http://www.public.asu.edu/~adamsgrl/IPPA.html
Immunization
Policy and Practice in Arizona
Catherine Bertrand
POS 417
Spring 2000
Arizona State University
The purpose
of this paper is to examine immunization policy and practice in Arizona.
I will first describe current law, and the history that shaped it. Then I
will review what scientific evidence there is both supporting and condemning
mandatory vaccination. Finally I will discuss the political implications
for individual Arizona citizens, and their representatives in the legislature.
Current
immunization law focuses on children and infants. A.R.S. 36-672 gives the
Director of the Department of Health Services (DHS) the responsibility to
create a vaccination schedule required for school attendance. A.R.S.
15-872 states that the Director of the DHS and Superintendent of Public
Instruction would devise the standards for “documentary proof” of immunity to
various infectious diseases. No public, private or religious school could
then admit any student who failed to show such proof. The only exceptions
are detailed in A.R.S. 15-873, the philosophical and medical exemptions.
However, during the 1989-1990 school year, only .3% of Arizona’s school
children were granted such exemptions (Murphy, 1993).
Most parents think
of immunization in conjunction with well-baby check-ups, and with school
entrance. They therefore may assume that they have some time after their
child’s birth before immunization begins. They will most likely be caught off
guard when they are then handed a consent form to sign while recovering from
labor, granting permission for their child’s first immunization to be
administered, the Hepatitis B shot. While the injection is not legally
required to be administered at this time, it is both recommended by the Arizona
DHS, and required to be given at some point in infancy. It is therefore
easy to confuse recommendation with mandate, and no attempts are made in the
literature presented to parents to distinguish between the two. The
likely reaction during the confusion of the moment and the desire to do
everything possible to benefit this new life is to sign the consent form and
allow the child to be whisked away for his first vaccination. If this
sounds a bit coercive, it is. This practice familiarizes parents with the
process of relinquishing control of their child to the medical community from
the beginning. It is also likely that parents who have consented to
having their newborn vaccinated will likely follow up with the pediatrician for
further immunizations so the first shot will not have been a waste.
Therefore commencement of vaccination during a time when parents are not likely
to refuse, is one of the best ways to ensure future immunizations will be given.
Additionally, there
are sub-groups within our population that do not have the luxury of abstaining
from immunization until school entry, or utilizing the philosophical
exemption. Infants and children in day care are often required by the
institution they attend to comply with the recommended schedule and are denied
admittance without documentary proof that they are up to date. Further,
families who receive cash assistance from the federal government, must immunize
their children according to the schedule set forth by the DHS, or lose benefits
for the entire family, in accordance with A.R.S. 46-292 and A.R.S.
46-300. This is clearly a case of extortion against those families who
are most vulnerable.
The history of
immunization dates back to 1796, when Edward Jenner created the smallpox
vaccine. He noticed that milkmaids exposed to cows (and therefore cow
pox) seemed immune to the smallpox epidemic surrounding them. (Rimland,
1998). Thirteen years after Jenner’s work began, the first laws went in to
effect, in Massachusetts, encouraging towns to vaccinate every citizen (Murphy,
1993). The rush to mandate this medical intervention removed the chance
that the effectiveness or safety of the smallpox vaccine would ever be studied
empirically. Indeed, many people were seriously injured in the first
vaccine experiments. There were numerous cases of tumors, skin disorders,
paralysis, and other mysterious afflictions occurring in the limb used for
inoculation, and throughout the body (McCormick, 1995). In fact, the 1904
verdict of the U.S. Supreme Court which ruled in essence that the good of the
many outweighed the needs of the few came before any studies were performed to
determine vaccine safety and effectiveness, yet this is the precedent on which
the current state laws stand. Today the subjects of vaccine
experiments are childand often minorities, as evidenced by the current
plans to test the new Pneumococcal Pneumonia vaccine on Native American and
African-American children (Classen, 2000). This is presumably done under
the guise of “helping” children considered to be “at-risk” for such diseases,
but in practice it uses minority children to test the safety of a vaccine that
will be indicated for use on all children. Test subjects receiving these
vaccines are monitored for a period of days or weeks. Blood serum
antibody levels are tested and adverse events following immunization are
recorded. This data is the basis for the claims of the Centers for
Disease Control and Prevention that vaccines are safe, and effective. No
long-term, longitudinal study has ever been done on any vaccine (Thinktwice,
1997).
