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http://www.detnews.com/2001/health/0105/11/a01-223143.htm

Fewer kids get immunizations
Parents opt out, weigh health risk versus benefit


Todd McInturf / The Detroit News


Arguments over shots
   Backers say
   * Childhood diseases remain a risk, so it's prudent to protect kids.
   * Diseases spread more easily in an age of world travel.
   * A few vaccinated youngsters will catch a disease anyway, so overall
safety increases as more kids are protected.
   Critics say
   * Parents, not the state, should decide whether pupils get shots.
   * Vaccines can have side-effects or other risks.
   * Drug firms seeking a wider market are partly behind vaccine drives.

By Margarita Bauza / The Detroit News

    An $84-million crusade to boost Michigan's child immunization rates in
the past six years hasn't brought significantly more kids to clinics and
doctors' offices for shots.
   Nearly one-quarter of youngsters up to age 3 weren't vaccinated in the
latest year studied, a slight decline from the year before. The rate has
stayed about the same since 1995 when the state began its drive to immunize
kids.
   During the same time, cases of most diseases being vaccinated against
decreased -- raising questions about the need for a costly health campaign.
   Mumps and two kinds of measles are at the lowest levels ever, a drop that
began before the state launched its mission.
   Although fewer children are catching the diseases that vaccines can
prevent, state health officials and medical specialists insist it's vital to
improve immunization rates to keep children healthy.
   But opponents of mandatory shots say the risks outweigh the benefits and
parents should decide.
   "By the time (kids) are age 6, they've had more than 30 vaccines," said
Suzanne Waltman of St. Clair Shores, president of a 700-member group called
Michigan Opposing Mandatory Vaccines. "People now are starting to question
this."
   The paradox of falling disease cases at a time of stable vaccination
numbers seems to support critics' belief that shots may not be needed.
   Some argue that profit-motivated drugmakers are partly behind vaccine
crusades in Michigan and elsewhere.
   In 1994, just 61 percent of children under 3 had their required vaccines,
ranking Michigan last in the nation.
   By 1999, compliance reached 76 percent -- down slightly from the
preceding year's 79 percent -- and the state now ranks 43rd.
   "We would like it to be 100 percent," said Bob Swanson, manager of the
state's immunization division.

Parents get waivers
   Parents last year received waivers exempting nearly 3 percent of Michigan
kindergartners, or 3,728 pupils, from the three required vaccinations
because of philosophic, religious or health reasons.
   The three shots protect children against two kinds of measles, mumps,
tetanus, diphtheria, whooping cough and polio.
   Educators don't always mention the waiver option, but word of its
availability is being spread by activists. Last year's waiver rate was the
highest ever.
   That trend bothers health guardians, who worry about missed school days
and illnesses spreading in classrooms and recreation centers.
   "We cannot do away with the polio vaccine yet, for example, because we
are in a worldwide community," Swanson said. "Polio is still endemic in
parts of the world."
   Most measles cases reported in Michigan in recent years were contracted
outside the United States, Swanson said.
   "Had people not been vaccinated, it would have spread through the
community like wildfire," he said.

State spends millions
   Since efforts intensified in 1995, Michigan has spent $84 million in
federal and state money on vaccines, clinic expenses, a publicity blitz and
other efforts to immunize youngsters. Most of the money -- $54 million --
came in grants from Washington.
   Such spending is inappropriate, insist groups that oppose mandatory
vaccination.
   Waltman -- who has a daughter, Dana, in elementary school -- believes a
young cousin died in 1959 because of a vaccine he got for pertussis (also
known as whooping cough).
   She founded her nonprofit group in 1993 when legislators tried
unsuccessfully to drop the state's philosophic exemption to vaccines.
   Groups such as Waltman's have seen a surge nationwide because of
publicity regarding vaccine safety.
   In 1999, a vaccine against rotavirus was pulled from the market after
reports that a number of infants developed bowel blockages after being
vaccinated against the gastrointestinal disease.
   Also in 1999, the federal government and the American Academy of
Pediatrics recommended against giving a hepatitis B vaccine to newborns
until the manufacturer removed a preservative containing mercury.
   Perhaps most damaging were reports that vaccines against chicken pox,
diphtheria, measles, mumps and rubella (German measles) were linked to
autism and sudden infant death syndrome.

Safety fears voiced
   Medical professionals dismiss the reports as unscientific. But
information spread on the Internet and through word of mouth has swayed
public opinion, a University of Michigan study released this month shows.
   Seventy percent of U.S. doctors say more parents are voicing fears about
vaccine safety, the research shows, and more than one-third of physicians
polled had their own concerns about vaccine safety.
   And in Michigan, where children must produce immunization records to
enroll in day care and public schools, nearly 4,000 of 136,000 public school
kindergartners came to school with waivers instead of vaccine records last
year.
   That's up from 1.8 percent in 1994 to 2.7 percent in 2000. In private
schools, the latest rate was 3.05 percent.
   Waltman hails this change as a personal victory. An increase in waivers
shows that a slight dip in immunization rates since 1997 could be a result
of well-informed parents fearful of vaccine injuries, rather than neglect.

Long-term benefits
   The growing number of waivers bothers doctors and educators.
   "It's a parental choice. That's clear," said state Department of
Education spokesman T.J. Bucholz. "But a child who doesn't have a vaccine is
at risk of infection."
   Such children are at higher risk than others to become ill, infect other
children and miss school, he said.
   "The Department of Education believes strongly in immunizations for
children. We believe it's important for the long-term health of children,"
he added.
   Joanne Clinchoc, a registered nurse who works for the Detroit Health
Department, feels strongly about the need for shots for her kids and all
others. "You don't want to play around with these things."
   Her son Peter, now 18, had chicken pox at 11. "I would much rather have
given him the shot," Clinchoc said. "That stuff is scary."
   Dr. J. Patrick Quigley, a Troy pediatrician said the growing number of
children with waivers is of grave concern.
   "Now we're going to have individuals in a school setting exposed to
diseases that they may not have been exposed to," Quigley said.
   "It's a crap shoot. If I were a parent and I knew these kids were in my
class, I wouldn't want them in that class," Quigley said.
   "Even though my kids are immunized, none of the immunizations are 100
percent. Because someone is not vaccinated, now you've exposed those kids to
unvaccinated children."
   Swanson, of the health department, said officials are concerned about the
jump and are investigating why the numbers increased.

Benefits vs. risks
   Health officials said vaccines are not absolutely safe. But they believe
benefits highly outweigh risks.
   As a result, Congress in 1986 created the National Vaccine Injury
Compensation Fund, which reimburses families for the expense of any
vaccine-related injuries. The program has received more than 5,000 claims
and paid millions of dollars since October 1988.
   Warren attorney William DoBreff, who has been handling vaccine cases for
10 years, said the fund might do more harm than good.
   It exempts manufacturers from liability and eliminates incentives for
pharmaceuticals to invest in research to improve vaccine safety, DoBreff
said.
   "They've reduced the incentive to make a safer product," DoBreff said.
"The vast majority of children that get injured are severely disabled."
   The relatively low number of injuries might be viewed as acceptable by
society unless you're the parent of an injured child, he said.
   "Is this fair?" he asked. "Prior to the act, there was a lot of money
spent on making safer vaccines."

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