began to act differently after that and was never the same. A year later, Nicholas was diagnosed with a severe intellectual disability. The Wildman’s were convinced that the MMR vaccine had caused the damage to their son’s brains but Dr. Paul Offit—pediatrician and director of the vaccine education center at the Children's Hospital of Philadelphia—states that while the very contagious virus that gives rise to measles in people who aren't vaccinated can lead to permanent brain damage, the version of the virus used in the MMR vaccine is so drastically weakened, it's impossible for it to penetrate the brain and create a permanent injury. Furthermore, Offit argues, many developmental conditions first make themselves known around the time of life when kids are also getting vaccinated. But that coincidence of timing doesn't mean there's a causal connection between the vaccine and the condition. The Office of Special Masters of the U.S. Court of Federal Claims — commonly called the “vaccine court”—is where cases like the Wildman’s are now handled. Established in the 1980s, “to deal with the possibility of rare but devastating vaccine injuries, the panel made a conscious decision to favor the families when the compensation program was created. To execute this goal, the court does not require petitioners to prove beyond a reasonable doubt that they or their child have been harmed by a vaccine. They must simply demonstrate, through ‘a preponderance of the evidence,’ that it's more likely than not that the vaccine caused the injury – a 51 percent chance, roughly speaking.” However, some believe that this bar is set too high; that, even if they can’t scientifically prove their case, these families have suffered enough to garner some sort of compensation. 6: So What?: This source was valuable for my project because it addressed another values issue in the debate: is it better to favor the law or compassion? The science regarding vaccinations, as many sources have pointed out, is not exact. Does the government, or health officials at the least, have any sort of moral obligation to compensate these types of families even if they did nothing “legally” wrong?

Wood-Harper, Janice. "Informing education policy on MMR: balancing individual freedoms and collective responsibilities for the promotion of public health." Nursing Ethics 12.1 (2005): 43-58. EBSCO. Web. 3 June 2015.

1. Author: Janice Wood-Harper is a Lecturer in Biology and Health Studies at Salford College. 2: Type of source: This scholarly article was published in the journal Nursing Ethics and found on the EBSCO database.

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3: Audience and Purpose: As this article was published in a journal titled Nursing Ethics, the audience of this article were medical and health professionals and potentially policy makers. 4: Main Claim: Wood-Harper states that the aim of this article is to highlight the main ethical issues relevant to vaccination decisions in order to give health professionals some further guidance on how they can improve communication with parents, particularly in those regions where low uptake rates are presenting a threat to public health. 5: Evidence and Reasons: Mass vaccination programs raise complex ethical issues that centre on respect for parents’ rights, the duties and responsibilities of health care professionals, and the role of government in dictating policies for the protection of society and the promotion of public health (45). For instance, it is doubtful whether most parents would prioritize the wider consequences of their decisions for the health of present and future communities if they viewed such decisions as compromising their duty of care towards their own children. On the other hand, it is arguable that parents should at least be aware of, and if possible assume some degree of responsibility for, the potentially harmful repercussions of decisions to refuse vaccination such as loss of herd immunity. Mandatory vaccination could overcome these harms but it is important to consider whether such a gain justifies overriding individual freedom of choice (45-46). 6: So What?: This article was incredibly useful for my project because it outlined both sides of the vaccination debate pretty thoroughly. It balanced the issues of individual rights against the moral obligation to contribute and protect society. Wood-Harper discusses mandated vaccination programs, but she argues that education is the best possible route to increase vaccine uptake once again. I admired Wood-Harper’s call to action especially, which stated, “There is a need for education to focus on two dimensions: communication of current research findings about the true extent of MMR risks and overwhelming international support for the vaccine aimed at assurance and restoration of public confidence; and also explanation of the implications of vaccination refusals for both present and future family members, and for the population at large” (54).

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Sub One: Research Outline

I. Topic Question: Should the U.S. federal government mandate certain vaccines, such as MMR, to lessen the potential threat of lethal, communicable diseases?

II. Underlying Social Problems:

A. Social Problems: Some of the major competing social problems entailed in the vaccine controversy are public health and a prior rights such as bodily autonomy. Each side of this debate is concerned with public health, but each side has a different view on how best to protect public health. Regarding bodily autonomy, each side desires the right to bodily integrity but feels that the other side’s position violates this integrity.

B. Scope of the Social Problems:

1. Studies conducted in California that found five hot spots, including a 1.8-mile area in Vallejo, where 22.7 percent of kids were under-vaccinated. More than 10,000 toddlers lived within the five clusters. The team also identified five clusters where all vaccines were refused for the babies and toddlers in the study. This clustering effect is detrimental, Gross states, as last year, when a record number of California parents claimed personal belief exemptions, health officials reported the most measles cases seen here since 1995 and the most whooping cough cases since 1947 (L. Gross)

2. Since 2008, the Council of Foreign Relations has been studying all the cases of measles, mumps, rubella, and polio around the world. In 2011, France reported a massive measles outbreak with nearly 15,000 cases. Only the Democratic Republic of Congo, India, Indonesia, Nigeria and Somalia suffered larger measles outbreaks that year. In 2012, the U.K. reported more than 2,000 measles cases, the largest number since 1994. And here in the U.S., the prevalence of whooping cough shot up in 2012 to nearly 50,000 cases. Last year cases declined to about 24,000 — which is still more than tenfold the number reported back in the early '80s when the bacteria infected less than 2,000 people (Doucleff.)

III. Proponent Stakeholders

A. Proponents’ Position: Everyone should vaccinate their children, especially against lethal, communicable diseases. If they refuse, some proponents believe that the government or other authorities should intervene.

B. General pro stakeholders

1. Most physicians and health professionals

2. Most scientists and research experts in the field

3. Many parents, especially of young or immunosuppressed children

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C. Specific pro stakeholders

1. Centers for Disease Control and Prevention (CDC)

2. American Medical Association

3. Voices for Vaccines

4. National Vaccination Information Center

IV. Proponents’ Issues, Arguments, Evidence, and Plans/Actions

A. Issue 1: Public Health/Safety

1. Argument: Proponents of mandated/necessary vaccines argue that immunizations protect public health. Many sources cite a phenomenon named “herd immunity” which states that the more people who are immunized, the more protection the general population has against potentially lethal diseases like measles, mumps, and rubella.

B. Issue 2: Bodily Integrity/Autonomy

1. Argument: Proponents argue that individuals who are not vaccinated (by personal objection) and subsequently (although unknowingly) pass along communicable diseases are violating their bodily integrity. Some individuals cannot be immunized for health reasons and are therefore at risk as the number of unvaccinated people rise.

D. Examples of Pro Plans/Actions

1. Stricter mandates on immunizations

2. More accurate and detailed information on vaccines and side-effects

V. Examples of Proponents’ Values

A. Pro Stakeholder Values: Safety

B. Pro Stakeholder Values: Health

C. Pro Stakeholder Values: Bodily integrity

VI. Opponent Stakeholders

A. Opponents’ Position: The decision to vaccinate one’s child should be left up to the each individual family, as a parent has the right to decide what is right for their child.

B. General con stakeholders

1. Some parents (mostly those whose family was allegedly affected by vaccines)

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2. A few physicians

3. Many individuals defending a priori rights

C. Specific con stakeholders

1. Dr. Andrew Wakefield

2. Jenny McCarthy

3. LivingWhole.org (and other “natural” living organizations)

VII. Opponents’ Issues, Arguments, Evidence, and Plans/Actions

A. Issue 1: Public Health/Safety

1. Argument: Opponents of mandated/necessary vaccines argue that immunizations are toxic and cause severe, adverse side-effects; most notable of these alleged side-effects is autism and other developmental disorders.

B. Issue 2: Bodily Integrity/Autonomy

1. Argument: Opponents argue that the government has no right to forcibly vaccinate anyone, that this violates the a priori right of bodily integrity and self possession. Especially in America, citizens see this as a violation of not only their human rights, but of democracy as well.

C. Issue 3: Governmental/Corporate Profit

1. Argument: Many opponent sources cite the issue of conflict of interest in government mandated medication. For every vaccine given, a profit is being made by major corporations, such as Merck, and opponents argue that mandated vaccinations would not be for society’s greater good but rather for monetary gain.

D. Examples of Opponents’ Plans/Actions

1. Opposition/refusal to vaccinate their children

2. Advocate and educate the public on the dangers of vaccinations

VIII. Examples of Opponents’ Values (i.e. self-reliance, security, equality, liberty)

A. Con Stakeholder: Values: Safety

B. Con Stakeholder: Values: Health

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C. Con Stakeholder: Values: Bodily integrity

IX. Definitions/Explanations: Readers should be familiar with vaccine terminology (MMR, DTP, etc.) and the diseases they prevent (measels, mumps, rubella.) Readers should also be aware of the dangers of these illnesses as well as the names of certain vaccine ingrediates, most notably mercury and thimerosal.

