When parents do not believe in childhood immunization
by Beth Hibbs, RN, MPH

Special to Infectious Diseases in Children

November 1999
Part of every pediatric health care worker's job today is counseling parents. With so much health information available today, they are bound to come into the office with misinformation. One of our jobs is to correct this. Here's how. First, start by learning something about the parents' belief systems. Focus on identifying what the specific concern is and write it down while listening to the parent so that you can address specific questions directly. Some chiropractic viewpoints in the literature include a belief that proper nutrition can take the place of immunization by strengthening the immune system defenses against disease.

While a nutritious diet certainly is helpful in building the immune system, diet alone cannot prevent disease. Another common belief is that vaccines can overload the immune system. What patients don't realize is that our immune systems are exposed to many antigens every day in food and water. Both of these viewpoints are addressed in a publication by the Centers for Disease Control and Prevention (CDC) entitled The 6 Common Misconceptions about Vaccination and How to Respond to Them, available free through the National Immunization Program (NIP).

Some concerned parents may themselves have had an adverse event following a vaccination, or know someone close to them who has. In this case, be sure to complete a Vaccine Adverse Event Form, which is required for reporting adverse reactions in children under the National Vaccine Childhood Injury Act. The Vaccine Adverse Event Reporting System (VAERS) collects all reports of ill effects following vaccination. Some of these reports to VAERS are caused by vaccination and others are not related, but coincidently happened around the time the vaccine was given. Anyone can report to VAERS, including parents. VAERS can be reached at (800) 822-7967.

Second, identify the source of the concern about immunization that serves as the parents' reference. Is it based on recognized medical or scientific organizations? Point out that several organizations like the American Academy of Pediatrics, the American Academy of Family Physicians and federal health agencies like the CDC are in agreement about the value of vaccines and make recommendations for immunization practices. In some instances it may be appropriate to intervene with the source, especially if inaccurate or misleading information is made public and published in your local newspaper. A letter to the editor from a local physician can help to set the record straight.

If the source is chiropractic science, one approach is to point out that chiropractors are not in agreement about the value of vaccines. The largest U.S. chiropractic professional organization is the American Chiropractic Association (ACA). The ACA policy on immunization practices states that "the ACA recognizes and advises the public that: Vaccination has been shown to be a cost effective and clinically practical public health preventive procedure for certain viral and microbial diseases as demonstrated by the scientific community." The policy goes on to state that "the use of vaccination is not without risk and that the association supports each individual's right to freedom of choice in his or her own health care based on informed awareness of benefits and possible adverse effects of vaccination (ACA 1996)."

Third, help the patient evaluate the specific concern. Many groups that put out information about vaccines on the Internet may have official-sounding organizational names, when in actuality they are not science- or medical-based organizations and primarily serve to reflect the opinions of individuals. If the topic of concern is published in a journal, point out that it is the weight of scientific evidence or number of studies showing the same result that determines fact from fiction. If only one study suggests an association it cannot be assumed to be factual until it is verified by other researchers. Several recent vaccine safety allegations that some patients may have seen are based on isolated studies that have never been confirmed.

Fourth, don't alienate the patient by simply dismissing their information source or becoming defensive. If you are not familiar with the specific concern, don't try to fake it but use your resources to investigate the question and get back to them or to refer them for more information. You might want to discuss with the parents how the medical and public health systems protect the public and the safety of vaccines. Governmental agencies like the Food and Drug Administration, the CDC, and professional medical associations as well as scientists are continually monitoring and studying the safety of vaccines. The suspension of rotavirus vaccine this summer was a good example of how the system works.

Fifth, use your resources. Every physician who administers vaccines is required under the National Childhood Vaccine Injury Act to supply a Vaccine Information Statement (VIS) to the parent or guardian of the child receiving recommended vaccines. Some concerned patients need other resources to double-check information that they receive from you and others, and an effective intervention on your part is to recognize this need and provide them with additional resources to further gather information. Feel free to share the number for the CDC Immunization Hotline: (800) 232-2522 (English) and (800) 232-0233 (Spanish). The hotline has a knowledgeable staff who is aware of current vaccine safety rumors and facts. The vaccine has since been pulled voluntarily from the market by the manufacturer.

The NIP also has a Web site that includes information about vaccine safety. See www.cdc/nip.gov. For the specific Web page on vaccine safety see www.cdc.gov/nip/vacsafe/. You might also want to pick up for your office the book What Every Parent Should Know About Vaccines by Paul Offit, MD, and Louis Bell, MD.

Sixth, if all else fails, agree to disagree. There are some individuals who have already made up their mind about vaccine risks and benefits. The best thing you can do in these instances is to state your own beliefs about the importance of vaccination and respect their final decision. You might also want to counsel them on specific measures they will need to take if their child comes down with an infectious disease, e.g., keeping their child out of school.

Beth Hibbs, RN, MPH, is with the National Immunization Program, Centers for Disease Control and Prevention.

What Should Physicians Do?
1. Learn about the parents' belief systems.
2. Id the source of concern about immunization that serves as the parents' reference.
3. Evaluate the specific concern.
4. Don't alienate parent by dismissing their information source or becoming defensive.
5. Use your resources.

A Reply By Dr. Len Horowitz, DMD, MA, MPH

To whom it may concern:

Beth Hibbs with the National Immunization Program, Centers for Disease Control and Prevention (CDC), has issued a series of counseling recommendations to health workers supportive to vaccinating and persuading people that vaccine abstinence is inconsistent with scientific consensus. In her zeal, she states the CDC's position is supported by the American Chiropractic Association (ACA). She writes, "the ACA policy on immunization practices states that 'the ACA recognizes and advises the public that: Vaccination has been shown to be a cost effective and clinically practical public health preventive procedure for certain viral and microbial diseases as demonstrated by the scientific community."