Because smallpox is
no longer a threat, it is perceived as proof that those injured or killed in
the process of eradicating a disease are an unfortunate necessity. Since
Jenner’s time vaccines have been created for several diseases: diphtheria,
tetanus, pertussis, polio, measles, mumps, rubella, haemophilus influenza type
B, referred to as Hib (meningitis), hepatitis A and B, varicella (chicken pox),
pneumonia, influenza, rotavirus, and numerous others that are used less often
and are not mandated.
On the surface,
there seems to be very little to question about immunization policy.
Immunizations keep us healthy, and prevent needless suffering. Everyone
should have them. Medical doctors care about the health of their
patients. The government cares about the health of its citizens, and
therefore has a right to mandate we undergo this procedure. Side effects
are rare so those who are affected by them are an unfortunate reality if we
want to eradicate disease globally. A statewide and national registry
would enable those who need to know an individual’s immunization status know,
and an individual’s right to privacy would not be compromised. The money
made by pharmaceutical companies is secondary to the joy they find in
eliminating infectious disease from the face of the earth, which we are getting
closer to achieving. Medicine, politics and money are three completely
unrelated concepts. As is the case with clothing, one size fits
all. When did you begin to suspect these statements were not entirely, if
at all, true? None of them are.
To better understand
what the controversy is regarding immunizations and the laws that make them mandatory,
I will outline some of the basic facts about the schedule, the products used,
and the diseases they are meant to prevent.
One of the stated
goals of the CDC and the Arizona DHS is to protect individuals and the
community at large from infectious disease (CDC,2000a; ADHS, 2000a) through
mandatory immunizations and on-line registries which confirm an individual’s
status. Yet immunization laws cover only children and military personnel,
both considered to be captive audiences.
A classic example of
the “captive audience” phenomenon is the practice of vaccinating newborns for
Hepatitis B. This is a blood-borne disease that primarily infects the
sexually promiscuous and those who share needles (ADHSa, 2000). While it
is a serious disease, it is only carried by one-tenth of one percent of the
population (Scheibner, 1993), and less than 1 percent of those cases occur in
children under the age of 15 (Alter, 1990). Clearly this is not a
childhood disease, nor a common one among adults. Why then, the need to
vaccinate all children at birth, or at any time in infancy? Michael
Belkin, director of the Hepatitis B Vaccine Project of the National Vaccine
Information Center (NVIC) postulates that health officials, frustrated at
unsuccessful attempts to target those at high-risk for Hepatitis B for
vaccination, chose to pursue a more willing set of subjects, newborns (Belkin,
1997a). The results were catastrophic for Arizona families. In 1996
“there were more than three times as many reported serious adverse reactions as
reported cases of the disease in the 0 to 14 age group” (Belkin, 1997b).
The FDA acknowledges that less than 10% of all adverse effects are ever
reported to the Vaccine Adverse Event Reporting System (VAERS); these
statistics may be more alarming than they initially appear (Miller, 1996).
Approximately 300
members of the U.S. military have voiced their opposition to risking their
health through mandatory vaccination, and are now facing the repercussions,
forfeiting their careers. Some are being prosecuted in military court
(Yahoo!, 2000).
According to the
U.S. Census Bureau, children under the age of 18 comprise one-fourth of
Arizona’s population, and children under the age of five comprise one-third of
that sub-group. Therefore, existing immunization laws, cover only 25% of
Arizona’s population. By focussing on initial school entry, they target a
mere 8% of our population (Census, 2000a; Census 2000b). How can such a
limited campaign be effective, when boosters of seven of the shots are required
in adulthood in order to maintain immunity (CDC, 1998c)? By not following
these children into (civilian) adulthood, the effectiveness of the childhood
laws diminishes, as does the likelihood of eliminating disease. But the
likely reaction of Arizona citizens to the plans of the State Bureau of
Epidemiology and Immunization to establish a registry of adult immunization
status (Lutz, 2000) is well represented by State Senator Tom Freestone, who
believes that such a requirement and registry would invade an individual’s
right to privacy. He likened the possible negative effects to the
identity thefts that have occurred with the widespread use of Social Security
numbers (Freestone, 2000).