X. Limits: This project will primarily focus on the MMR vaccine and it’s controversial, alleged link to autism. Most of the project will cover the post-Wakefield article era, which sparked the greatest vaccine uptake reversal. There have been other vaccine scares and controversies (for example the DTP scandal in the 1970s) but these prior events fall outside the scope of this project.

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Submission Two

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Jade Yamamoto Prof. Eakman CAPS 4360.01 11 June 2015

Submission 2:

Should the U.S. federal government mandate certain vaccines, such as MMR, to lessen the potential threat of lethal, communicable diseases?

Introduction/Exigence While America certainly is not the largest, nor arguably the best, democracy in the modern world, it seems to be the most prominently known. Raised on the ideology of “the land of the free and the home of the brave,” citizens of the United States value, at time above all else, the unalienable rights of life, liberty, and the pursuit of happiness that Thomas Jefferson promised in the Declaration. While most reasonable and sane people do not object to the concept of these rights, troubles often arise in their execution and enforcement. It is a precarious balancing act America’s government has to maintain, weighing the rights of individuals against the overall welfare of its citizens. One frontier in which this balancing act has become more prominent in recent years concerns the medical procedure of vaccination. In 2015, from January 1 to May 29th, the United States experienced a sizeable measles outbreak: 173 people from 21 states reported a confirmed diagnosis. Sixty eight percent of these cases were part of a multi-state linked outbreak that originated in a Californian amusement park. While this might seem an isolated event, in 2014 the United States reported a record number of 668 confirmed measles cases from 27 states; this was the greatest number of cases seen since measles’ eradication from the United States in 2000. In the wake of such alarming numbers, a poignant controversy has re-awakened within the American population. One side maintains that inoculation, especially against communicable and potentially lethal diseases like measles, should be mandated, required, in order to ensure public health and safety. The opposing side, however, argues that vaccines are dangerous and toxic and that refusing them is actually an effort to protect the health and safety of every individual. The opposing side also argues that the government—or any authority—is overreaching its power and infringing on individual rights in enforcing mandated inoculation.

This Capstone project will investigate the ongoing debate over inoculation and address the question of should the U.S. federal government mandate certain vaccines, such as MMR, to lessen the potential threat of lethal, communicable diseases. Key Terms

Autism: a serious developmental disorder that impairs the ability to communicate. This disorder typically appears and is diagnosed in early childhood. Combination vaccines: two or more vaccines that could be given individually but are placed into one shot.

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Compromised immune systems: immune systems that have been weakened or made vulnerable by disease or other factors. Most individuals (children) with compromised immune systems cannot be vaccinated and are therefore at higher risk of contracting diseases. Herd immunity: the number of vaccinated individuals is high enough that viruses have trouble moving from host to host and cease to spread, sparing both the unvaccinated and those in whom vaccination has not produced immunity

Immune system overload: the worry that the current vaccine schedule is overwhelming to a child’s immune system and can cause detrimental side effects MMR vaccine: a combination vaccine that inoculates against the diseases of measles, mumps, and rubella. Measles: a highly contagious virus that exhibits symptoms of fever, runny nose, cough, red eyes, a sore throat, and a rash that spreads over the body. While mild for most adults, this virus can prove lethal for some children. Mumps: a highly contagious virus that exhibits symptoms of fever, headaches, muscle aches, tiredness, loss of appetite, and swollen salivary glands. Rubella: a highly contagious virus that exhibits symptoms of fever and rash. While the infection is usually mild, it is especially dangerous for pregnant women as the virus can cause birth defects of deafness, cataracts, heart defects, mental retardation, and liver and spleen damage. According to the CDC, there is at least a 20% chance of damage to the fetus if a woman is infected early in pregnancy.

Thimerosal: a mercury-based preservative that was removed from every childhood vaccine except multidose flu vaccines by 2002. Preservatives such as thimerosal are necessary for the shipment and storage of multidose vaccines, especially in poorer or developing countries. Vaccine court: officially known as the the Office of Special Masters of the U.S. Court of Federal Claims, the vaccine court was set up in the 1980s as a no-fault alternative to the civil courts. To deal with the possibility of rare but devastating vaccine injuries, the panel made a conscious decision to favor the families when the compensation program was created. To execute this goal, the court does not require petitioners to prove beyond a reasonable doubt that they or their child have been harmed by a vaccine. They must simply demonstrate, through “a preponderance of the evidence,” that it's more likely than not that the vaccine caused the injury – a 51 percent chance, roughly speaking (Kelto). Vaccine schedule: a list vetted by the CDC, American Academy of Family Physicians, and the American Academy of Pediatrics of 26 vaccinations and their recommended times of administration. The schedule is particularly concentrated in a child’s first two years of life.

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Scope In order to maintain organization and a sense of focus, this project will primarily focus on the use of the MMR vaccine and its controversial, alleged link to autism. Most of the project will cover the post-Wakefield article era, as this article sparked one of the greatest vaccine uptake reversal on record. There have been other vaccine scares and controversies throughout (for example the DTP scandal in the 1970s) but these prior events fall outside the scope of this project. However, some history of vaccination, and certain vaccines, will be given for the sake of background and context. Narrative Although it has been dragged to the forefront of controversy in recent years, according to writer and editor Eula Biss, inoculation is actually a precursor to modern medicine, not a product of it. The first “vaccine,” a term used loosely in this context, was created to combat smallpox, a lethal disease that killed thousands in earlier centuries. In 1774, however, an English farmer—after realizing that milkmaids who contracted cowpox (a less dangerous cousin of the variola virus) were immune to contracting smallpox afterward—took a darning needle and injected infected cow pus into the arms of both his wife and child. While this act might seem to us barbaric and atrocious, it did save the farmer’s family and, subsequently, the lives of millions.

The current debate over inoculation, however, circles the question of whether or not vaccination is more monstrous than the diseases it prevents. Additionally, another issue of main concern, especially here in the United States, is the protection of an individual’s a priori rights, such as the right to bodily autonomy and integrity. It is interesting to note that each side of this debate is concerned with the protection of public health, but each side has a vastly different view of what constitutes “public health” and what should be done to protect it. Bodily integrity is also a value held by both sides but, again, each side has their own perspective. Proponents of inoculation—which include most physicians, health professionals, and parents—hold that all able-bodied individuals should be vaccinated, especially against communicable and potentially lethal diseases such as measles. This position adheres to the principle of “herd immunity,” which is where the number of vaccinated individuals is high enough that viruses have trouble moving from host to host and cease to spread, sparing both the unvaccinated and those in whom vaccination has not produced immunity. Herd immunity is particularly crucial for those who cannot be vaccinated due to compromised immune systems. According to an NPR article written by Lisa Aliferis, six year old Rhett Krawitt was diagnosed with leukemia when he was an infant. While Rhett is now in remission, his immune system remains ravaged and vulnerable due to the cancer and subsequent chemo treatments. Because of this, Rhett cannot be vaccinated and must rely on the herd immunity of his community to protect him from the spread of infectious disease. However, the Krawitt family lives in California, a state that has the highest number of personal exemption cases for inoculation. According to Liza Gross, studies conducted in California found five hot spots, including a 1.8-mile area in Vallejo, where 22.7 percent of kids were under-vaccinated. More than 10,000 toddlers lived within the five clusters. The team also identified five clusters where all vaccines were refused for the babies and toddlers in the study. This clustering effect is detrimental, Gross states, as last year, when a record number of California parents claimed personal belief exemptions, health officials reported the most measles cases seen here since 1995 and the most whooping cough cases since 1947.

While these “free-riders”, as Janice Wood-Haper labels them, are “generally tolerated, or certainly are not subjected to any penalties, as long as vaccination rates in the population remain high, as more individuals become free-riders and non-immunity nears a critical point where it

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threatens significant harms to society from increasing outbreaks of measles epidemics, then it becomes important to question the morality of free-riding” and, in conjunction, the morality of compulsory inoculation. Proponents argue that individuals who are not vaccinated due to personal objections, and subsequently (although unknowingly) pass along communicable diseases, are violating their bodily integrity. Some individuals, like Rhett Krawitt, simply cannot be immunized for health reasons and are therefore at risk as the number of unvaccinated people rise.

While the United States has never had a federal compulsory vaccination law, there were several instances that toed the line. In Eula Biss’ book, On Immunity: An Inoculation, it is mentioned that “George Washington, a survivor of smallpox, wrestled with the question of whether or not to require inoculation for revolutionary soldiers long before vaccination became a question of conscience. In 1775, roughly a third of the Continental Amery fell ill to smallpox while laying siege to Quebec. Several times, Washington ordered inoculation and then withdrew the order days later. Finally, with rumors in the air of a British plan to spread smallpox as a form of biological warfare, Washington ordered the inoculation of all new recruits.” Biss goes on to discuss that in the early 20th century some states had compulsory laws, but 2/3 of the states did not, and a couple states had laws against compulsion. However, the uptake of vaccinations was much higher in the 20th century, in the generation that Biss calls the “Polio Pioneers.” Living in the wake of war and in the shadow of the A-bomb, the generations of the 20th century took the risk of inoculation, even though the polio and smallpox vaccines were far more dangerous that any of our current childhood vaccinations; it is estimated that the risk of death, Biss states, was about one in a million.