Firstly, the ACA's policy, which reflects political restraints more than sound science, does not reflect the consensus of chiropractic doctors¹ opinions. In fact, the entire concept of vaccinating, in an effort to prompt human immunity, is foreign to the great natural healing foundation and tradition upon which the chiropractic profession rests. Chiropractic's founding fathers--Dr. Palmer and Dr. Upleger--would be unnerved by the idea of inducing humoral immunity through vaccination. Furthermore, the ACA¹s statement, which simply reflects the CDC¹s emissions (i.e., propaganda), is entirely false and misleading. The "scientific community" has, in fact, failed to deliver definitive support for vaccination. The truth is that NO DEFINITIVE COST EFFECTIVENESS STUDY HAS EVER BEEN DONE ON ANY OF THE VACCINES. Published "scientific" studies that allege favorable cost/benefits for vaccinations have consistently failed in their methods to examine all the related costs. Especially overlooked has been the cost to society from lost productivity, and increased health care expenditures, associated with vaccine injured persons. Worse than this, NO DEFINITIVE RISK/BENEFIT STUDY HAS EVER BEEN CONDUCTED ON ANY OF THE VACCINES. Thus, Ms. Hibbs, other CDC officials, and the "scientific community" at large, do not, in fact, know if vaccination is helping or saving more people than are being killed and maimed. The omission by Ms. Hibbs of the recent request by the American Academy of Physicians and Surgeon¹s (AAPS) to CDC and FDA officials concerning the hepatitis B vaccine for infants serves as a good example, and ongoing tragedy, reflecting increased mortality and morbidity associated with vaccination policies. In this case, allegedly to spare approximately 4,500 people annually at high risk for hepatitis B infection and death (over ninety percent of whom were predisposed to infection through lifestyle risks, including sexual promiscuity and drug abuse) approximately 25,000 people, mostly healthy low risk infants, children and teenagers were seriously injured or killed by the vaccine according to published data. These facts prompted the AAPS to request public health officials rethink their hepatitis B vaccine policy.

Ms. Hibbs explained that "some concerned parents may themselves have had an adverse event following a vaccination, or know someone close to them who has. In this case, be sure to complete a Vaccine Adverse Event Form, which is required for reporting adverse reactions in children under the National Vaccine Childhood Injury Act. The Vaccine Adverse Event Reporting System (VAERS) collects all reports of ill effects following vaccination. . . . VAERS can be reached at (800) 822-7967."

However, she neglects to relay that according to MMWR reports published by the CDC, vaccine injuries get reported less than 10% of the time. This is one of the main reasons why the "scientific community" has yet to adequately access vaccination risks. Thus, her appeal for increased reporting is justified. Yet, once reported, current follow-up, thanks largely to the National Vaccine Childhood Injury Act of 1986, is entirely inadequate. The legislation simply shielded vaccine makers from liability claims while leaving hundreds of thousands, a hideous number, of injured children and their families in the lurch. To date, according to authorities, less than 3,000 families have received financial remuneration from the billion dollar superfund.

I called "the CDC Immunization Hotline" recommended by Ms. Hibbs to determine the adequacy of their "knowledgeable staff who is aware of current vaccine safety rumors and facts. [(Hotline: (800) 232-2522 (English) and (800) 232-0233 (Spanish).] " The Hotline's "knowledgeable staff" person admitted to me that he lacked formal academic training in public health, and held no degree in biological science or any related health field. His "knowledge," he relayed, simply came by reading the Institute of Medicine's (IOM) recommendations, along with those of the Advisory Committee on Immunization Practices (ADIP). The ADIP¹s February 18, 1999 conference transcript included references to books that relay "concern" from the "alternative health arena" that "average practitioner[s] had difficulty answering, and that the average ‹ kind of the disease-specific expert at CDC tend not to recognize the broad range of concerns that are raised, and also had difficulty responding to . . . " Thus, I asked this person, who Ms. Hibbs said was "aware of current vaccine safety rumors and facts," if he had ever read any of these books mentioned at the ADIP meeting including the national bestseller "Emerging Viruses: AIDS & Ebola-- Nature, Accident or Intentional?" (Tetrahedron Publishing Group, 1997; 1-888-508-4787) by this author and W. John Martin, M.D., Ph.D. He said he hadn¹t. Nor could he address other reports, including those in the scientific literature, upon which class action lawsuits are pending concerning polio vaccine delivered cancers from monkey cancer virus contaminants. So much for "knowledgeable staff . . . aware of current vaccine safety rumors and facts."

Time does not permit me to reply to several more glaring omissions and misleading allegations in Ms. Hibbs's report to the health care community. The bottom line is that I, like her, was trained in public health education, behavior modification, and persuasion technologies. (My master's degree came from Harvard's School of Public Health.) Her recommendations are consistent with, and complementary to, these fields of practice. Once upon a time, I issued articles and reports similar to Ms. Hibbs. Having awakened to the blatantly suppressed facts, and greater truths concerning the policy of vaccination, I can no longer encourage anyone to get vaccinated with anything, until there is at least one legitimate independent scientific investigation into all of the documented facts. Facts that show that today's vaccination agenda is far more deadly and destructive than almost everyone imagines. Moreover, I would like to see at least one definitive risk/benefit study on vaccines showing favorable outcome(s) before I can change my "alternative" mind.

Sincerely yours,

Leonard G. Horowitz, D.M.D., M.A., M.P.H.
President, Tetrahedron Publishing Group
P. O. Box 2033
Sandpoint, Idaho 83864
1-888-508-4787; (FAX) 208-265-2775
e-mail: tetra@tetrahedron.org