One of the centers
of controversy is the contents of each dose of vaccine. All vaccines
contain one or several of the following: aluminum, formaldehyde, ammonium
sulfate, thimerosal (which is 49.6% mercury), beta-propiolactone, monosodium
glutamate (MSG), animal products and antibiotics (both possible allergens),
human diploid cells, originating from aborted fetuses (PDR, 1997). Some include
animal material, such as bovine serum and sheep red blood cells, by design
(PDR, 1997). Some unintentionally carry animal viruses and DNA from the
bacteria having been cultured on monkey kidneys, or pig pancreas. (Neustaedter,
1996). This information is not unknown to the purveyors of vaccines; in fact
all of the aforementioned questionable chemical ingredients are intentionally
inserted, as each serves some purpose. Antibiotics are used to prevent the
growth of the vaccine’s bacteria while in transit(CDC, 2000b), yet since
vaccinations begin at birth it is impossible to know if your child is allergic
the antibiotics used. Aluminum gels or salts are used as catalysts for
antibody production(CDC, 2000b), despite being a suspected cardiovascular,
neurological, and respiratory toxicant (EDF, 2000). Formaldehyde kills
unwanted viruses and bacteria that might occur in the concoction(CDC, 2000b);
it is also not safe for human consumption in any amount. It is a
recognized carcinogen, and known or suspected to be toxic to nearly every body
system (EDF, 2000). MSG, another product that many people have severe
allergic reactions to, is used as a stabilizer(CDC, 2000b). The purposes for
some substances used in vaccines, such as beta-propriolactone, a recognized
carcinogen, and ammonium sulfate, a liver, gastrointestinal, neurological and
respiratory toxicant, (EDF, 2000) are unexplained by the ADHS or CDC.
Thimerosol is a preservative (CDC, 2000b), a recognized developmental toxicant,
and a suspected skin and sense organ toxicant (EDF, 2000).
Thimerosol is of
particular concern, though none of these substances is benign. 187.5 micrograms
of mercury is injected into babies by the time they are six months old, via
thimerosol (Redwood, 2000). Infants who are vaccinated from multi-does vials, a
common, cost-effective way to purchase and dispense vaccines, can receive as
much as 62.5 micrograms of mercury per doctor visit. The level
established by the Environmental Protection Agency for acceptable daily
exposure to mercury is 0.1 microgram per kilogram (Redwood, 2000).
What is further
disconcerting is the trend toward administering multiple vaccinations,
including combination vaccines, at increasingly younger ages, with no studies
having been performed to assess the safety of doing so (Thinktwice, 2000).
Initially vaccines were administered individually, but as the movement to
globally eradicate all infectious disease gained momentum vaccines were
combined, such as the diphtheria – tetanus – pertussis combination vaccine
known as DTP. The current drive to fully vaccinate all children by the
age of two, a stated goal of the legislature through the DHS’s health start program
(A.R.S. 36-697), and the increased length of the schedule, has led to children
routinely receiving more than one immunization at one time. To make matters
more precarious, some physicians, on advice of the American Academy of
Pediatrics, have abandoned the cautious practice of immunizing only completely
healthy children, which was done to ensure the immune system would be able to
defend the body and produce antibodies. Now every trip to doctor’s office
is a time to update immunizations (AAP, 1995).
Toxins introduced to
the body via vaccines enter the bloodstream directly. Germs and viruses
encountered naturally have to pass through the body’s well-designed filtration
system of hairs, cilia and villi lining the air passages, esophagus, and
intestines, and the mucous and secretions of the digestive tract. Thus
the body will already have to fight harder to prevent illness from a vaccine
than a natural microbe. Certainly, the viruses are weakened before
injection, but having discussed previously what substances they are weakened
with, the process hardly seems to eliminate toxicity, rather it could be
inferred that it is actually increased. Therefore children are introduced to
more antigens at one time, and at younger ages than would occur without immunization.