However, the mentality of our parents’ and grandparents’ generation has fallen out of favor. Diseases like smallpox and polio have been eradicated from the first world and, therefore, the fear associated with them has dissipated. As such, mandated vaccination is no longer seen as a safety precaution, but rather a violation of civil rights. Opponents of mandated inoculation hold that the decision to vaccinate one’s child should be left up to each individual family, as a parent has the right to decide what is right for their own child. Furthermore, opponents argue that the government has no right to forcibly vaccinate anyone, that this violates the a priori right of bodily integrity and self possession. Especially in America, citizens see this as a violation of not only their human rights, but of democracy as well.

At first glance, the opposition’s side might seem overly politically motivated, but their staunch defense is actually rooted in the desire to protect public health. In 1998, Dr. Andrew Wakefield and twelve other scientists published an article that alleged a link between the MMR vaccine and the development of autism in young children. According to pediatrician Jeffery Baker, in the 1990s, physicians saw a sharp rise in autism diagnoses. However, “parents confronted with their child's diagnosis in the 1990s were met with long waiting lists and primary care doctors who seemed barely familiar with the condition. Placed in this predicament, parents not surprisingly turned to one another and the Internet.” One theory that came into prevalence was the “leaky gut” theory that proposed that an abnormality in intestinal permeability may admit intestinal toxins affecting the nervous system at an early age. Wakefield utilized this theory in his study of the MMR vaccine and soon the ethyl-mercury preservative, thimerosal, was implicated as the catalyst for autism development. In the burgeoning era of the world-wide-web, there were quickly numerous cases and anecdotes that detailed children experiencing adverse reactions—uncontrollable screaming, raging fevers, deterioration in mental facilities—soon after receiving the MMR vaccine. Baker also states that “although noting that there was no evidence that the use of thimerosal as a vaccine preservative had caused any true harm” it was decided that “thimerosal-containing vaccines should be removed as soon as possible given the concerns raised by the Environmental Protection Agency's guidelines.”

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In the decades since Wakefield’s initial article, there have been numerous in depth studies concerning vaccines, thimerosal, autism, and other adverse side effects. All of these studies have concluded that, while there are some very minor and rare risks of vaccine induced side effects—Biss reports a study that found convincing evidence that the MMR vaccine can, very rarely, cause a condition called measles inclusion body encephaltitis in people with compromised immune systems—vaccines, most especially the MMR vaccine, are safe and should not be skipped. Still, some parents are concerned that the chemicals in vaccines are unnatural and therefore dangerous. Immune overload is also a primary concern with parents, who believe that the current recommended vaccine schedule is “too much, too soon” for a child’s vulnerable and still developing immune system. One response to this theory, Eula Biss reports, is found in The Vaccine Book written by Robert Sears. Within this book, Sears details two alternatives to the current vaccine schedule: a selective vaccine schedule and a complete alternative vaccine schedule. Under the selective option, Sears recommends covering only “important” vaccines, leaving out hep B, polio, measels, mumps, and rubella. Under the complete alternative option, Sears recommends spreading out all the vaccines a child would receive in a two year span over the course of eight years, to lessen the amount of substances a child is injected with and to lessen the chance of severe, adverse reactions.

Along the lines of immune overload, there are those who contend the diseases that current vaccines try to prevent—chicken pox, measles, mumps, rubella, etc.—are not that severe or dangerous, and so children should not inoculated against them. There are also some parties that believe government mandated medication is a conflict of interest since, for every vaccine given, a profit is being made by major corporations, such as Merck. Opponents of vaccination, therefore, argue that mandated inoculation would not be for society’s greater good, but rather for monetary gain. Nevertheless, despite the evidence to the contrary, in the 1980s, the Office of Special Masters of the U.S. Court of Federal Claims, often referred to as “the vaccine court”, was set up as a no-fault alternative to the civil courts. According to an NPR article written by Anders Kelto, “to deal with the possibility of rare but devastating vaccine injuries, the panel made a conscious decision to favor the families when the compensation program was created. To execute this goal, the court does not require petitioners to prove beyond a reasonable doubt that they or their child have been harmed by a vaccine. They must simply demonstrate, through ‘a preponderance of the evidence,’ that it's more likely than not that the vaccine caused the injury – a 51 percent chance, roughly speaking.”

Eula Biss makes another interesting point when she notes that “perhaps what matter is not whether people are right on the facts” about vaccines “but whether they are frightened.” She goes on to say “What vaccines do not cause is significantly harder to establish than what they do cause. While a substantial amount of evidence is acceptable as proof that an events does and can happen, there is never enough evidence to prove that an event cannot happen.” As demonstrated above, safety and health are the crux issues in the vaccine debate, and whether an individual stands in solidarity or opposition of mandated inoculation, it all boils down to what is considered the safest route for each child and, unfortunately, until science evolves to be more exact, the “safest route” will continue to be different for every individual. Plan of Work Dear Beth, I am writing to present an overview of my plan of work to complete my Capstone project for the summer semester of 2015. I will need to accomplish submissions 3, 4, and 5 over the course of the next 7 weeks and feel that I have the resources to complete the project well and on time.

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Project Overview This Capstone project will investigate the ongoing debate over inoculation and address the question of should the U.S. federal government mandate certain vaccines, such as MMR, to lessen the potential threat of lethal, communicable diseases. Proponents of inoculation maintain that it is for the good of society, in order to protect and secure public health and curb any infections diseases that could potentially threaten and or devastate the population. Opponents, however, hold that vaccines are dangerous and toxic, and that government mandated inoculation is a violation of civil rights. This project will examine the values, concerns, and consequences of both sides. Objectives

• Research vaccines and the controversy surrounding them, especially the MMR combination • Draft an annotated bibliography of sources and outline debate (Sub 1) • Draft a narrative of the debate (Sub 2) • Analyze the arguments of each side and their validity (Sub 3) • Find and interview subjects pertinent to debate (Sub 4) • Write a final draft of project (Sub 5) • Upload files to issuu.com

Work Completed

• Research vaccines and the controversy surrounding them, especially the MMR combination • Draft an annotated bibliography of sources and outline debate (Sub 1) • Draft a narrative of the debate (Sub 2)

Work Remaining

• Analyze the arguments of each side and their validity (Sub 3) • Find and interview subjects pertinent to debate (Sub 4) • Write a final draft of project (Sub 5) • Upload files to issuu.com

Discussion Currently, I am somewhere between on schedule and behind it. With this project broken up as it is, it feels like accomplishing each task is manageable in the times between each submission, but I also feel that I’m too focused on current portions and not looking forward to impending deadlines. For the most part, I’m talking about interview subjects. Up until this point, the project has mostly relied on research and drafting papers, which are rote tasks for most college seniors. But, in between drafting submissions and a new summer job, I fear that I will not delegate myself enough time to find and interview subjects for my submission 4. To combat this, I hope to find some potential interviewees in the next week, perhaps after a meeting with you, Beth, to see if you might have any suggestions.

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Conclusion Research has proven fruitful, and drafting a narrative of this controversy has turned out to be more than just a tad enlightening. Despite some minor concerns and some polishing and perfecting, I am confident that with my resources and time management strategies I will complete this task on time. Sincerely, Jade Yamamoto

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Works Cited


June 2015.


Journal of Public Health 98.2 (2008): 244-53. EBSCO. Web. 3 June 2015. Biss, Eula. On

Immunity: An Inoculation. N.p.: Graywolf, 2014. Print.










Health Shots. NPR. Web. 3 June 2015.

Kassianos, George. "What is wrong with the single vaccine?" Pulse 14 Apr. 2003: n. pag. EBSCO.

Web. 3 June 2015.






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developmental disorder in children." The Lancet 351.9103 (1998): 637-41. EBSCO. Web. 3

June 2015.




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Submission Three

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Sub 3 Worksheet

Name: Jade Yamamoto

Normative question: Should the United States maintain the current vaccine schedule of 26 vaccinations (which include combination vaccines like MMR) over a child’s first two years of life or adopt alternative schedules, like single vaccines or the schedules proposed by Dr. Robert Sears?

