o the Editor:

The failure of significant numbers of children to be vaccinated is America's dirty little public health secret. As you point out in "When Parents Say No to Child Vaccinations" (front page, Nov. 30), unvaccinated children are at far greater risk from potentially lethal infectious diseases than those who have been vaccinated, and are a threat to the community.

States should terminate "personal" and "philosophical" exemptions from vaccination, and only documented allergy or sensitivity to vaccines should qualify.

Schools should aggressively enforce vaccination requirements, and child-welfare and law enforcement agencies should regard the failure to vaccinate a child as tantamount to subjecting him to a game of Russian roulette with a handgun. Children's advocates should consider lawsuits against parents whose unvaccinated children contract serious illnesses from which they could have been protected.  
HENRY I. MILLER, M.D.
Stanford, Calif., Nov. 30, 2002
The writer was an F.D.A. official, 1979-94.