This does not give the immune system time to develop, before assaulting
it. Children are normally protected from disease by way of parental care
and breastfeeding, which grants the mother’s antibodies to the child (Murphy,
1993). Few, if any, of the good parents in Arizona would allow their
newborn to be exposed to the filthy conditions that would produce diphtheria,
nor allow their baby near a person with pertussis, nor would a baby have much
chance of acquiring tetanus as he is not yet mobile enough to find that dreaded
rusty nail (Neustaedter, 1996). As the only cases of polio to occur in
the U.S. since 1980 have been caused by the vaccine (Strebel, 1992), the
chances of acquiring wild polio are zero. Meningitis remains a remote
possibility for a 2 month old, but Hepatitis B would only be possible if the
mother was infected at the time of the child’s birth, and she would have been
screened for this in the hospital (Belkin, 1997b). Few babies inject drugs or
have risky sex, or even have close contact with those who do (ADHS,
2000c). Further, what is the possibility of one infant, at two months of
age, encountering all of these diseases at one time? They are less than
one in 6 billion; I am sure no child has ever been exposed to so many antigens
in such a short period of time. That is, except for 75.9% of Arizona’s
babies (CDC, 1998b), brought to the pediatrician’s office, by dutiful parents,
to be vaccinated. The Arizona DHS would like to see this number increased
to 90% by the end of this year (ADHS, 2000a).
These disturbing
facts lead us to the subject of vaccine injury. Jenner’s detractors
ascribed the milkmaid’s smallpox immunity trend to coincidence, much as today’s
vaccine proponents attribute claims of death, acute and chronic illness, and
developmental delay to coincidence rather than to immunizations (Rimland,
1998). The CDC, who is charged with the conflicting responsibility of
promoting vaccine use and monitoring vaccine safety has made numerous
statements in their literature alluding to the safety of vaccines and their
method of administration. Their disregard for the intelligence of America’s
parents is evident throughout. Repeatedly, they refer to those who
experience adverse effects as either confusing association with causation, or
they blame the individual themselves, claiming factors systemic to the
individual caused the subsequent illness or death (CDC, 2000f; CDC, 2000h).
Nevertheless,
parents who have watched a child scream from the moment they received an injection
until the moment they died 12 hours later (Miller, 1996), and parents who have
watched previously healthy children develop a myriad of health problems
suddenly, know that vaccines can and do harm (Thinktwice, 1998). Some,
like myself, have watched a thriving, normally developing child lose the
ability to speak, and become intolerant of normal sensory experiences, such as
being held, or walking flat-footed. When these parents finally learn what
robbed their child of his personality is called autism, they find that
literature speaks of this disorder which has grown in prevalence in proportion
to the number of immunizations given (Coulter, 1990; Rimland, 1998). They then
look back on deceptively simplistic “information” provided by the local health
departments and realize they were duped.
The AAP claims, “By
making sure that your child gets immunized on time, you can provide the best
available defense against many dangerous childhood diseases… hepatitis B,
polio, measles, mumps, chickenpox…” (AAP, 2000). When they consider what
diseases they were “protecting” their child from, and compare them to what
their child now endures, many find it an unfair exchange. Chicken pox is,
and measles once was, considered a common childhood disease, with rare complications.
Mumps and rubella were similarly regarded as benign in children, though more
serious for adults. However, widespread immunization of children has led
to more of these infections occurring in precisely the population for whom it
is most dangerous. Specifically, children are not getting mumps, when it
would be harmless, rather they are getting it when they are adolescents or
adults and development of the reproductive organs has begun. This is when
mumps infection can cause sterility. Had these people contracted mumps at
an earlier age, they would have acquired immunity to it before it became
dangerous (Neustaedter, 1996).
Conversely, autism
was unheard of before 1943, when Leo Kanner described a new psychological
disorder, differing “so markedly and uniquely from anything reported so far”
(Coulter, 1990). The first autism epidemic consisted of 11 children
through out the U.S. The number of children Kanner saw rose to 150 by the
late 1950’s (by which time other doctors had a small sample in their
practices), almost all of whom came from highly intelligent, upper class
parents, all in some way connected with medicine (Coulter, 1990). These
children were likely the first recipients of the new pertussis vaccine, which
was taken advantage of by mainly wealthy parents with some knowledge of new
medical developments. The occurrence of autism was initially rare, but its
prevalence grew through the 1950’s and 60’s, when parents began to flood the
offices of psychologists. The timing of this upsurge parallels the
introduction of the new polio vaccine, for which America’s school children
lined up at school to receive in an attempt to avoid the iron lung.