Issue #1: Public Health/Safety

• Proponents of maintaining the current schedule argue that adopting a “selective schedule”, as Robert Sears advocates, does not cover vaccines for hep B, polio, measels, mumps, and rubella, which are communicable and potentially dangerous diseases. Sears’ other alternative, aptly named the “complete alternative vaccine schedule,” spreads out all the vaccines a child would receive in a two year span over the course of eight years, but proponents argue this can increase a child’s risk for adverse reactions. Also, proponents argue that single vaccines have neither proven more effective nor any safer, and in some areas have not properly prevented the spread of communicable diseases.

• Opponents argue that the current vaccine schedule is “too much, too soon,” and subjects a child’s vulnerable and still developing immune system to unnecessary diseases and toxins.

Critical analysis

From a critical and scientific perspective, proponents of the standard inoculation schedule have substantially more evidence to support their claim. Since Andrew Wakefield published his article in 1998 implicating vaccines as a cause or catalyst of autism, there have been numerous in depth studies—conducted by impartial medical boards, the CDC, the Institute of Medicine and other professional health organizations—concerning vaccines, thimerosal, autism, and other adverse side effects. All of these studies have concluded that, while there are some very minor and rare risks of vaccine induced side effects—Eula Biss reports a study that found convincing evidence that the MMR vaccine can, very rarely, cause a condition called measles inclusion body encephaltitis in people with compromised immune systems—the currently recommended vaccines, most especially the MMR vaccine, which has been used for 50 years, are safe and should not be skipped. Single vaccines have also been found to be less effective, in Japan especially when they switched to single vaccines in 1992, after a problem with the mumps virus in their homemade MMR, but there has not been a decrease in autism. Nor have single vaccines controlled measles infections. The issue of herd immunity also gives the proponent side more substantial weight, as widespread vaccination must occur in order to protect large populations. Additionally, the most recent measles outbreaks—like the Disneyland epidemic—have given herd immunity more exigence. On the other side, the opponents of the current inoculation schedule have neither much substantial evidence nor precedence. The Andrew Wakefield article, that first stone in the avalanche of vaccine uptake reversal, has long since been retracted by the journal it was published in, The Lancet, and has been disproven as a cause of autism multiple times by other studies. There have been some studies that found a marginal number of children suffered adverse reactions to the vaccines,

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but there has been no concrete evidence that the contents of the vaccines had been toxic. Nevertheless, pediatrician Jeffery Baker states that “although noting that there was no evidence that the use of thimerosal as a vaccine preservative had caused any true harm” it was decided that “thimerosal-containing vaccines should be removed as soon as possible given the concerns raised by the Environmental Protection Agency's guidelines.” In result, thimerosal, the accused preservative in much of the autism rhetoric, has been removed from every American childhood vaccine except multidose flu vaccines since 2002. Opponents also argue that the diseases that some of these vaccines prevent—measles, mumps, rubella, hep b—aren’t severe enough to warrant inoculation. Katrina Brown reports that in many cases, opponents had “experienced measles, mumps and rubella in themselves or their siblings as children. Most of these first-hand experiences were mild” and so affect parent’s decisions to reject vaccines like the MMR combination. However, these diseases have still proven fatal in many cases, especially for those with compromised immune systems. Ethical analysis

From an ethical standpoint, however, the issue of public safety in this debate is not as clear cut. Eula Biss points out that “what vaccines do not cause is significantly harder to establish than what they do cause. While a substantial amount of evidence is acceptable as proof that an events does and can happen, there is never enough evidence to prove that an event cannot happen.” She also makes the poignant statement that “perhaps what matter is not whether people are right on the facts, but whether they are frightened.”

Even if the science is not substantial or exact, there are still numerous cases and anecdotes that detailed children experiencing adverse reactions—uncontrollable screaming, raging fevers, deterioration in mental facilities—while adhering to the current vaccine schedule. And these anecdotes and cases are just as heartbreaking and deserving of sympathy as those of children actually contracting measles. The government has even admitted that they are not infallible, that the science of inoculation is not exact, and established the “Vaccine Court” in the 1980s to—according to NPR journalist Anders Kelto—“to deal with the possibility of rare but devastating vaccine injuries, the panel made a conscious decision to favor the families when the compensation program was created. To execute this goal, the court does not require petitioners to prove beyond a reasonable doubt that they or their child have been harmed by a vaccine. They must simply demonstrate, through ‘a preponderance of the evidence,’ that it's more likely than not that the vaccine caused the injury – a 51 percent chance, roughly speaking.”

Both proponents and opponents of mandated inoculation value health and safety, and each side has potential and detrimental consequences for their course of action. For proponents, the consequences of their position is that, in future, it may be proven that components of vaccines are toxic, or that they affect developing immune systems in unforeseen ways, and numerous children could be put at risk for severe side effects. For opponents, not vaccinating their children according to the official schedule can—and has—led to serious outbreaks of communicable diseases such as measles. Not inoculating also puts already sick and vulnerable individuals at a higher risk of further disease and potentially death since they cannot be vaccinated. Despite these conflicting consequences, both sides still maintain similar obligations and responsibilities: parents have the obligation to do what (they believe) is best for their children. In result, doctors and health professionals have the obligation to distribute accurate and detailed information about vaccines and medicines so that parents can make the best decisions.

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Issue #2: Bodily Integrity/Autonomy

• Proponents argue that individuals who do not vaccine properly due to personal objections, and subsequently (although unknowingly) pass along communicable diseases, are violating their bodily integrity. Some individuals, those with suppressed immune systems, simply cannot be inoculated for health reasons and are therefore at risk as the number of unvaccinated people rise.

• Opponents argue that the decision whether and how to vaccinate one’s child should be left up to each individual family, as a parent has the right to decide what is right for their own child and that the government has no right to forcibly vaccinate anyone as this violates the a priori right of bodily integrity and self possession.

Critical analysis

From a definition stand point, both sides make a valid case regarding the concept of bodily autonomy/integrity. Bodily integrity emphasizes the importance of personal autonomy and the self-determination of human beings over their own bodies. According to this definition, each side of the debate argues that the other side is directly violating this a priori right. For proponents, making the decision to not vaccinate one’s child puts the whole of society at risk. There is no physical way to tell if someone is vaccinated, and individuals may carry viruses without presenting any symptoms. For individuals with suppressed immune systems or those who otherwise cannot vaccinate, not vaccinating directly affects them, without their knowledge or consent. On the other side, opponents argue that neither the government nor any authority has the right to forcibly require someone to medicate themselves. Especially in our American democracy, any action that seems to violate an individual’s rights is viewed as abhorrent and, by definition, mandated inoculation does violate these upheld rights. Ethical analysis

Ethically, once again, the debate falls into a grayer area. Both sides hold the same values of bodily integrity and respect of individual’s rights, but their consequences differ in terms of scale and severity. If an individual with cancer or another autoimmune disease contracts measles from someone unvaccinated or under-vaccinated (which they are at higher risk for, going to and from hospitals for treatments, surgeries, etc.) the consequences could be potentially lethal. While the side effects that opponents allege are due to combination vaccines or immune overload can be severe and life altering (like in the case of autism), death is not as large of a concern. But, again, there are conflicting obligations in this debate. The government is obliged to protect and respect the rights of individuals, but in this debate, which “individuals” should be protected? How does one rank one side’s right to bodily autonomy over the other side’s?

Discussion and Conclusion

While extensive research has brought to my attention many facts and issues that I did not know surrounded the immunization debate, I still maintain my prior opinion on current, official inoculation recommendations: the current schedule should be maintained and enforced, and

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“personal exemptions” should be more strictly regulated. The consequences of allowing everyone to opt out of vaccines if they so choose just seem to dire and damning; already the number of measles cases in this year alone have escalated past records over the last half century. While I am sympathetic to the anecdotes of vaccine reactions, for lack of a less callous phrase, these smaller number of reaction cases seem an acceptable risk, following the principle of least harm, when thinking about the consequences of a widespread epidemic, especially when considering the level of lethalness an epidemic could pose for those already ill.

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Submission Four

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Jade Yamamoto Prof. Eakman CAPS 4360.01 21 July 2015

Submission 4

Expert Interviews

Interviewee: Wesley J. Hodgson, MPA, School Compliance Coordinator, Assessment, Compliance and Evaluation Group Immunization Branch Texas Department of State Health Services

[Some technical di f f i cul t i es with recording were exper ienced during the f i rs t part o f this interv iew. As such, the f i rs t two responses are paraphrased and summarized from notes taken by the interv iewer .]

1) Can you lay out the current childhood immunization schedule and briefly explain the rational behind it?

