Vaccine Debate Heads to Court

Should parents be fined or jailed for refusing to vaccinate their children? Hundreds of parents may face both if they don't show up at court to have their children vaccinated this weekend. A Maryland school district has ordered the parents of 2,300 students to court Saturday for missing the September immunization deadline. The students, in fifth through 10th grade, failed to show proof that they had been vaccinated against chicken pox and hepatitis B, a liver disease typically transmitted through sexual intercourse or shared IV drug needles. District officials say they turned to a circuit court judge to intervene as a last resort after the students continued to show up at school. Those who appear with their parents on Saturday will be immunized. Parents who fail to appear in court could face fines or jail time. Such action is rare, but may become more common. Maryland is one of 30 states where vaccinations are mandatory, and health officials fear a growing number of parents are refusing to immunize their kids.

Data continues to demonstrate benefits from vaccinations--a report published just this week in the Journal of the American Medical Association (JAMA) showed the rates of death and illness from vaccine-preventable diseases like the mumps, measles and smallpox, have dropped dramatically in the United States since national vaccine recommendations were implemented, according to the Centers for Disease Control and Prevention. But some parents are still reluctant to get their kids vaccinated over fears of side effects or a possible link to autism (though none has been proven). NEWSWEEK's Anna Kuchment spoke with Dr. Robert Sears, a pediatrician and author of "The Vaccine Book" (Little, Brown), about the case in Maryland and the benefits--and risks--of vaccines. Excerpts:

NEWSWEEK: Should states, like Maryland, have mandatory vaccination laws?
Robert Sears:
I don't think they should because I view the decision to vaccinate or not as a medical decision that every parent should have the right to make for their children. Now, an exception to that would be if there's an outbreak to a disease.

Parents who choose not to vaccinate need to be responsible about that, and they need to play their role in protecting the public health when there is an outbreak. But, ultimately, I don't think states should have the right to tell parents to vaccinate--especially for diseases like chicken pox, that used to be a routine childhood disease.

The case in Maryland also includes the vaccine that protects against hepatitis B.
I think it's odd that Maryland is focusing on hepatitis B because that disease is a sexually transmitted disease. It's not something that's going to run through the school in a big epidemic, except for those kids who are practicing unsafe sex or sharing their IV drug needles. As long as children are responsible about their behavior, then the hepatitis B vaccine isn't something they really need ... Most parents would want their kids to have the hep B vaccine [eventually]. But why force it on a fifth grader when sexual activity is going to be extremely unlikely at least for the next few years?

Why do you think more parents are refusing vaccinations for their children?
I think it's a lack of access to good, unbiased information on vaccines. Everything parents have to read on the Internet is either completely anti-vaccine or it's a completely pro-vaccine site that only discusses how bad the diseases are. There's really no good place where parents can go to read a comparison of both sides of the issue.

But wouldn't most medical experts say there's only one side to the issue: that you should vaccinate you child?
Vaccines are very important, and they've played a tremendous role in getting rid of diseases. But the reasons why some parents are not vaccinating is they don't feel like they're being told what the risks are with vaccines. Because doctors feel that the benefits of vaccination outweigh the risks, they don't take the time or have the time to go over what the very small risks are. Because some parents feel unsure about it and they want to be well informed and fully educated, a lot of them are just choosing not to vaccinate because no one will give them a straight answer on what the small risks are.

What are the risks?
Some vaccines have a lot more potential to cause reactions than other vaccines. There's a whole ranking. Some parents will specifically choose to skip one or two vaccines that are well-known to cause reactions. Interestingly, the hepatitis B vaccine is one of the vacccines that's known to be fairly reactive and cause a severe side effect more often than a lot of the other vaccines.

What kind of severe side effects?
Some of the biggest side effects, especially for adults and teenagers, is there's a lot of potential neurological side effects: numbness and weakness in their arms and legs. Now these kinds of reactions almost never occur in infants and young children, mainly the teens and the adults. Can I tell you the exact number? I can't. It's not made public.

What makes the hepatitis B vaccine more risky?
I have no idea. When you look at the ingredients, there's not much in there that we can really pinpoint.

At what age is the hepatitis B vaccine typically given?
It's usually given to newborn babies in the hospital and then two more times during the first year of life. The parents in this [case] probably elected to skip the vaccine when their children were young.

What's the rationale for giving the hepatitis B vaccine to babies?
The rationale is that we want to get a whole generation protected from this disease and the easiest time to make sure it gets done is during the infant years. It's much harder to get a teenager into the office for a three-round series of shots, as the state of Maryland is finding.

What choices did you make for your own children when it came to vaccination?
I prefer to keep my own personal choices out of the story. Because I'm out there giving people all over the country advice on vaccines, I don't want anyone to do what I did just for the sake of it. I want them to make their own choices.