Further, the introduction of the DTP shot was widely available and the earlier
trends of only upper class children becoming autistic ceased to be (Coulter,
1990). The oft-cited statistics claiming autism occurs in approximately 4 to 5
in 10,000 births comes from this era. Levels of autism diagnoses remained
relatively constant until the late 1980’s when the introduction of the
combination vaccine MMR was mandated to replace the individually given measles,
mumps, and rubella injections (Rimland, 1998). The numbers then began to
change dramatically, showing 1 in 1,000 children were now affected. But
the ink on those statistics was not yet dry when the Hib and Hepatitis B
vaccines were introduced and quickly mandated in the 1990’s. In the
United States, autism currently affects 1 in 500 children (SARC, 2000; CDC,
2000d). Last year rotavirus and Hepatitis A were added to the schedule
(that is, before rotavirus was taken off the market for causing bowel collapse
in infants(CDC, 2000e); pneumococcal vaccine is likely to be next (Neustaedter,
1996). One can reasonably wonder: what will the statistics on autism be
in five years? These same trends have been observed in other “civilized”
nations, such as Britain and Japan, with the rises in autism rates paralleling
the rise in vaccination coverage and number of vaccines on the schedule
(Coulter, 1990; Rimland, 1998).
Essentially, the
“healthy dose of love” (ADHS immunization card, 1999) the Arizona DHS has
pressured law makers into requiring, has increased suffering in many instances.
Between 1990 and 1997, VAERS received 80,000 reports of vaccine-caused injury
or death (NVIC, 1999). We are immunizing our kids against diseases that
either don’t affect them, or should affect them now, when the danger is less,
and the benefit is life-long immunity. In return we have created new
epidemics of diabetes, asthma, and intestinal, autoimmune and neurological
disorders (Coulter, 1990; NVIC, 1999). This observation has been made by many
in the scientific field, but to no avail. Harold L. Weiner, an
immunologist at Harvard Medical School, confirms this trend (NVIC, 1999). In
1997 articles appeared in Science News, Epidemiologist, and The Economist
detailing international studies showing children who contract the “childhood
diseases,” instead of being vaccinated against them, have lower levels of
asthma, diabetes, and allergies (NVIC, 1999).
So, armed with the
facts about the beneficial nature of childhood diseases’ effect on the
developing immune system, the toxic nature of vaccines, and the absence of any
long-term study proving they are safe, how did the immunization empire grow to
be the size it is today? The answer was surprisingly easy to find.
One look at the CDC Vaccine Price List indicates the amount of money at stake
in the quest to immunize everyone in Arizona, America, and beyond. A single
dose of one vaccine, purchased from the manufacturer, ranges from $10.40 to
$59.45 in the private sector (CDC, 2000i). The CDC pays approximately
one-third of this price to manufacturers for use in community outreach programs
such as the Vaccination for Children (VFC) program (CDC, 2000i).
Considering how many vaccines are currently mandated, and the booster shots
that are needed to maintain this artificial immunity, to say nothing of the
others that are available and often chosen by adults, it becomes clear how much
money is at stake in vaccinating only one individual for life. A more
revealing picture was set forth by the Logistics Management Institute, at a
presentation to state health departments. They determined that the cost
to administer the early childhood series (20 doses) should cost the VFC program
$193.00 per child. This includes $188.10 to be paid for the vaccine
product and $4.40 to be paid in delivery (Nolan, 1999). Using the Census
Bureau’s estimations of Arizona’s population, we currently have 386,000
children who will be of age to enter kindergarten this fall and are subject to
immunization law (Census, 2000b). In order for them to enroll in school,
they must receive their shots. If they all got their shots through VFC, (and we
know most see private doctors who pay up to three times this cost for vaccines)
the cost generated for the manufacturing companies would exceed $74 million.
This is the total for just one year’s worth of kindergarten enrollees in
Arizona alone.