“Every year, the CDC publishes a list of recommended immunizations and their timelines for children and adults. The state of Texas then takes these recommendations and turns them into requirements for school grades K-12 and for childcare facilities. However, Texas standards require only a certain amount of doses for a child to attend school; these standards do not track or consider the CDC recommended timelines for immunizations. As such, some vaccine administration can be delayed and a child may still attend school and or childcare.” 2) I’ve heard many opponents against the current schedule mention the concept of

“immune overload.” How much of a concern do you believe this phenomena is? “This concept has been studied extensively by the CDC and they’ve found it to not be an issue. And the reasons for this is…well consider this analogy: When a child contracts the common cold, they are exposed to 4 to 10 antigens at time; additionally, a child exposed to strep is exposed to 25 to 50 antigens. This demonstrates that the immune system is capable of addressing and handling multiple antigens at one time without much of a problem. Our vaccines, in comparison to these diseases, do not contain anywhere near this number of active antigens.” 3) Have you ever had a patient, or contact with a patient, who suffered adverse reactions to inoculation? If so, could you briefly describe the experience?

“I’ve never had. I don’t do direct services. Earlier on in my career, I worked in direct services and immunizations were provided in the clinic, but I never saw an adverse events or reaction. But there are systems in place to monitor those. The Centers for Disease Control…first of all the CDC ensures that vaccines are tracked to see if there are any possible problems with them so they can have early warning, and do a recall with the vaccine if there’s a problem. I wouldn’t compare it to a

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car recall because it works much faster, but there’s a monitoring system in place, so that’s what I wanted to get across to you. There are three primary vaccine safety activities. The Vaccine Adverse Event Reporting System, known as VAERS it’s an early warning system where people can report vaccine concerns and it helps the Centers for Disease Control and the Food and Drug Administration to detect possible side effects or adverse events following vaccination. Then there’s also the Vaccine Safety Data Link and that’s a collaborative effort between the CDC and other healthcare organizations using de-identified health records to monitor and evaluate adverse events following vaccination. And there’s the Clinical Immunization Safety Assessment Network, another collaboration with the CDC and some medical research centers to conduct research into how adverse events might be caused by vaccines. So you can see there’s a three-pronged approach to monitoring adverse events to help protect the safety of the vaccine and also the individual, which is our main concern.”

[In a lot of my research, the main issue that people were arguing about were the potential adverse reactions to vaccines, and obviously the autism scare that people jumped on board with a few years back. I was just wondering about that experience.]

“Well, you know Autism, that whole report was debunked. But people don’t forget it the first time around. They see the report and they don’t see the retraction, even though the doctor what conducted the study was disbarred and not allowed to practice anymore. I think he only had a few select patients that he monitored. The CDC study this case extensively, and they found no association with Autism and the administration of vaccines. […] The FDA licenses vaccines, and they have to go through trials just like any other new medications, and they look for adverse events following the administration of vaccines. So it goes through the normal human testing. Of course, it’s recorded and monitored thoroughly to make sure no events or clusters of events are happening, and if there are then they would make an immediate adjustment to the schedule or the use of the vaccine.”

4) One of the ethical issues surrounding this controversy is how to balance the safety and welfare of the individual v. that of the general public. Where do you fall on the issue?

“The welfare of the individual and the welfare of the general public—we fall on both sides. The individual should be immunized to protect them against diseases, as well as the general public. An individual that is not immunized can infect the general public, and so that’s an issue there. They can bring it into the community. The cornerstone to the immunization program is to prevent deadly diseases from reaching the citizens. Vaccines are highly effective in preventing death and disability, and they save billions of dollars annually. A decision to vaccinate is to help protect not only the individual but the entire community from diseases. A decision not to vaccinate puts the individual and the community at risk because of that susceptible population that can transmit the disease if they contract it to the rest of the population. Despite vaccines being very highly efficacious, some of them are not completely 100% so they are still slight percentages of susceptible population, plus people that are unimmunized for several reasons. They might have a medical reason to not be vaccinated, for example they might be immunocompromised, or they might have a conscientious exemption against getting vaccinated. So there are several things to consider there. But when a community reaches what’s called a “herd” level of immunity, that’s when…think of a large cluster of people in a circle. If one or two are unvaccinated in the middle, but you have all of these protected people around them, that will prevent the unimmunized from getting infected because there is no

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transmission possibility because everyone is immune. So you’ll have some individuals that are not vaccinated that will still be protected from the disease. Therefore, the likelihood that a infected person would transmit the disease to a susceptible person is greatly reduced.”

5) Recently, Austin Regional Clinics have begun to refuse unvaccinated children. Do you see this trend continuing throughout the medical community on a more state or national level?

“This is a very topical and interesting question. I was not surprised, but certainly I’m for immunization, so I was glad to hear this proclamation by Austin Regional Clinics. You have to keep in mind, though, this only pertains to the pediatric population. They obviously had reasoning to make the decision, where they were probably seeing a lot of children coming in who weren’t immunized and just felt that in a waiting room, in a clinic, they see a lot of sick children, and they probably have seen some with vaccine preventable diseases and a lot of transmission can occur, particularly in a pediatric population where children or infants who are too young to be immunized are still susceptible and a lot of spread can go on within a medical facility. So I think that’s one of the reasons that they came up with that policy. I’m going to compare this to the recent epidemics in California where they had the measles cases. The problem with those cases is the preponderance of them where unimmunized based on their philosophical beliefs, which we call conscientious objections here in Texas. There was a real fear here in Texas and in schools, childcare facilities and doctor’s offices. It was a very busy time because we received so many inquiries about that. There were facilities asking if they could exclude, just like the Austin Regional Clinics. In my opinion, if we have more outbreaks like this, we’re going to see a lot more of this extreme concern, and possibly there might be ramifications like at the Austin Regional Clinics. We’re at a point here in Texas where we have each year more and more children who get exemptions from immunizations for philosophical beliefs. These were first allowed in 2003 and they are up to probably about 50,000 now here in the state, and that’s a significant amount. If we don’t have this herd immunity we talked about before, if we get too many susceptible, then we are opening up the door to going back to the earlier days where diseases were rampant. I think one of the contributing factors to people not wanting to get their children vaccinated or not considering it important is the fact that no one’s seen these diseases, really, because of the effectiveness of vaccines, and I think this leads to a certain degree of complacency. Back in the 50s, when polio the counts were so high and individuals could actually see the ravages of the disease—the paralysis and iron lungs—people really ran to go get their immunizations. But that’s not the case now. People don’t see measles or diphtheria, I mean we still have pertussis more than anything, but they still don’t see that either. They’re all horrible diseases, you can die from them. Immunizations are one of the most effective prevention efforts in public health ever.”

6) In your opinion, what do you think is going to be the most effective method going forward in convincing parents, and the community at large, to vaccinate their children?

“It’s a multi-pronged approach. Visible outbreaks, evidence in the community that cases are occurring, is one way to educate parents about the importance of vaccinations. But we also have education programs for parents. We have a website that has a lot of information, and we send out information as well. We have tons of brochure and things like that. We also provide—one of the key factors in getting someone vaccinated is the education of their physician or provider. We have training, the CDC has trainings every year, and we have a training module on our website where

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physicians can go through that and become familiar with the whole program in order to spread the information to patients. A physician saying to a patient “You need to get vaccinated.” is a very effective way to actually getting children vaccinated since patients trust their provider. Just addressing the facts and letting people know the right information and debunking the autism theory that everyone has heard about and talks about, we need to debunk it, show that it’s not a genuine thing, dispel any myths and rumors about vaccination programs and show the positive side of immunizations. And these outbreaks like in California will cause parents to become more aware that these diseases are still around. Then parents will think a second time, ‘Well I didn’t get my child vaccinated and maybe I do need to get them immunized.’”

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Interviewee: Michelle Schneider, Legislative Outreach Coordinator for Texans for Vaccine Choice

1) Can you talk a little bit about what you do at Texans for Vaccine Choice and the organization’s mission statement? “We are actually a fairly new organization. We came about in February of 2015. A North Texas member of the House of Representatives announced to the media on a Friday afternoon that he intended to file a bill to eliminate what are called “reason of conscience exemptions” from childhood vaccination requirements for public schools. So a bunch of active parents came together on Facebook and decided that we needed to do something about this to prevent it from happening. Within about six weeks, we grew to about 1300 members from all across the state.” 2) What is your position on the current CDC recommended schedule of childhood immunizations? “There are some [members] who vaccinate completely, some vaccinate on an alternative schedule, some don’t vaccinate at all, some…for some vaccination isn’t the issue, it’s more the overarching issue of privacy and liberty. What we focus on is not necessarily the safety and efficacy of vaccines and we definitely don’t recommend a particular schedule, that’s not really our place, but what we do is try to, in many different ways, is we try to protect our right to decide what goes into our bodies and the bodies of our children, and the right to make medical decisions for ourselves and our children.” 3) Can you briefly describe what your personal experience has been with inoculation? “I have a fully vaccinated seven-year-old daughter, a partially vaccinated four-year-old daughter, and a completely unvaccinated two-year-old son. The reason they are have different experiences is that I had vaccinated my seven-year-old up until four years completely and that was the last time she was due for shots so, for her age, she is completely vaccinated. At twelve months, my daughter Reece [four-year-old] was due for one shot to catch her up on a series, the HIB series, and that was on a Friday afternoon. By Sunday, which is when we had her first birthday party, we noticed a huge difference in her demeanor. There was lack of engagement, lack of eye contact, lack of affect in general, and from there it sort of snowballed over the subsequent months. Various health conditions began coming up and then eventually she was diagnosed with encephalopathy. She’s also got a hearing loss disorder, a genetic disorder that affects her hearing and thyroid, and there’s multiple other diagnoses: seizures and autism and a number of different health conditions that she suffers from. Currently, we have an opened petition in the US Federal Court of Claims and the Vaccine Court. So that’s sort of our history and obviously when I became pregnant with our third child it was kind of an easy decision: this was not benefiting our family, the risk vs. the benefit was not panning out the way it should for our family, and we just decided to avoid that risk all together, and he is [her son] completely unvaccinated.”

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4) One of the ethical issues surrounding this controversy is how to balance individual rights and the rights of the community at large. How do you think this balance can best be accomplished? “I think we have a good balance now. Once reasons of conscience exemptions were introduced, our state vaccination rate actually rose. So, in my opinion, and this is borne out of statistics, and the State Department of Public Health confirms this with their numbers, that exemptions are not posing a risk to public health. We still have very high vaccination numbers in the state, so I think that we are able, in this state right now, to maintain a really good balance between parental rights and public health. And I think that allowing people to make this decision and ultimately leaving it in the hands of themselves and their chosen medical practitioners is the best way, the most ethical way to go, and it preserves ideals of informed consent, bodily autonomy, and just let the patient make the ultimate decision.” 5) Recently, Austin Regional Clinics have begun to refuse unvaccinated children. Do you see this trend continuing throughout the medical community on a more state or national level? “I absolutely do. I think that this is fairly calculated. The Texas Medical Association strongly pushes each legislative session for more strict rules as far as exemptions. They were unsuccessful this past session because they had seventeen bills filed in both chambers and I think sixteen bills failed. So now it’s a matter of trying to get it done in the private sector, eliminating the right to choose in the private sector, and it’s actually going to negatively impact the most vulnerable population. So kids who are on Medicaid and CHIP, this is going to impact them the most. It’s hard for them to find a new practitioner; we get private messages throughout each week that say “Listen, my doctor used to be okay with the vaccination schedule that we’re on, but now he’s saying that the clinic he practices under is making him do this and making him refuse care.” In my experience, at one point in time, all three of my children were on Medicaid and finding a practitioner that accepts new patients with Medicaid, and that accepts new patients on Medicaid who delay or opt out of vaccines, is a huge burden. And it’s going to snowball. It’s going to be repeated in clinic after clinic, and we’re seeing that already.” 6) Going forward, how do you, and Texans for Vaccine Choice, plan to continue advocating and educating the community? “As we go forward our goal is basically to reach out to as many people who hold the reigns as possible. To get our members to actively engage in the political process and to reach out to their representatives and do what constituents are there to do and hopefully the people that represent us will do what they are obligated to do, which is to listen to us and hear us out, hear our concerns, and advocate for us and on our behalf. As far as the Austin Regional Clinics issue, we’ve actually been in contact with them since before they implemented the new policy, in an attempt to get them to sort of compromise with us and their patients and be a little bit more accepting. There is a law on the books that protects patients and allows them to make this decision for whatever reason they want, but enforcement is not a option. There’s no fine or fee associated with that. But we obliviously don’t want patients to be left without a medical home, and that’s sort of the biggest issue for us. When it comes to these more private sector matters, it ultimately leaves patients without care. And finding

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doctors that are more understanding of this choice is a goal of ours and creating a database of them and also of doctors who are not as understanding of it. We want to be a resource for people, we want to be a resource for legislators, because I think that no one is beyond education, I don’t think that anyone is patently, woefully ignorant. I think there is a way to compromise on this, a way to not be so heavy-handed, and I think that so far we have succeeded in that, it’s now just a matter of maintaining it.”

Civic Engagement

Regarding my civic engagement, I’m still trying to find a clinic or other health provider in need of a brochure and or pamphlet. The ones that I contacted in the past either did not respond or did not accept my offer. I’m hoping to have better luck this week.

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Submission Five (Revision One)

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Jade Yamamoto

Prof. Eakman

CAPS 4360.01

24 July 2015

Submission 5

The year is 2015, according to the Gregorian calendar. In America, it is the year of

presidential campaigns, the year of groundbreaking Supreme Court decisions, the year of torrential

Southern floods; for better or worse, it is the year of rejuvenation. Vintage is making a come back, if

fashion magazines and the reboots of late 20th century classics such as Jurassic World, Mad Max:

Fury Road, and Terminator: Genisys are anything to go by.

However, it seems pop culture and political parties are not alone in their revivals: something

more sinister seems to also be on the rebound. In the early months of 2015, news stations across the

United States tracked the spread of a potent measles strain that originated in California’s Disneyland

amusement park. From January 1 to May 29th, 173 people from 21 states reported a confirmed

diagnosis. In the light of America’s large population, these numbers and cases might seem

insignificant or at least unimposing; there is also the temptation to call this an “isolated event.” But

in 2014 the United States reported a record number of 668 confirmed measles cases from 27 states.

This was the greatest number of cases seen since measles’ eradication from the United States in

2000.xlii

Given these collective numbers, it seems these viruses and microbes of bygone eras are

rallying for a nostalgic reunion tour. In the wake of 2014’s Ebola scare,xlii which—given the news

coverage—for a while appeared to be teetering on the edge of a full-scale, global epidemic,

American citizens quickly grew tense and concerned with the mounting cases of measles, especially

since the majority of potential victims tended to be infants and children. It’s an instinctual urge we

have to protect our young; it’s primordial, potent, fierce as a wild lioness defending her cubs. Eula

Biss, author of On Immunity: An Inoculation, references the Grecian hero Achilles, whose mother—

motivated by love and fear—dipped him in the river Styx to try and make him immortal, to try and

make him invincible. Take away the mythology and magic, inoculation falls under the same premise

of dipping our children in the Styx: it is an effort to protect and fortify them.

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And yet the nation has already begun to divide itself over something as seemingly

innocuous as inoculation. As the media is wont to do, at first glance the opposing sides of this

controversy seem polarized. On one side are pitted the “professionals” the “experts”: doctors and

scientists, health care providers from A-Z. These individuals are portrayed as authoritative and

knowledgeable—which is understandable, given their plethora of degrees and qualifying credentials.

They cite medical studies and empirical evidence, quote CDC and FDA findings and conclusions.

The overwhelming message is simple: “Vaccinate your children according to (the CDC

recommended) schedule.” And who is an ordinary citizen to argue with such upstanding and valued

institutions? Inoculation is touted as the only sane and responsible choice for parents to make.

Especially when the opposing side is almost always portrayed by the most vocal and most visible

extremists. You’ve seen them, no doubt: angry, anti-vax mothers standing in front of clinics,

crowing from their soapbox about mercury poisoning and toxicity and all natural alternatives. Jenny

McCarthy is their poster celebrity.

But what the media (surprisingly) does not articulate is that this controversy is more nuanced

and intricate than it appears at first blush. Both sides of this debate have valid concerns and

admirable values; in fact, they share many of the exact same values and concerns. The welfare and

health of a child is paramount; again, it is genetically encoded in the smallest building blocks of

humanity to protect our progeny. Each side of the vaccine debate holds, what they believe to be, a

child’s best interest at heart: stalwart pro-vaccine individuals advocate for strict adherence to the

current CDC recommended schedule of 26 childhood immunizations; however, anti-vaccine

individuals aren’t as extreme or unreasonable as previously portrayed. A majority of “anti-vax”

individuals are actually ordinary parents, with no political or secondary agenda, who only want to

make a decision that they feel is best suited for their family and circumstance, whether that decision

is to forgo vaccination completely or adopt an alternative schedule.

So now, the debate over inoculation becomes less clear cut. It’s no longer science v. science

fiction, medical professions against the likes of Jenny McCarthy. It becomes the rights of an

individual v. the rights of community. No case is the same and no solution can be completely

satisfactory.