If money is the crux
of the matter, then how do the manufacturing companies ensure a constant,
growing consumer base? The method being employed currently, it would
seem, is to simultaneously convince the public and the legislature of the need
for these products. If vaccines were truly as effective as they claim to
be, and as safe as we all wish they were, then parents would bring children to
the doctor for the full series of shots without coercion (Thinktwice,
1997). The successes of smallpox and polio cannot necessarily be replicated,
and in fact attempts to do so have failed. When measles vaccine was first
licensed, the CDC declared measles would be eradicated by 1982 (Neustaedter,
1996). Instead childhood diseases are being experienced in the more
dangerous and painful adult years. More and more booster shots (complete
with toxic ingredients, and potential side effects) are being taken to avoid
this, but outbreaks still occur. Instead of man conquering nature, it has
become apparent that, as in the breastmilk vs. formula case, nature has
provided us with a better product than man could devise. But science is
in the eye of the beholder and in the hands of the powerful. When the
varicella vaccine was anticipated to be available for use soon, promotional
posters were posted around doctor’s offices, to instill the fear of chicken pox
in us. As I recall, the claim made then (1995) was that twelve children
died annually from complications of chicken pox, thus necessitating puncturing
millions of babies worldwide. Today, Merck (varicella vaccine
manufacturer) claims 40 deaths per year from chicken pox necessitate timely
global immunization (Merck, 2000). The Arizona DHS, following the lead of
the CDC, further bloats the figure to 100 people per year (ADHS, 2000b; CDC, 98a).
Further, the prevalence and severity of adverse reactions to vaccines, and the
existence of toxic lots of vaccine depend on whether you ask non-profit parent
organizations, or “official sources” (CDC, 2000h). For politicians who may not
wish to invest the amount of time in research as I and other parents have, the
version of the facts that most often gets represented is that which is
sponsored by the World Bank and the Rockefeller Foundation, and not that of
independent scientists (WHO, 1997). Pharmaceutical companies and
manufacturers, physicians, and the political action committee of the American
Medical Association gave nearly $300,000 to Arizona political candidates in
1998 alone (NIMSP, 2000a). It is, therefore, no surprise that our state
has compulsory vaccination laws, nor that our lawmakers have allowed an
electronic registry to be formed which details every child’s immunization
status to be viewed by state employees, day cares, schools, physicians, and
anyone else who can hack into a private web site.
When I spoke with
State Senator Tom Freestone, he told me he adamantly opposes the creation of
such a registry for adults, though he has no problem with the monitoring of
children’s medical records. He does however, feel we have gone far beyond
what we should in creating and mandating vaccines for “carte blanche” use on
children. He further believes we need to use what we know about the immune
system to safely allow mild childhood illnesses like chicken pox and measles to
occur, thereby strengthening the immune system to last a lifetime. He noted
that when children contracted the mild childhood diseases, we had lower rates
of cancer and other serious disease. (Freestone, 2000). It is worth
noting that the only medicine-related donation he accepted was from an
optometry PAC (NIMSP, 2000b).
No medical practice
can be forced on an American citizen… except vaccination. Medical records are
confidential… except your immunization status. Elected officials
represent their constituents… and their contributors. The CDC states that
they believe, “parents should be fully informed about the risks and benefits of
vaccination,” (CDC, 2000c). Yet they fail to mention the fact, or even
the possibility, of death as a possible side effect on the information sheets
they are required to disseminate to parents in accordance with the National
Childhood Vaccine Injury Act (CDC, 2000g). Instead the literature from
sources such as these is peppered with reassurances that the toxic chemicals in
vaccines are also found in other parts of a person’s environment (CDC,
2000b),and dire warnings about the dangers of leaving a child unprotected from
minor childhood illnesses such as chickenpox (CDC, 2000c; ADHS, 2000b).
Truth is truth. Parents must not compare the benefits of vaccines to the
risks of illnesses, this is comparing apples and oranges. We must compare
the worst that can occur following a vaccine with the worst that can occur with
an illness. Merck currently describes the risks involved in chickenpox as
250-500 lesions (that is, lots of spots), skin infections after chicken pox,
parents missing time from work to care for children or themselves, the cost of
a doctor visit and very rarely, brain inflammation and pneumonia (Merck,
2000). To avoid missing time from work and ugly red spots, we are
instructed to risk debilitating and life long injury. In the case of
measles, we are to avoid the possibility of ensuing encephalitis by giving a
vaccine which causes encephalitis (Neustaedter, 1996). My son’s autism is
necessary to keep you from missing work when your child has chicken pox.
I don’t think so.
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ALL
INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR
GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE
KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED
AS PROVIDING MEDICAL OR LEGAL ADVICE. THE DECISION WHETHER OR NOT TO
VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU
ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.