Although it has been dragged to the forefront of controversy in recent years, Eula Biss gives

a surprising reminder that inoculation is actually a precursor to modern medicine, not a product of

it. The first “vaccine,” a term used loosely in this context, was created to combat smallpox, a lethal

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disease that killed thousands in earlier centuries. In 1774, however, an English farmer—after

realizing that milkmaids who contracted cowpox (a less dangerous cousin of the variola virus) were

immune to contracting smallpox afterward—took a darning needle and injected infected cow pus

into the arms of both his wife and child. While this act might seem to us barbaric and atrocious, it

did save the farmer’s family and, subsequently, the lives of millions.xlii

While nothing so severe as smallpox is currently running rampant in America, the debate

over inoculation still circles the question of whether or not vaccines are more monstrous than the

diseases they prevent. Opponents argue that vaccines, at least in some capacity, are toxic. The

ethylmercury containing preservative thimerosal is often cited as the most prominent culprit, after

it’s infamous link to autism was reported in the late 1990s. This link appeared in the wake of a sharp

rise in autism diagnoses. According to pediatrician Jeffery Baker, as more and more parents were

faced with this diagnosis, they were also “met with long waiting lists and primary care doctors who

seemed barely familiar with the condition. Placed in this predicament, parents not surprisingly

turned to one another and the Internet.”xlii

One theory that came into prevalence and attempted to explain the increase in autism

diagnoses was the “leaky gut” theory. This theory proposed that an abnormality in intestinal

permeability may admit intestinal toxins affecting the nervous system at an early age. In 1998, Dr.

Andrew Wakefield and twelve other scientists utilized this theory in their study of the MMR vaccine

and alleged a link between the vaccine and the development of autism in young children.xlii

Wakefield’s article, although redacted by The Lancet (the journal it was originally published in) and

debunked by a multitude of subsequent studies, sparked the largest uptake reversal of vaccines in the

last half century. What is interesting, however, is that mercury has been used as a preservative in

vaccines since the early 1900s. Before the use of such preservatives, one of the most troublesome

safety issues afflicting early 20th century child immunization was that of bacterial contamination. This

could easily occur on a sporadic basis, when general practitioners might have to draw vaccines from

multidose vials under poor hygienic conditions. The need for effective preservatives was readily

apparent and represented one of the most important safety issues for the promoters of new

vaccines.xlii

However, concerns over mercury and mercury based preservatives arose in the latter half of

the 20th century, when citizens of Minimata, Japan were discovered to have methylmercury

poisoning from a factory dumping waste into their water supply.xlii A global treaty was called for the

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banning of mercury in consumer products, but The World Health Organization recommended that

thimerosal be excluded from the ban in the interest of global health and the American Academy of

Pediatricians supported the recommendation. Nevertheless, in April of 1998 the Center for

Biologics Evaluation and Research (CBER) at the FDA initiated a formal risk assessment of

thimerosal in vaccines; they found that a minority of infants could receive as much as 187.5 mg of

ethylmercury during the first 6 months of life but, lacking any standard for ethylmercury the CBER

team compared this exposure to standards for methylmercury (its more dangerous and toxic cousin)

and discovered that it exceeded that set by the Environmental Protection Agency.xlii In result, and

under the onslaught of numerous anecdotes detailing children experiencing adverse reactions to

vaccines—uncontrollable screaming, raging fevers, deterioration in mental facilities—thimerosal was

removed from every childhood vaccine except multidose flu vaccines by 2002. xlii

While legally, and perhaps ethically, these health organizations never violated any standards,

many citizens and parents felt that their trust had been violated. Even after the redaction of

Wakefield’s article, too many people had lost faith in health providers and doctors; many felt lied to

and deceived. And there were still the numerous cases of rapid onset autism or other neurological

problems that doctors did not have answers for. Consequently, some parents who felt let down by

their health providers began to rely on their own intuition and their own research. Alternatives to

the “official” inoculation model—which has been accused of causing “immune overload” or

overwhelming a child’s vulnerable and still developing immune system—also began to arise. Dr.

Robert Sears wrote The Vaccine Book, in which he details two alternatives to the current CDC

recommended vaccine schedule: a selective vaccine schedule and a complete alternative vaccine

schedule. Under the selective option, Sears recommends covering only “important” vaccines, leaving

out hep B, polio, measels, mumps, and rubella. Under the complete alternative option, Sears

recommends spreading out all the vaccines a child would receive in a two year span over the course

of eight years, to lessen the amount of substances a child is injected with and to lessen the chance of

severe, adverse reactions.xlii

These alternative and selective schedules are actually more the norm than the strict refusal of

all vaccines. Michelle Schneider is the Legislative Outreach Coordinator for Texans for Vaccine

Choice. A relatively new organization, Texans for Vaccine Choice works to promote the

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preservation of personal liberties and informed consent. As such, they oppose any measures to limit

vaccine choice rights, persecute those who exempt themselves or their children from immunizations,

track immunization history without consent, or coerce citizens into medical procedures to which

they object. Unlike the media’s illustration of “anti-vax” mothers, Ms. Schneider was very calm and

articulate when discussing the finer points of her organization. “We came about in February of

2015,” she said over the phone. Her voice was steady and pleasant, neither aggressive nor sermonic.

“A North Texas member of the House of Representatives announced to the media on a Friday

afternoon that he intended to file a bill to eliminate what are called ‘reason of conscience

exemptions’ from childhood vaccination requirements for public schools. So a bunch of active

parents came together on Facebook and decided that we needed to do something about this to

prevent it from happening. Within about six weeks, we grew to about 1300 members from all across

the state.”xlii

Schneider herself is a mother of three: she has a fully vaccinated seven-year-old daughter, a

partially vaccinated four-year-old daughter, and a completely unvaccinated two-year-old son. While

her children laughed and played in the background of our conversation, Schneider revealed her

experience with inoculation and the reasoning behind her own personal, alternative schedule.

“The reason they [her children] are have different experiences is that I had vaccinated my

seven-year-old up until four years [old] completely and that was the last time she was due for shots

so, for her age, she is completely vaccinated. At twelve months, my daughter Reece [her four-year-

old] was due for one shot to catch her up on a series, the HIB series, and that was on a Friday

afternoon. By Sunday, which is when we had her first birthday party, we noticed a huge difference in

her demeanor.” Schneider paused, and took a deep breath. “There was lack of engagement, lack of

eye contact, lack of affect in general, and from there it sort of snowballed over the subsequent

months. Various health conditions began coming up and then eventually she was diagnosed with

encephalopathy. She’s also got a hearing loss disorder, a genetic disorder that affects her hearing and

thyroid, and there’s multiple other diagnoses: seizures and autism and a number of different health

conditions that she suffers from. Currently, we have an opened petition in the US Federal Court of

Claims and the Vaccine Court.” She paused once more, and in the background one of her children

shrieked with laughter, to which she responded with a quiet and polite hushing noise. “So that’s sort

of our history,” she concluded. “And obviously when I became pregnant with our third child it was

kind of an easy decision: this [inoculation] was not benefiting our family, the risk vs. the benefit was

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not panning out the way it should for our family, and we just decided to avoid that risk all together,

and he is [her son] completely unvaccinated.”

Within Texans for Vaccine Choice, this variety of schedules is common, Schneider revealed.

“There are some [members] who vaccinate completely, some vaccinate on an alternative schedule,

some don’t vaccinate at all. Vaccination isn’t the issue,” she stressed, unveiling an often overlooked

concern that is actually one of the core tenants of the anti-vaccination movement. “It’s more the

overarching issue of privacy and liberty. What we focus on is not necessarily the safety and efficacy

of vaccines and we definitely don’t recommend a particular schedule, that’s not really our place, but

what we do is try to, in many different ways, is we try to protect our right to decide what goes into

our bodies and the bodies of our children, and the right to make medical decisions for ourselves and

our children.”

Here is where we finally unravel the ethical implications and foundations of the opponents’

side. As previously mentioned, due to the media’s skewed perspective, it is easy to write off

opponents of vaccination as irresponsible, irrational, or uneducated. However, they do harbor some

valid concerns, one of which is bodily integrity/autonomy. Schneider put this quite eloquently when

she stated “we try to protect our right to decide what goes into our bodies and the bodies of our

children, and the right to make medical decisions for ourselves and our children.” This is a very

American ideal; a very Libertarian ideal. Under the Libertarian ethical system, individual liberty is

valued above all else; people are entitled to use their property and live their life as they see fit, as

long as they do not violate the rights of others. Paternalist legislation, which mandated inoculation

falls under, violates this ideal of self-possession and bodily integrity.

But are health providers, medical officials, and ultimately government organizations right to

require/enforce their own schedules? These authoritative entities admit, to an extent, that they are

not infallible, that while the current vaccines undergo vigorous trials and verifications, there are still

some variables they cannot account for or control. Therefore, , in the 1980s, the Office of Special

Masters of the U.S. Court of Federal Claims, often referred to as “the vaccine court”, was set up as a

no-fault alternative to the civil courts. According to an NPR article written by Anders Kelto, “to

deal with the possibility of rare but devastating vaccine injuries, the panel made a conscious decision

to favor the families when the compensation program was created. To execute this goal, the court

does not require petitioners to prove beyond a reasonable doubt that they or their child have been

harmed by a vaccine. They must simply demonstrate, through ‘a preponderance of the evidence,’

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that it's more likely than not that the vaccine caused the injury – a 51 percent chance, roughly

speaking.”xlii

Despite the existence of the Vaccine Court, however, and its implications of medical

fallibility, proponents of inoculation—which include most physicians, health professionals, and

parents—still hold that all able-bodied individuals should be vaccinated according to CDC

recommendations, especially against communicable and potentially lethal diseases such as measles.

In spite of the anecdotes of terrible adverse reactions, proponents maintain that vaccines are safe. In

a telephone interview, Wesley J. Hodgson, the School Compliance Coordinator of the Immunization

Branch Texas Department of State Health Services stated “There are systems in place to monitor

those [adverse vaccine reactions]. The Centers for Disease Control…” Here he paused to collect his

thoughts. “First of all the CDC ensures that vaccines are tracked to see if there are any possible

problems with them so they can have early warning, and do a recall with the vaccine if there’s a

problem. I wouldn’t compare it to a car recall because it works much faster, but there’s a monitoring

system in place, so that’s what I wanted to get across to you.”

Hodgson then went on to break down the vaccine monitoring systems, carefully and with

copious detail. He was calm and self-assured, confident in his information. “There are three primary

vaccine safety activities,” he began. “The Vaccine Adverse Event Reporting System, known as

VAERS it’s an early warning system where people can report vaccine concerns and it helps the

Centers for Disease Control and the Food and Drug Administration to detect possible side effects

or adverse events following vaccination. Then there’s also the Vaccine Safety Data Link and that’s a

collaborative effort between the CDC and other healthcare organizations using de-identified health

records to monitor and evaluate adverse events following vaccination. And there’s the Clinical

Immunization Safety Assessment Network, another collaboration with the CDC and some medical

research centers to conduct research into how adverse events might be caused by vaccines. So you

can see there’s a three-pronged approach to monitoring adverse events to help protect the safety of

the vaccine and also the individual, which is our main concern.”

Regarding the concern of “immune overload,” Hodgson gave the following response: “This

concept has been studied extensively by the CDC and they’ve found it to not be an issue. And the

reasons for this is…well consider this analogy: When a child contracts the common cold, they are

exposed to 4 to 10 antigens at time; additionally, a child exposed to strep is exposed to 25 to 50

antigens. This demonstrates that the immune system is capable of addressing and handling multiple

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antigens at one time without much of a problem. Our vaccines, in comparison to these diseases, do

not contain anywhere near this number of active antigens.”xlii

A concept that is of major concern however, Hodgson stressed, is the principle of “herd

immunity,” which is where the number of vaccinated individuals is high enough that viruses have

trouble moving from host to host and cease to spread, sparing both the unvaccinated and those in

whom vaccination has not produced immunity.xlii Herd immunity is particularly crucial for those

who cannot be vaccinated due to compromised immune systems. According to an NPR article

written by Lisa Aliferis, six year old Rhett Krawitt was diagnosed with leukemia when he was an

infant. While Rhett is now in remission, his immune system remains ravaged and vulnerable due to

the cancer and subsequent chemo treatments. Because of this, Rhett cannot be vaccinated and must

rely on the herd immunity of his community to protect him from the spread of infectious disease.xlii

However, the Krawitt family lives in California, a state that has the highest number of personal

exemption cases for inoculation. According to Liza Gross, studies conducted in California found

five hot spots, including a 1.8-mile area in Vallejo, where 22.7 percent of kids were under-vaccinated.

More than 10,000 toddlers lived within the five clusters. The team also identified five clusters where

all vaccines were refused for the babies and toddlers in the study. This clustering effect is

detrimental, Gross states, as last year, when a record number of California parents claimed personal

belief exemptions, health officials reported the most measles cases seen here since 1995 and the

most whooping cough cases since 1947.xlii

While these “free-riders”, as Janice Wood-Harper labels them, are “generally tolerated, or

certainly are not subjected to any penalties, as long as vaccination rates in the population remain

high, as more individuals become free-riders and non-immunity nears a critical point where it

threatens significant harms to society from increasing outbreaks of measles epidemics, then it

becomes important to question the morality of free-riding” and, in conjunction, the morality of

compulsory inoculation.xlii Proponents argue that individuals who are not vaccinated due to personal

objections, and subsequently (although unknowingly) pass along communicable diseases, are

violating their bodily integrity, a value their share with their opponents but viewed from a different

perspective. Some individuals, like Rhett Krawitt, simply cannot be immunized for health reasons

and are therefore at risk as the number of unvaccinated people rise.

While the United States has never had a federal compulsory vaccination law, there were

several instances that toed the line. Eula Biss cites that “George Washington, a survivor of smallpox,

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wrestled with the question of whether or not to require inoculation for revolutionary soldiers long

before vaccination became a question of conscience. In 1775, roughly a third of the Continental

Amery fell ill to smallpox while laying siege to Quebec. Several times, Washington ordered

inoculation and then withdrew the order days later. Finally, with rumors in the air of a British plan to

spread smallpox as a form of biological warfare, Washington ordered the inoculation of all new

recruits.”xlii Biss goes on to discuss that in the early 20th century some states had compulsory laws,

but 2/3 of the states did not, and a couple states had laws against compulsion.xlii However, the

uptake of vaccinations was much higher in the 20th century, in the generation that Biss calls the

“Polio Pioneers.” Living in the wake of war and in the shadow of the A-bomb, the generations of

the 20th century took the risk of inoculation, even though the polio and smallpox vaccines were far

more dangerous that any of our current childhood vaccinations; it is estimated that the risk of death,

Biss states, was about one in a million.xlii

However, the “better safe than sorry” mentality of our parents’ and grandparents’ generation

has fallen out of favor. Diseases like smallpox and polio have been eradicated from the first world

and, therefore, the fear associated with them has dissipated. Hodgson emphasized this fact. “I think

one of the contributing factors to people not wanting to get their children vaccinated,” he said. “Or

not considering it important is the fact that no one’s seen these diseases, really, because of the

effectiveness of vaccines, and I think this leads to a certain degree of complacency. Back in the 50s,

when polio the counts were so high and individuals could actually see the ravages of the disease—

the paralysis and iron lungs—people really ran to go get their immunizations. But that’s not the case

now. People don’t see measles or diphtheria, I mean we still have pertussis more than anything, but

they still don’t see that either. They’re all horrible diseases, you can die from them. Immunizations

are one of the most effective prevention efforts in public health ever.”

Hodgson also stressed that inoculation was for the good of the individual as well as the good

of the community. “The individual should be immunized to protect them against diseases, as well as

the general public. An individual that is not immunized can infect the general public, and so that’s an

issue there. They can bring it into the community. The cornerstone to the immunization program is

to prevent deadly diseases from reaching the citizens. Vaccines are highly effective in preventing

death and disability, and they save billions of dollars annually. A decision to vaccinate is to help

protect not only the individual but the entire community from diseases. A decision not to vaccinate

puts the individual and the community at risk because of that susceptible population that can

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transmit the disease if they contract it to the rest of the population. But when a community reaches

what’s called a “herd” level of immunity, that’s when…think of a large cluster of people in a circle.

If one or two are unvaccinated in the middle, but you have all of these protected people around

them, that will prevent the unimmunized from getting infected because there is no transmission

possibility because everyone is immune. So you’ll have some individuals that are not vaccinated that

will still be protected from the disease. Therefore, the likelihood that a infected person would

transmit the disease to a susceptible person is greatly reduced.”xlii

Sadly, though, mandated inoculation or enforced adherence to a certain schedule is no

longer seen as a safety precaution, but rather a violation of civil rights. American, democratic ideals

and principles do not coincide well with the utilitarian foundation of required vaccines. While

utilitarianism prides itself in wanting the greatest good for the greatest number, in our individualistic

society, this is sometimes viewed as unfair, inhumane, unconstitutional. Citizens don’t want to be

viewed as just another number, a part of the aggregate whole; they want to be valued intrinsically,

individually. “The good of the many outweighs the good of the few,” has become too callous of an

idea for us. We can’t swallow it. So, we reject it. As the anti-vaccine movement has so infamously

done.

Eula Biss makes another interesting point when she notes that “perhaps what matters is not

whether people are right on the facts” about vaccines “but whether they are frightened.” She goes

on to say “What vaccines do not cause is significantly harder to establish than what they do cause.

While a substantial amount of evidence is acceptable as proof that an events does and can happen,

there is never enough evidence to prove that an event cannot happen.” As demonstrated above,

safety and health are the crux issues in the vaccine debate, and whether an individual stands in

solidarity or opposition of the CDC recommended schedule or an alternate version, it all boils down

to what is considered the safest route for each child and, unfortunately, until science evolves to be

more exact, the “safest route” will continue to be different for every individual.

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Appendices

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Appendix One: U.S. Infographics of Measles Outbreaks in 2015 (created by the CDC)

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Appendix Two: Official Copy of Michelle Schneider’s Petition to the Vaccine Court

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